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An Opportunity for Cross-jurisdictional Learning: COVID Response Virtual Learning Cafes

By Anne Siegler, DrPH and Hanna Tessema, DrPH(c), MPH, MSW

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Citation

Siegler A, Tessema H. An opportunity for cross-jurisdictional learning: COVID response virtual learning cafes. HPHR. 2021;48.  

An Opportunity for Cross-jurisdictional Learning: COVID Response Virtual Learning Cafes

Abstract

As the COVID-19 pandemic unfolded, over 3,000 local health departments (LHDs) in cities and counties across the US were tasked with developing and implementing COVID-19 prevention and response initiatives. While formal trainings and webinars were available, the opportunity for local health departments to informally learn, promote promising practices and strategize around effective COVID-19 response across jurisdictions was limited. Often, cities and counties facing similar challenges in the COVID-19 response were creating solutions independently and in a vacuum, without the benefit of learning from shared experiences.

To address this gap, Resolve to Save Lives, as part of its United States COVID-19 Response program, began hosting monthly “COVID-19 Response Virtual Cafés” in October 2020. The cafés were designed for LHD staff to share promising COVID-19 response practices and jointly strategize around common challenges in a non-threatening, collaborative environment.

A regularly occurring informal venue for LHDs to candidly discuss and share promising practices has been a valuable addition to health departments’ learning opportunities and ultimately their COVID-19 response. As the pandemic rapidly evolves, opportunities for continued learning and real-time dissemination across jurisdictions play an important role in COVID-19 control.

As the COVID-19 pandemic unfolded, more than 3,000 local health departments (LHD) in cities and counties across the U.S. were tasked with a responsibility unlike any they had experienced in a century. Faced with the duty of providing how-to information about a disease that did not exist before LHDs faced unprecedented organizational, managerial and clinical challenges (Nembhard et al., 2020).

 

Resolve to Save Lives (RTSL), an initiative of the global public health organization Vital Strategies, works to strengthen health systems by designing and supporting scalable solutions to prevent disease and death around the world.  As technical assistance providers during the COVID-19 pandemic, we witnessed the almost immediate action of small- and medium-sized health departments to develop and roll out large-scale testing and vaccine initiatives; hire, train and manage cadres of contact tracers and case investigators; coordinate support services for individuals in isolation and quarantine; manage public perceptions and expectations through public relations and media campaigns; and process and report large amounts of epidemiological data daily.

 

Making decisions and responding quickly was crucial to containing the novel coronavirus.  Processes that public health typically relies on to form knowledge, test hypotheses and develop evidence-based policy and practice were ill-suited to support public health practitioners who were required to make policy decisions and implement interventions immediately, despite a lack of empirical data and evidence.  Globally, researchers quickly became aware that “[…] we cannot act with the same sense of certainty about ‘what works’.  Moreover, there is limited time for ‘business-as-usual’ processes of research translation.” (Lancaster et al., 2020)

 

Groups such as the Centers for Disease Control and Prevention, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, Johns Hopkins University and others quickly began providing guidance, tools, trainings and webinars.  However, the opportunity to informally learn, share promising practices and strategize around effective COVID-19 response across jurisdictions was limited.  In a brief online survey of local health department leadership, one official stated, “We have not had much opportunity to come up for air over the past year to speak directly with others.” (Siegler, A., 2021) There was often a gap between official guidance and what was possible, or necessary, in an emergency.  LHDs lacked concrete support around navigating these decisions and information on how other jurisdictions were handling similar challenges, including issues of equity and access to COVID-19 services.  Often, cities and counties facing similar challenges in the COVID-19 response were creating solutions independently, in a vacuum, without the benefit of learning from shared experiences.  According to one midwestern county health official surveyed, “We’re all inventing these things on our own.” (Siegler, A., 2021)

 

Management research has found that the most successful organizations facing complex problems are those that harness collaborative partnerships.  “Having outside partners […] grants access to novel knowledge about innovations and their implementation, more minds for problem-solving and help for dealing with issues like equipment and personnel shortages.“ (Nembhard et al., 2020)

 

RTSL formed its U.S. COVID-19 Response Program in April 2020 to help county and city health departments model effective and equitable COVID-19 response at the local level.  As part of this initiative, and to address the gap of informal cross-jurisdictional learning opportunities, RTSL began hosting monthly online meet-ups for city and county health department leadership – known as  “COVID Response Virtual Cafés”  — in October 2020. The cafés are designed as an opportunity for LHD staff to share promising COVID-19 response practices and jointly strategize around common challenges. 

 

The cafés are not widely advertised; participation is by invitation only, and is limited to LHDs from RTSL’s partner jurisdictions, which represent multiple regions throughout the United States. Participation has increased over time as we have continued to widen our scope of partnerships with LHDs.

 

The monthly COVID Response Virtual Cafés focus on topics pertinent to the current challenges of the pandemic and are informed by LHD interests. Café topics to date are listed in Table 1.  At each café, after the topic is introduced, a participating jurisdiction presents a promising solution, idea or practice from the field.  The rest of the session serves as an open forum for participants to discuss their experiences, challenges and ideas.

