This document summarizes findings from interviews with 33 infection control liaisons from VA facilities regarding communication and information sharing during the 2009 H1N1 influenza pandemic. Key findings include that the most common barriers to effective communication were information overload and contradictory information from different sources. Facilitators included timely and organized information from multiple channels. Recommendations focused on developing standardized educational materials and communication plans within facilities to disseminate information and prevent future issues.

1. Communication and Information Sharing at VA Facilities During the 2009 Novel H1N1 Influenza Pandemic Sara M. Locatelli 1 , Sherri L. LaVela 1,2 , Timothy P. Hogan 1,3 , Amy N. Kerr 1 , Sean Tully 1 , Frances M. Weaver 1,2,3 , Barry Goldstein 4 1 Department of Veterans Affairs, Hines, Illinois 2 Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 3 Loyola University, Chicago, Illinois 4 Department of Veterans Affairs, Seattle, Washington 17/OCTOBER 2011

3. Four Elements of Health Communication Audience Message Source Channel Source: Freimuth, Linnan, Potter, 2000

7. Results: Sources of Public Health Information *Multiple information sources were commonly reported. Information Source* n (%) Veterans Affairs national leadership 25(75.8%) VA regional leadership 6 (18.2%) Centers for Disease Control and Prevention (CDC) 24 (72.7%) Local health department 10 (30.3%) World Health Organization (WHO) 5 (15.2%) State department/Flu lab 4 (12.1%) Association for Professionals in Infection Control (APIC) 2 (6.1%) Healthcare Response Coalition 1 (3.0%) Kaiser Permanente 1 (3.0%) Society for Healthcare Epidemiology of America (SHEA) 1 (3.0%)

8. Results: Barriers to Effective Communication Theme Illustrative Quote “ Information Overload” “ And before you could decipher what was most important, more information would come in that superseded that… Sometimes it was hard to determine the priority” Contradictory Information “ The discrepancy between the level of respiratory protection [that] was needed… continued to thwart our efforts. What we have been taught… what we believed to be true, and what was recommended by federal agencies… did not agree which became problematic”

9. Results: Facilitators of Effective Communication Theme Illustrative Quote Timely and Organized “ We received all in timely way and turned that information around. With the help of the director’s office, we were able to get advisories distributed out to the staff [quickly]” Multiple Channels “ The [state] was very strong, and public health, in keeping us informed… We had information coming in from conference calls… [and] local offerings… We were very well informed” Included Educational Materials “ VA… shared many pamphlets and brochures, and DVDs… CDC had excellent resources on [their] website – [we] downloaded a lot of content [to share]”

10. Results: Information Dissemination within Facility *Multiple dissemination methods were commonly reported. Dissemination Method* n (%) Formal Education Sessions 23 (69.7%) Emailed Materials 22 (66.7%) Informal One-on-One Education 18 (54.5%) Posted Information 18 (54.5%) Intranet or Internet 14 (42.4%) Brochures & Handouts 9 (27.3%) Newsletters 4 (12.1%) Phone Line 4 (12.1%) Closed Circuit TV 3 (9.1%)

11. Results: Barriers to Information Dissemination Theme Illustrative Quote Insufficient Communication Plan “ It would probably be good to revisit [our plan]. We didn’t have enough people [for our plan to work]” Posting Procedures “ Any signage… had to go through a governing body that looks at everything, which caused some delay in getting information out”

12. Participant Recommendations Education and Educational Materials Standardized Materials “ [Someone should create a] kit that had all the signs that could be pre-approved… Then everyone would have something ready and would be able to change if it were the avian, seasonal, or H1N1 flu” Alternative Approaches to Education “ [We should] deputize a couple of people to help with infection control education. It was difficult with only two of us” Importance of Vaccination “ [We need to make] employees understand how important it is [to] protect patients by getting vaccinated… There are many negative attitudes toward vaccinations [that] hurt the patients”

13. Recommendations Quality and Quantity of Information Prevent “Information Overload” Establish proper timing for releasing new information; deviate only for very important material Clear Guidance “ It would be nice for the VA to come out with a hard stance, rather than leaving so much leeway. We required everyone to use N95 masks, but in the community, they were running low, so they started using surgical masks. It made it difficult to enforce usage of N95s among providers who also work in the community”

14. Recommendations Internal Communication Identify Single Information Source “ We got our public affairs person involved… [who sent information] via the intranet and via our bulletins… That person did a really good job getting the information out” Standardized Responses “ We standardized answers to questions asked through the telephone line... If someone called in with a new question, we got together to determine the answer for future callers” Facility Communication Plan “ We made sure we had education ready immediately... Our Chief Epidemiologist and another Epidemiologist… started immediate employee forums… Our Pan Flu Plan was… like a little check-list”