Using mixed methods to identify high reliability organization measures for local health department disaster preparedness

When disaster strikes, the difference between high and low impact on health and society will be determined by preparedness. Yet recent experiences and governmental advisories indicate that timely federal and state level aid are not reliable. Therefore, the nexus of preparedness must be at the local level. However, a consistent and effective approach to local coordination does not exist, although health departments are mandated and funded to be prepared to respond to a public health catastrophe such as pandemic influenza.;The most important criterion for local health departments to meet in the event of an emergency is reliability. In other fields, such as military operations or flight traffic control, high reliability organizations have been developed to ensure that failures are rare. A high reliability organization is an organization that functions nearly perfectly over long periods of time under stressful conditions. This high reliability framework, when applied to the local health department context, would result in a resilient organization with built in redundant processes composed of individuals that meet or exceed public health worker competencies.;How prepared and competent are California public health workers today? What processes of a local health department would lead to high reliability and how would that be measured? The answers to these questions will produce a method to measure emergency response capacity by forming organizational competencies for disaster preparedness in local public health organizations.