Table 1.  COVID Response Virtual Café Topics

Using data to inform school opening and closure decisions

Prioritizing case investigation and contact tracing during the surge

Engaging community in communications around COVID-19 vaccines

Strategies to reduce racial inequities in vaccine roll-out

The cafés address the needs of city and county jurisdictions for which RTSL is providing COVID-19 response support. Participants include LHD commissioners and deputy commissioners and leadership from epidemiology, communications, contact tracing, vaccination clinics, school health and community engagement.  The average café has between 12 and 24 participants, representing five to nine small- and medium-sized health departments from cities and counties across the Untied States. State health departments have not been included in this program because many of the issues they face are distinct from those of county and city health departments; a future café series is being planned for state health departments.

 

The cafés are purposefully structured to be supportive and non-threatening, to enable LHD staff to comfortably discuss weaknesses in their COVID-19 responses.  Collaborative partnering demonstrated in the cafés “requires that people feel safe to ask questions, raise concerns offer suggestions and share differences of opinion about strategy – an environment not always found among health care workers.” (Nembhard et al., 2020)

 

Feedback on the cafés has been positive.  A small online survey of participants who attended the October 2020 café (n=9) had a response rate of 89% (8/9).  We found that the majority thought the cafés were “extremely useful” or “very useful” (75%) to their work, and all stated that they would attend another café.  “This café was not just useful […] it was needed,” said one survey participant.  Nearly all respondents reported that they were “very likely” or “likely” (88%) to recommend the café to a colleague.  Another participant noted, “the tone of this meeting was perfect!” Several participants stated that the most useful part of the cafés was the opportunity to hear from other jurisdictions and to have informal discussions with experienced LHDs. “It was nice to hear what other local health departments are doing.  We all seem to have the same challenges.”  “[The aspects of the cafes that are most helpful are] learning about specific issues and challenges, and what works and doesn’t work in other jurisdictions; having the opportunity to ask questions and get meaningful suggestions on what we can try in our jurisdiction; and knowing that others are experiencing or have experienced similar challenges.  We are all in this together.”

 

As a monthly informal venue for discussing and sharing promising practices, the café event has generated key learnings among participating LHDs, reinforcing their COVID-19 response.  A representative of one midwestern county said, “The outreach efforts we learned about in [a southeastern county] have informed several of our initiatives.  The café on mapping was informative and will be integrated into our work very soon.”  Another stated, “Our contact tracing methods were influenced by the café held in November.”  Table 2 illustrates characteristics of discussions that have been particularly fruitful.  RTSL plans to expand its learning opportunities and build on the café model to allow more jurisdictions, both local and state health departments, to participate in the future.

Table 2.  Characteristics of Successful Cafés

The discussion goes beyond characterizing the problem and includes ideas for solutions.

Subject matter experts are present and available as a resource, but LHD staff experience is the key focus.

The topic of each event is pertinent across jurisdictions, and there has been sufficient time for LHD staff to grapple with the issue on the ground.

The format is unstructured and allows for free-flowing discussion.

LHDs feel comfortable sharing weak aspects of their COVID-19 response and discussing areas for improvement candidly.

As the pandemic rapidly evolves, health departments must adapt quickly, and opportunities for continued learning and real-time dissemination across jurisdictions play an important role in COVID-19 control.  Cross-jurisdictional conversations, in an informal space where participants feel comfortable discussing opportunities for improvement of their public health system’s response, should be expanded.  Ideally, these dialogues would be facilitated by state and local health departments in collaboration with national public health non-governmental organizations. 

 

The need to make rapid decisions with incomplete information is not limited to COVID-19 response—it applies to many areas of public health.  COVID-19 has begun to reveal new and different methods of producing and disseminating evidence. The café format is a model that can be replicated to address public health issues beyond COVID-19 response, such as epidemic preparedness and chronic disease management, to help expedite and maximize the sharing of promising practices.

References

Lancaster, K., Rhodes, T., & Rosengarten, M. (2020). Making evidence and policy in public health emergencies: Lessons from COVID-19 for adaptive evidence-making and intervention. Evidence & Policy: A Journal of Research, Debate and Practice, 16(3), 477–490. https://doi.org/10.1332/174426420X15913559981103

 

Nembhard, I. M., Burns, L. R., & Shortell, S. M. (2020). Responding to Covid-19: Lessons from Management Research. NEJM Catalyst Innovations in Care Delivery. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0111

 

Siegler, A. (2021).  Survey of COVID-19 Response Café Participant Satisfaction and Impact.  [Unpublished raw data.]

About the Authors

Anne Siegler, DrPH

Anne Siegler, DrPh is a epidemiologist and evaluation specialist 

Hanna Tessema, DrPH(c), MPH, MSW

Hanna Tessema, DrPH, MPH, MSW is a Senior Public Health Advisor with 15 years of experience managing HIV/AIDS capacity building, training, and technical assistance programs in the US. She has significant experience applying behavioral theories to the development of public health interventions. Tessema is also an adjunct faculty member at the George Washington University teaching a Social & Behavioral Approaches to Public Health course to MPH students.

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