Model Practice: Communication and Collaboration

Introduction

FoodCORE aims to improve state and local enteric disease outbreak detection and response by building capacity; developing collaborative surveillance and response programs; conducting rapid, coordinated, standardized investigations; developing and implementing measurable performance indicators; and identifying and documenting replicable model practices. FoodCORE activities focus on three core disciplines involved in enteric disease surveillance and outbreak response activities: laboratory, epidemiology, and environmental health.

Close communication and collaboration among these three disciplines is critical for timely and effective outbreak detection and response. Having relationships in place before an outbreak occurs is critical for establishing clear lines of communication. Delays or interruptions in communication and data sharing between team members can impede investigations; a prepared and coordinated team can work together to quickly solve and stop outbreaks, preventing additional illnesses.

The FoodCORE Model Practice: Communication and Collaboration describes successful strategies used in FoodCORE centers to establish and maintain connections among laboratorians, epidemiologists, and environmental health specialists.

Key Messages:

• Build trusting, respectful relationships with team members before a response
• Work together in a manner that benefits public health

Identifying team members

In the FoodCORE centers, the size and members of each multidisciplinary team depends on the infrastructure and needs of the jurisdiction. The disciplines and agencies represented vary, but every team should have the knowledge, skills, and authority necessary for thorough surveillance and outbreak response activities. The essential members of successful teams are laboratorians, epidemiologists, and environmental health specialists that work for their state or local government. These positions can have different titles based on the jurisdiction and the scope of their responsibilities (e.g., public health nurse, sanitarian). Other disciplines may be included on a team depending on the needs of the investigation or jurisdiction; these may include public information officers, emergency preparedness experts, veterinarians, health care providers, and representatives from academia, private industry, and other jurisdictions such as the federal government.

The common members of teams – laboratorians, epidemiologists, and environmental health specialists – have specialized roles and depend on one another for the most effective response activities.

Listed below are common responsibilities of these team members in FoodCORE centers; however, some jurisdictions may combine roles, and the tasks may change given the needs of a particular situation.

Laboratory Scientists

• Test food, clinical, and environmental specimens and confirm test results from clinical labs
• Conduct molecular typing (PFGE and/or WGS) on isolates to identify clusters
• Report cases and clusters to epidemiology partners
• Advise environmental health specialists and epidemiologists on the collection, handling, and transport of specimens and follow-up testing
• Coordinate courier service and receive specimens from clinical labs
• Perform additional testing as needed (e.g., antimicrobial susceptibility testing)
• Provide updates on laboratory activities to epidemiologists and environmental health specialists

Epidemiologists

• Interview cases to gather exposure data to identify potential sources of infection
• Identify clusters and outbreaks from laboratory results and epidemiologic data
• Coordinate outbreak responses
• Distribute and collect stool specimen collection kits
• Conduct epidemiologic studies and analyses to determine the likely source of outbreaks
• Provide education to the public and exclude cases from high-risk settings to limit additional spread of infection (duty may be shared with or done by environmental health specialists)
• Provide updates on epidemiologic activities to laboratorians and environmental health specialists

Environmental Health Specialists

• Conduct environmental health assessment at restaurants and growing, processing, manufacturing, and retail facilities
• Implement control measures in establishments where deficiencies are found
• Collect environmental, food, and food worker specimens
• Determine contributing factors and environmental antecedents (underlying factors) of outbreaks
• Collect data to conduct product traceback investigations
• Provide updates on environmental health activities to laboratorians and epidemiology partners

Improving communication

Establishing Points of Contact

To improve communication and collaboration in their multidisciplinary teams, FoodCORE centers have started by engaging stakeholders and gathering contact information for core team members before an outbreak begins. At a minimum, this contact information includes primary phone numbers, 24-hour phone numbers, email addresses, and fax numbers. Other parties may need to be included in communication during particular situations (e.g., agency directors, people at other government agencies, health care providers, and public information officers), so including contact information for these additional roles has been useful to FoodCORE centers. With frequent staff turnover in some agencies, contact lists should be reviewed and updated throughout the year at least semi-annually.

After contact information is compiled, FoodCORE centers benefited from holding a meeting with at least the core members of the multidisciplinary team to introduce themselves, establish team member roles, and prepare communication protocols. A meeting is also a good opportunity to discuss the needs and challenges of the team and to develop a plan to address them. This is also an opportunity to learn the capabilities of the team members and their organizations (e.g., staffing levels, software licenses or expertise, upcoming changes or new activities, etc.). Having this information allows the team to maximize resources when facing time or resource constraints often encountered during outbreaks.

