Factors Influencing Multi-Jurisdictional Collaboration Within State Food Emergency Rapid Response Teams

Randy J. Treadwell, MPH

Washington State Department of Agriculture

International Food Protection Training Institute (IFPTI)

2014 Fellow in Applied Science, Law, and Policy: Fellowship in Food Protection

Correspondence concerning this article should be addressed to Randy Treadwell (rtreadwell@agr.wa.gov)

Abstract

National Rapid Response Team (RRT) best-practices have yet to identify factors that influence multi-jurisdictional collaboration within these teams. A study was carried out using interviews with each RRT. Thematic analysis identified common themes related to collaboration success, barriers, and strategies. Study results included findings of increased partner familiarity, increased awareness of RRT capabilities, and institutionalization of collaboration into agency culture as common success themes. Common barriers included perception of turf, restricted information sharing, and lack of dedicated RRT personnel. Common strategies included persistent communication, building personal relationships, dedicated RRT personnel, and leadership buy-in. In conclusion, when considered together, these factors may build upon existing best-practices to assist teams in increasing collaboration successes. Study recommendations included the need to maintain persistent communication in order to institutionalize collaboration; meet face-to-face to build personal relationships and understand capabilities/limitations; establish dedicated RRT personnel; carry out an equal partnership in sharing information; and obtain leadership buy-in for collaboration by marketing capabilities of the multi-jurisdictional team.

Keywords: multi-jurisdictional, collaboration, Rapid Response Team, institutionalization, organizational culture.

Background

          Rapid Response Teams (RRTs) have been commonly used in the emergency medical (Devita et al. 2006) and disaster/humanitarian (UNDAC, 2014) settings. However, RRTs are relatively new to the regulatory food safety arena. The Food Protection RRT Program was created in 2008 as a United States Food and Drug Administration (FDA) initiative to partner with state food/feed safety regulatory agencies for building emergency response capacity within an integrated food safety system (FDA Rapid Response Teams, 2014). The program currently consists of 18 teams housed in state regulatory agencies. Teams carry out all-hazards responses that include a wide array of food/feed emergencies and are encouraged to share resources, knowledge, and lessons-learned guidance among their public health partners to expedite control and mitigation of food/feed-related incidents.

These responses require the participation of multiple agencies and stakeholders due, in part, to jurisdictional requirements, areas of expertise, and resource needs. Collaboration between participating agencies is essential during a response and has often relied on institutional knowledge housed within those agencies to be effective.

Joint guidance documents created by the RRTs and the FDA Office of Partnerships (FDA OP) provide a solid foundation on which to base collaboration efforts; however, specific strategies implemented by RRTs have yet to be captured. Furthermore, each state was granted an appropriately wide berth to promote the development of its RRT with respect to its unique operational and jurisdictional framework. Due to these factors, current literature and cross-sectional lessons-learned guidance is limited in terms of identifying factors that influence multi-jurisdictional collaboration efforts within the RRTs.

Problem Statement

There is limited information on a national level that characterizes successes, barriers, and strategies pertaining to multi-jurisdictional collaboration for current RRTs functioning in diverse operational and jurisdictional frameworks.

Research Questions

In order to characterize factors influencing collaboration efforts in the current 18 RRTs, this study was designed to address the following:

1.     What multi-jurisdictional collaboration successes have the current RRTs experienced?

2.     What collaboration barriers have the current RRTs experienced?

3.     What strategies were implemented to address and resolve the identified barriers to multi-jurisdictional collaboration?

Methodology

The author obtained information from 18 existing RRTs by means of telephone interviews and an informal feedback group conducted after a majority of the interviews were completed. Study participants were identified through the national RRT Program directory maintained by FDA OP. A web-based interest survey was emailed to each of the identified RRT representatives. The survey provided the opportunity for each RRT Program Director/Manager to identify another individual within the same agency who may have had greater experience with their team’s multi-jurisdictional collaboration efforts.

A total of 18 telephone interviews using a semi-structured questionnaire were conducted from October 2014 to January 2015. Interview questions captured general descriptive data for each RRT, as well as data pertaining to that team’s experience with multi-jurisdictional collaboration such as successes, barriers, and strategies. The interviews were recorded and transcribed. Theoretical thematic analysis was manually conducted on the transcriptions to code the interview data and identify common themes (Braun and Clarke, 2006). Common themes were stratified based on identified successes, barriers, and strategies to address barriers.

Results

          Eighteen total interviews were completed—nine from RRTs created in 2008/2009 (“Original” RRTs) and nine from RRTs created in 2012 (“New” RRTs). RRTs were equally housed in their respective state’s Departments of Health or Agriculture. Thirty-three percent (N=6) indicated a centralized local health jurisdiction structure (local health units led by state and state retains authority [ASTHO, 2012]), while 61 percent (N=11) indicated a decentralized structure (local health units led by local employees and local governments retain authority [ASTHO, 2012]). One RRT did not specify its state’s local health structure.

Initial review of the data set revealed several commonalities between the RRTs related to collaboration successes, barriers, and strategies. Subsequent thematic analysis revealed common themes related to collaboration among both original and new RRTs.

