Communication and coordination

Overview

Effective communication and coordination between investigative partners is fundamental to any outbreak investigation. The complexity of investigations in terms of the number of partners involved, the volume and different types of information to be shared, and the urgency necessitates clear lines of communication and a coordinated approach.

Communication and coordination may be improved through fostering healthy working relationships with partners, developing and implementing communication procedures, using templates and online platforms for sharing information, and documenting the outbreak. This article also contains an overview of two federal examples that can facilitate effective communication and coordination: the Foodborne Illness Outbreak Response Protocol (FIORP) and the Canadian Network for Public Health Intelligence (CNPHI).

Communication between partners

There are a variety of communication strategies to consider for effective communication between investigative partners during an outbreak investigation. Some strategies to consider include:

Recognize that investigative partners have varying areas of expertise, whether it is in epidemiology, microbiology, food safety, or communication. It can be challenging to coordinate a team of highly skilled experts to reach a common goal. Clearly defining roles of each partner or a group of partners is essential.
When hosting/participating in meetings it is important to come to the meeting prepared to keep all partners informed of the investigation status and direction of the investigation.
At times, it might be efficient to have targeted communications amongst subsets of the investigative team (e.g., technical meeting to refine case definitions with epidemiological partners).
Share information in a timely manner with the investigative team via email or a web-based platform such as the Canadian Network for Public Health Intelligence (CNPHI) or SharePoint; this helps to keep partners informed of decisions made and advances in the investigation between meetings.
Where possible, include visuals (graphical representations) to help communicate very technical information.
Use a business cycle that sets out a timeline for the provision of document updates. This ensures that each update is associated with a specific “time stamp” and establishes predictability in the provision of updates.

Outbreak response protocols

Response protocols to facilitate communication and coordination during foodborne outbreak investigations can be found at all levels of government in Canada. These protocols are especially useful when multiple jurisdictions or organizations are involved in an outbreak investigation and response. An example of a protocol used at the national level is Canada’s Foodborne Illness Outbreak Response Protocol (FIORP) (see below), which is used to guide a multi-jurisdictional response to foodborne outbreaks.

Foodborne Illness Outbreak Response Protocol (FIORP)

The FIORP is the primary guidance document for multi-jurisdictional investigations of foodborne illness outbreaks in Canada. The FIORP applies to enteric outbreaks in Canada when cases are reported in more than one province or territory, or in Canada and another country, and when multiple agencies are involved, thereby necessitating active collaboration among a large number of players to identify and respond to an outbreak situation.

The objectives of the FIORP are to enhance collaboration and coordination among partners, to establish clear lines of communication, and to improve the efficiency and effectiveness of outbreak response. To meet these objectives, the FIORP delineates the roles and responsibilities of investigative partners and provides detailed operating procedures for coordinating the response to a potential multi-jurisdictional foodborne illness outbreak. A summary of the roles and responsibilities of investigative partners can also be found in the “Public Health Partners” page.

National Outbreak Investigation Coordinating Committee (OICC): An Outbreak Investigation Coordinating Committee (OICC) serves as the main forum for sharing and interpreting information in an outbreak investigation. An OICC comprises of representatives designated to act on behalf of the partners from different departments and levels of government involved in a given outbreak investigation. These representatives may be from the Public Health Agency of Canada, Health Canada, the Canadian Food Inspection Agency, provincial/territorial public health and agricultural departments, or local public health units. Representation on an OICC includes persons with expertise in epidemiology, microbiology, food safety and communications. The main objectives of an OICC are to facilitate communication among participating agencies, to serve as a central point to share information from all sources, to discuss outbreak investigation findings, and to achieve consensus on investigation direction and public health action. An OICC assessment call is a teleconference call among all affected partners to review the available information and assess whether the activation of an OICC to carry out a coordinated investigation is warranted.
Link to the FIORP: https://www.canada.ca/en/public-health/services/publications/health-risks-safety/canadas-foodborne-illness-outbreak-response-protocol-fiorp-guide-multi-jurisdictional-enteric-outbreak-response.html

Emergency management

In outbreak situations where additional resources other than what is currently available are required, an Emergency Operations Centre (EOC) may be activated. This can happen as a result of the scope and severity of the outbreak, the human and operational resources needed to manage the outbreak and implement prevention and control measures, or the political or media attention an outbreak investigation may be receiving. As a result, alternative structures are put in place to coordinate the response. The Incident Management System (IMS) and Incident Command System (ICS) are two examples of standardized approaches to emergency management, setting out how human resources, equipment, procedures, and communication strategies should be coordinated during an emergency. The IMS and ICS thereby provide clarity of roles, responsibilities and operating procedures and ensure that the work at an EOC is performed efficiently and effectively.

