America's hospitals and health systems must be prepared for anything, but as the range of threats to health in our communities becomes broader and the threats hit more quickly and frequently—whether it's the devastation of natural disasters or emerging threats such as the Zika virus—provider organizations will need to play bigger roles in heading off problems before they spiral into crises.
To support resilient communities that can meet and overcome threats to our health security, the Centers for Disease Control and Prevention established the National Health Security Preparedness Index as a streamlined tool to better understand the nation's capabilities.
It annually reports a national preparedness score from 0 to 10, as well as scores for each state, that can be used both as benchmarks and tools for collaboration. This work, now handed over to the Robert Wood Johnson Foundation, assesses preparedness across six areas—disease surveillance, community planning, incident management, care delivery, environmental health and countermeasure management.
The U.S. earned an overall score of 6.7 out of 10 for health security preparedness this year. That's an improvement of 3.6% since the index was launched in 2013. It's a small but nevertheless important shift. The index shows particularly strong preparation in incident command and control, as well as countermeasure management, but there's a real need for improvement in environmental and occupational health, as well as healthcare delivery.
National preparedness has improved most in community planning and engagement, rising 8.4% in three years. These improvements are moving in the right direction, but clearly we must do more.
For hospitals and health systems, no single domain is more relevant than healthcare delivery. When under crisis conditions, our nation's hospitals must continue to deliver efficient, high-quality care, which not only serves patients but protects communities. It's a test in which the industry cannot afford to earn anything but top marks. For the second consecutive year, the U.S. earned a score of 5.1 out of 10. To be clear, that's a national number. Capacities in each state, health system and hospital vary. For each, the index offers leaders a clear framework to better understand the strengths and gaps in capacity within their organizations.
Within that framework, there are elements that hospitals can control themselves or influence more directly, e.g., emergency room wait times, the number of staffed beds and level of specialist staffing. They have little control over others, such as the number of nurses in the state or how far people must travel to access specialized treatment facilities. Those factors must still be understood as reference points to understand the challenges in meeting the needs of the people and the communities those organizations serve.
Hospitals and health systems can also take the point on other elements, such as better integration of healthcare and social services. Through collaboration with other stakeholders, we could make significant progress toward improving the level of preparedness in the communities they serve.
Digging deeper into to the data, the index exposes a preparedness gap in stark geographic terms between highest- and lowest-scoring states—amounting to a 36% chasm in 2015. Maryland achieved the nation's highest overall preparedness level of 7.6 in 2015, 14% higher than the national average. A total of 18 states, many clustered along the Eastern Seaboard, Upper Midwest and Southwest, significantly exceeded the national average. Conversely, 16 states, especially in the Deep South and Mountain West, lagged significantly below the national average. Hospitals and health systems need to be willing partners in closing these chasms.
No single sector, agency, organization or program can be held accountable for all of the measures tracked within the index (or even a single domain), but hospitals and health systems can play pivotal roles with peers in public health and emergency management to improve overall preparedness. Keeping our neighbors safe is a responsibility we all share.