Success Themes

          Analysis revealed more effective and frequent communication between response partners as a common theme among both original and new RRTs. Identified successes related to this enhanced communication included a heightened sense of familiarity and increased awareness surrounding the RRT’s capabilities and its role in coordinated food/feed-related emergency responses.

I think one of the things that has been very valuable is that we meet on a quarterly basis so the players know each other. The members of the RRT understand what each group brings to the table, their abilities and their capabilities. We’ve also developed an updated contact list so that we’re able to reach out more easily. We’ve built this working relationship where you understand who you’re reaching out to, who to reach out to, and they are much more receptive because they understand who’s calling. -Interviewee 006

          Another common success theme was the institutionalization of routine communication between state partners, between the state and their FDA District Office, and between RRTs. Many teams described how frequent communication has become part of their agency’s “culture,” in that the increased level of communication and collaboration with response partners is no longer just encouraged, but expected. 

…that structure involves bi-weekly meetings with [FDA District Office] and the regional FDA Emergency Response Coordinators (ERCs) to give updates on what we’re doing, how we’re doing it, what we need to do, what we need to plan for… they’ve become just an extended family, an extended workgroup. If we don’t talk with them we feel like we’re missing out on something and we usually are. So it’s become more of a working relationship and I think communication is critical. Even when we bring in a new ERC from the district, it’s engrained into that district that you will communicate with the state, you will work together, and it’s to the benefit of both agencies. -Interviewee 005

               Co-location of response partners was also identified as a common aspect of successful multi-jurisdictional collaboration. RRTs that had the ability to easily communicate face-to-face with response partners identified this in-person communication as a success either because they were physically housed in the same building or because they held routine face-to-face meetings.

…the face-to-face meetings I think are really important because you get to know people and build relationships so you feel comfortable picking up the phone and talking to them…. -Interviewee 009

          Despite the multi-jurisdictional collaboration successes identified by the RRTs to date, barriers to success do remain.

Success Barriers

          One commonly-identified barrier to multi-jurisdictional collaboration pertained to the perception of “turf” or territory, where a jurisdiction assumes an RRT is going to seize absolute command of a response. “Turf” was also used to describe an unwillingness of some jurisdictions to relinquish a sense of control over an emergency response when multiple agencies are participating or when an RRT is being used to coordinate activities.

…it’s rough letting go. You have to be able to let go enough to trust that the relationship is going to work so we can build the bridge in the first place. So you do include those people in various groups. You give them a say, you go out and reach out to them. And it’s really been amazing the results people have seen from that. -Interviewee 003

          An additional barrier pertained to restrictions in information sharing between federal, state, and local response partners. Respondents emphasized the perception among state responders that, at times, they do not feel they are considered equal collaborators by their federal counterparts, despite holding valid commissions or operating under a confidentiality agreement in accordance with 21 Code of Federal Regulations (CFR) section 20.88.

…there still seems to be some lagging hesitancy to accept or recognize that we have to be equal partners. There is still some information that doesn’t necessarily make its way to us as a state agency…. -Interviewee 017

          A lack of dedicated RRT personnel was also identified as a barrier to successful multi-jurisdictional collaboration. Dedicated RRT coordinator positions were often reported to serve as familiar liaisons between the different jurisdictions in order to establish and maintain relationships.

          It’s essential that you have someone who is focused on being able to make that their task, rather than another job responsibility in a very full schedule. I’m really concerned. I think things have gone really well…but we need dedicated staff and funding to have this progression continue to support our RRT on an ongoing basis -Interviewee 006

          Despite continuing challenges to successful collaboration, the RRTs implemented strategies to overcome some of the barriers identified.

Barrier Reduction Strategies

          One common strategy that RRTs have implemented to reduce collaboration barriers is persistence in approaching routine communication with partner jurisdictions. Frequent and structured communication, whether in the form of weekly conference calls or routine face-to-face meetings, tended to serve as a precursor to institutionalizing collaboration into the participating jurisdictions’ organizational “culture” or routine operational environment.

It’s strange but it has become the culture…you work with FDA, it’s just what you do, why wouldn’t you? They can help you in some circumstances and in others we can help them. -Interviewee 005

          In-person meetings were reported to more quickly increase familiarity among partners through the establishment of personal relationships. 

We do have face-to-face meetings three times a year. We always had them in [state omitted] because we started out just being with the mentor state, but it progressed into all three of the states in the district getting together. At the meeting everybody gets to hear what’s going on, lots of good conversation. Questions about how this happened, how’s this going along, how’d you do this. Again, it’s very open to everyone, just very willing to share information, how they got something to work, things like that. ­-Interviewee 013

These face-to-face meetings were also reported to enhance understanding about each jurisdiction’s capabilities and limitations, which helped to better define advantages that the multi-jurisdictional RRT structure can bring to a food/feed-related response.

Yeah, once people have begun to see what we can deliver and how we do it and basically how we are an advantage to them for carrying out some of their activities, everything begins to come together…. -Interviewee 014

An additional strategy implemented by RRTs has been establishing dedicated RRT personnel positions that work exclusively on RRT development activities, including serving as a familiar liaison to build relationships between jurisdictions.