Maintaining Open Communication

To be successful, communication must be maintained after initially bringing the team together. FoodCORE centers have established regular, bidirectional communication among team members. Bidirectional communication is essential for an effective multidisciplinary team; it ensures that all parties are informed throughout an investigation as well as during routine activities. This not only improves specific responses but also allows for the exchange of ideas about accomplishments, challenges, new projects, or other updates.

FoodCORE centers have planned weekly, biweekly, monthly, or quarterly multidisciplinary team meetings, depending on their specific needs, in addition to the ad hoc communication related to ongoing outbreak investigations. These meetings can be held in-person, by phone, or a combination, depending on the location of team members. When team members work in different locations making in-person meetings difficult, FoodCORE centers hold more frequent conference calls. A typical agenda includes discussion of current investigations, recently closed investigations, and ongoing projects and challenges. Weekly calls in FoodCORE centers are often quick updates that take less than 30 minutes. Using these methods helps the FoodCORE centers ensure rapid cluster detection, rapid interviewing, and rapid public health action.

Data Exchange

To complement bidirectional communication efforts, FoodCORE centers have improved their data exchange practices. By granting core team members access to data, the team becomes more cohesive and critical data is available in a timely manner. The following practices have been successful in FoodCORE centers to improve data exchange:

• Epidemiologists have access to BioNumerics or state laboratory information management systems (LIMS)
• Laboratorians and environmental health specialists have access to epidemiologic surveillance databases with case information
• Team members have access to secured share drives/networks for storing and exchanging information
• Team members use platforms such as SharePoint and SEDRIC (System for Enteric Disease Response, Investigation, and Coordination) to access data for multistate outbreaks
• Students and staff members split their time between two or more disciplines to support data exchange (either by completing the tasks of multiple disciplines or by spending time working in multiple offices throughout the week)

Engaging Other Stakeholders

Enteric investigations often cross jurisdictions, so open communication is needed not only within a team, but across city, county, regional, and state borders. By implementing control measures locally, a team may be able to contribute to investigations and interventions on a state or national scale. To improve communications with local health departments, some FoodCORE centers conduct “roadshows”. During these events, FoodCORE staff travel around their state to show how the work of local health departments can impact investigations on a bigger scale by showcasing notable outbreaks. Roadshows are also a time to practice communicating during an outbreak tabletop exercise, discuss challenges, and make improvements. While visiting local health departments, FoodCORE centers also deliver trainings and advertise available resources such as updated protocols, interview teams, available laboratory resources, etc. If travel isn’t an option, roadshows can be conducted virtually through webinars.

Cross-training

Cross-training, training in the roles and responsibilities of other team members, is one way to promote teamwork and collaboration on a multidisciplinary team. Cross-training strengthens teams by improving the understanding of each other's tasks and allowing members to assist each other in ways that may be outside of their traditional roles. Team-based approaches to cross-training have the added benefit of strengthening and reinforcing relationships and communication between team members by bringing everyone together.

FoodCORE centers have conducted trainings in their jurisdictions using a variety of platforms. In some centers, multidisciplinary trainings have been part of planned outbreak exercises, less formal workgroups, and during in-person meetings of public health partners. Some centers use materials they have developed internally for those trainings, but there are also many training resources that are available to help jurisdictions improve collaboration across disciplines. These trainings vary in detail and breadth and some are available online while others are only offered in-person. Appendix B has information on some specific training that FoodCORE centers have used.

Evaluating to improve collaboration

As centers have improved their team collaboration, they've used FoodCORE performance metrics to document their successes and identify areas for continued improvement. Many FoodCORE centers identified ways to improve communication and collaboration on their multidisciplinary teams by evaluating the timeliness and completeness of their processes through these metrics. Conducting process evaluations can start conversations and get all disciplines engaged in improvement strategies. There are resources available for jurisdictions wanting to perform an evaluation (see Appendix B); they can use the FoodCORE performance metrics or less formal evaluation methods.

Implementing change

Appendix A is an optional checklist to assist jurisdictions working to implement changes to improve communication and collaboration on multidisciplinary teams. The checklist includes the practices described in this document as well as blank spaces to fill with additional, more specific tasks. This checklist can be used to plan a timeline, assign responsible parties, and create a follow-up plan to ensure that changes are implemented. Based on the needs of the team, changes can be prioritized, reflecting the importance of each item and time needed to make the change. Items include activities and actions that FoodCORE centers have previously found useful when implementing successful multidisciplinary communication and collaboration. Valuable feedback on implemented changes comes from asking opinions and getting suggestions from those whom the changes affect. This can be done formally with an online or written survey, or informally in an open forum setting.

Appendices

Appendix A: Checklist for FoodCORE Team Communication and Collaboration

Appendix B: Training and Resources

Appendix C: Communication and Collaboration Strategies used by FoodCORE Centers