The Public Health Emergency Preparedness and Quality Improvement (PHEP-QI) Intervention: Co-Creation and Pilot-Implementation of the PHEP-QI Intervention in Canada

When a community faces a sudden crisis, such as a severe storm or a widespread disease outbreak, public health agencies must act quickly to protect people. These organizations are the backbone of emergency response, but they often struggle to prepare effectively for the next disaster while managing the demands of the current one. To build a system that can withstand these shocks, experts rely on two main ideas: emergency preparedness, which is the planning and readiness for potential crises, and quality improvement, a method of making small, steady changes to processes to make them work better. While doctors and hospitals have long used quality improvement to refine patient care, public health agencies have been slower to adopt these tools for their emergency planning. The challenge lies in figuring out how to teach these organizations to use quality improvement specifically to become more resilient, or better able to recover and adapt, when the next emergency strikes.

A team of researchers in Canada set out to solve this problem by creating a new way to help public health agencies improve their emergency readiness. Instead of designing a training program in a lab and handing it down to workers, the researchers worked directly with the people who do the job. They partnered with five different public health agencies located across the country, from the Atlantic coast to the Pacific, to build a solution together. This approach, known as co-creation, meant that the agencies helped decide what they needed to learn and how they wanted to learn it. The result was a pilot program called the Public Health Emergency Preparedness and Quality Improvement intervention. This program was not a single lecture or a simple checklist; it was a year-long journey involving workshops, coaching, and ongoing collaboration designed to help these teams identify their weaknesses, set goals, and use data to make their emergency plans stronger.

The process began with a series of focused conversations called Structured Interview Matrix sessions. In these meetings, which lasted three to four hours, teams from each agency gathered to discuss their recent experiences with emergencies, including the global pandemic. They used a specific set of questions to identify what resources they already had, what parts of their emergency framework needed the most work, and what changes were actually possible to make within their organizations. Based on these discussions, each agency selected one specific area to focus on for improvement, such as how they engage with their local communities or how they recover after a disaster. This step ensured that the training that followed was tailored to the real, immediate needs of each team rather than a generic curriculum.

Following these initial meetings, the researchers and the agencies worked together to design a series of eight monthly online workshops. These sessions were built on the principles of adult learning, which recognize that experienced professionals learn best when they can connect new information to their own lives and work. The curriculum was flexible; at the start, the participants told the researchers what topics they wanted to cover, and the team adjusted the schedule accordingly. The workshops covered a wide range of subjects, from the basics of quality improvement tools to complex issues like leadership, data analysis, and how to maintain community partnerships, particularly with Indigenous groups. Between the monthly sessions, the teams worked on their own projects, receiving personalized coaching and access to resources to help them apply what they had learned.

A key feature of the program was the creation of a Community of Practice, a group where people from different agencies could share ideas and solve problems together. During the workshops, participants broke into smaller groups to discuss their progress, talk about the challenges they faced, and learn from the experiences of their peers in other regions. This cross-organizational collaboration allowed them to see how different agencies approached similar problems, fostering a network of support that extended beyond their own local offices. The researchers also made sure to include a focus on equity, ensuring that the teams considered how their emergency plans affected all members of their community, especially those who are often left behind during a crisis.

The pilot program ran for nineteen months, during which the five agencies moved from identifying their priorities to implementing specific changes in their work. The researchers found that the co-creation process was successful in engaging the participants and making the training relevant to their daily lives. The agencies developed concrete plans to improve their emergency preparedness, using the quality improvement tools they learned to track their progress and measure their success. The study showed that when public health workers are given the right tools and the freedom to shape their own learning, they can effectively use quality improvement methods to build more resilient systems.

This work suggests that the gap between clinical care and public health practice can be bridged by involving the people who do the work in the design of the solutions. The researchers did not claim to have solved every problem in emergency preparedness, but they demonstrated a clear path forward. By combining evidence-based frameworks with the practical wisdom of public health professionals, it is possible to create a system that learns and adapts. The success of this pilot suggests that similar approaches could be used in other organizations to help them prepare for the unpredictable challenges of the future, ensuring that when the next emergency arrives, the response is not just fast, but also effective and fair.