I would say having an individual to serve as a liaison to build those relationships and to communicate as a liaison to the different agencies and jurisdictions. It’s primarily the RRT Program Manager or Assistant Program Manager. -Interviewee 008

Top-down leadership buy-in was also identified as a common strategy. Leadership endorsement was reported to assist in adopting collaboration activities into that particular jurisdiction’s culture. Respondents indicated leadership buy-in has been obtained through conscious marketing of the RRT’s capabilities as an effective multi-jurisdictional public health response team.

I think it comes from the leadership from all of the organizations. If the leadership has the buy-in and staff down below see that the leadership is saying that this is our process, we worked hard to coordinate this, and we want to continue this process and this is our expectation…I think that’s a win. -Interviewee 010

Five Factors for Successful Collaboration

The common collaboration themes identified by the RRTs were further categorized into five generalized factors: familiarity, relationships, culture, communication, and resources.

These factors, when considered together, may be able to build on existing best-practice guidance to assist multi-jurisdictional teams in increasing their collaboration successes. Familiarity generalizes themes related to both personal familiarity between jurisdictional representatives, as well as familiarity of each jurisdiction’s capabilities and limitations when responding to a food/feed incident. The relationship factor refers to themes related to building personal relationships. The culture factor generalizes themes related to institutionalizing collaboration into a jurisdiction’s operational environment, as well as leadership buy-in and how it affects collaboration. Communication captures common themes related to routine activities, such as frequent face-to-face meetings, regular conference calls, joint trainings, etc. The resource factor refers to dedicating and maintaining necessary resources to support successful collaboration, including dedicated personnel and funding.

Conclusions

Interview data provided by the 18 RRTs provided several common themes associated with successes, barriers, and strategies related to multi-jurisdictional collaboration. Despite varied operational environments, shared ideas were identified related to increased familiarity, relationship-building, agency culture, persistent communication, and the allocation of adequate resources in order to maintain collaborative efforts. When considered together, these factors may assist multi-jurisdictional teams in enhancing their capacity to successfully collaborate with public health partners within an integrated food safety system.

Recommendations

          While this project identified several common themes related to multi-jurisdictional collaboration successes, barriers, and strategies among existing RRTs, only perspectives from state representatives were captured. Additional data collection from federal and local representatives is recommended in order to identify additional best-practices from those perspectives. Based on the common themes identified in this project, the following best-practice recommendations can be made:

1.     Maintain persistent communication with response partners in other jurisdictions in order to institutionalize collaboration efforts into agency culture. This could be accomplished through regularly-scheduled phone calls, webinars, face-to-face meetings, joint training opportunities, etc.

2.     Meet face-to-face prior to an emergency to increase familiarity among responders, build personal relationships, and increase mutual awareness around each jurisdiction’s capabilities and limitations.

3.     Establish permanent, dedicated RRT personnel who are able to work exclusively on team development and serve as a familiar liaison to response partners. 

4.     Work to obtain high-level leadership buy-in for collaboration efforts by marketing the multi-jurisdictional response capabilities of the RRT. Robust support from upper management increases the likelihood of having integrating collaboration into agency culture, which may assist in maintaining collaborative activities through changes in personnel, funding, etc.

Acknowledgements

          I offer my sincere gratitude to the International Food Protection Training Institute (IFPTI) for this invaluable learning experience. I would also like to thank my IFPTI mentor, Mr. Dan Sowards, and Research SME, Dr. Paul Dezendorf, for your considerable expertise, guidance, and encouragement throughout this Fellowship. My fellow cohort members: I continue to be in awe of your intelligence, experience, energy, and passion; thank you for teaching me and for your friendship. Thank you to the Washington State Department of Agriculture, particularly Kirk Robinson and Claudia Coles, for your support throughout this process. Finally, I’d like to thank my wife, Amanda—your unwavering support and encouragement serve as a testament to your character.

References

Association of State and Territorial Health Officials (ASTHO). (2012). State public health agency classification: Understanding the relationship between state and local public health. Retrieved from the National Organization for Research at the University of Chicago (NORC) website: http://www.norc.org/PDFs/Projects/Classification%20of%20State%20Health%20Agencies/ASTHO%20NORC%20Governance%20Classification%20Report.pdf

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

Devita, M.A., Bellomo, R., Hillman, K., Kellum, J., Rotondi, A., Teres, D., … Galhotra, S. (2006). Findings of the first consensus conference on medical emergency teams. Critical Care Medicine, 34(9), 2463-2478.

U.S. Food and Drug Administration. (2014). Rapid Response Teams. Retrieved from http://www.fda.gov/ForFederalStateandLocalOfficials/CooperativeAgreementsCRADAsGrants/ucm297407.htm

United Nations Office for the Coordination of Humanitarian Affairs (OCHA). (2014). United Nations Disaster Assessment and Coordination missions (UNDAC): from 1993 to 2013. Retrieved from https://docs.unocha.org/sites/dms/Documents/140206_undac_missions.pdf