Canadian Network for Public Health Intelligence

The Canadian Network for Public Health Intelligence (CNPHI) is a secure online platform for applications and resources that facilitate communication and coordination through disease surveillance, intelligence exchange, research and response. Data can only be shared to public health stakeholders at the local/regional, provincial/territorial and national levels who have access to CNPHI and specific applications within CNPHI. CNPHI applications used in enteric outbreak investigations include Public Health Alerts, Outbreak Central and Outbreak Summaries. CNPHI and its applications are not intended for public use. Only authorized users are granted access to application(s).

Link to CNPHI: www.cnphi-rcrsp.ca

Public Health Alerts (PHA)

Public Health Alerts is an application on CNPHI that allows for the timely notification and/or dissemination of information between local/regional, provincial/territorial and national public health stakeholders. Users can select the target audience (i.e., single P/T, multiple P/Ts, national) to whom an email notification will be sent to advise that a new PHA has been posted. PHAs are used for case finding and to provide situational awareness on current national, provincial/territorial and local investigations.

Example: Case study, Module 2 – Case finding

Public Health Notices (PHN)

During an active enteric outbreak investigation, a Public Health Notice may be posted to the Government of Canada website to alert the public about the on-going investigation. Once issued, the PHN is updated regularly to include the latest information on the investigation and advice on how Canadians can protect their health and prevent spread of illness. Information provided in a PHN typically includes the following sections: why you should take note, investigation summary, who is most at risk, what you should do to protect your health, symptoms, what the Government of Canada is doing, epidemiological information, links to additional information (i.e., on the pathogen or source of the outbreak), who to contact with questions, and investigation history.

Link to current and archived PHNs: https://www.canada.ca/en/public-health/services/public-health-notices.html

Outbreak Central

Outbreak Central is an event board on CNPHI that is used by investigative partners to view and manage documents related to an outbreak investigation. These documents may include epi summaries, epi curves, event summaries, food frequency tables, maps and meeting minutes.

Public communications

All investigative partners have a responsibility to ensure that communications to the public are timely, coordinated, and convey a consistent message. Typically, communications representatives from all organizations meet regularly throughout the investigation to share information and discuss communications tactics to ensure a coordinated approach. In most instances, the communications approaches will be complementary, if not identical. These discussions may take place during the OICC calls, during separate communications calls and/or during organization-specific calls. In today’s environment of 24/7 news and social media, it is important to provide timely and accurate information to the public. As food safety issues are very technical in nature, proper subject matter experts need to carefully review materials prior to release; however, information being disseminated to the public should be written in plain language and easy to understand.

Key communication areas to consider include:

Communication channels (media, web, social media, public enquiries)
Target audiences (e.g., at-risk populations, partner/stakeholder communications)
Timing and release of information to the target audiences
Risk communication factors:
- level of health risk to the target audience
- impact of communicating without knowing the source of illness
- impact of not communicating soon enough about an outbreak

Examples of public communications with a consistent message from different agencies:

Other public communication examples:

Documenting the outbreak

In addition to maintaining a record of key events and decisions during an outbreak investigation such as notes, meeting minutes and emails, the investigative team may also chose to develop an outbreak chronology (or timeline of events). An outbreak chronology is a record of the important events and decisions that occurred during an outbreak investigation. Chronologies may be used for a variety of purposes such as accountability, transparency and evaluation. There are two main types of chronologies:

Tabular or text-based: detailed summary of all important events occurring each day during the outbreak investigation.
Visual: main events plotted on an epidemic curve.

The content and detail of the chronology will vary with the intensity of the event. Different chronologies may be created for different audiences (e.g., the public, investigative partners, senior management).

Examples:

Tools

Toolkit acronym list

This resource contains a list of acronyms referenced within Toolkit and/or of interest to public health professionals working in enteric outbreak response.

Canada’s Foodborne Illness Outbreak Response Protocol (FIORP)

This is the primary guidance document for multi-jurisdictional investigations of foodborne illness outbreaks in Canada; it is followed when cases are reported in more than one province or territory, or in Canada as well as another country, and when multiple agencies are involved.

Toolkit assessment call template

This Microsoft Word document provides an example of a typical agenda of an Assessment Call, as well as a template for taking meeting minutes.

Toolkit teleconference call template

This Microsoft Word document provides an example of a typical agenda of a Teleconference Call, as well as a template for taking meeting minutes.

Toolkit Public Health Alert (PHA) template

This Microsoft Word document provides a suggested template for the content and layout of a Public health alert (PHA).

Toolkit chronology template

This Microsoft Word document provides instructions and suggested formatting for creating chronologies for outbreak investigations.

Toolkit chronology (visual timeline of events) template

This Microsoft Powerpoint document provides formatting instructions for creating a visual timeline of events in an outbreak investigation, which documents cases over time, as well as key events and public health actions.

Outbreak Toolkit