Emergency management education in healthcare education programs 85

Emergency Preparedness Content in

Health Care Administration Programs:
A Decade Later
Mary Helen McSweeney-Feld, PhD, H. Wayne Nelson, PhD,
Wendy Whitner, PhD, & Cyrus Y. Engineer, DrPH

Abstract
The need for emergency preparedness training for healthcare administration
professionals has increased significantly with more frequent weather and
man-made disasters throughout the United States disrupting the continu-
ity of healthcare organizations’ operations. This paper explores the current
state of emergency management education since Houser and Houser’s 2006
groundbreaking study of bioterrorism and mass-casualty management edu-
cation in healthcare administration programs more than a decade ago. A
survey of undergraduate and graduate healthcare management programs was
conducted in the spring of 2014 to collect information on the extent of course-
work and/or instruction about emergency preparedness and the healthcare
executive’s role. Findings from the survey strongly echo those from Houser
and Houser’s study, suggesting relative stability in the scope and focus of
healthcare administration emergency management education. However, the
new national disaster mentality “reality” identified by these authors has not
driven healthcare management curricular augmentation or sharp increases
in academic engagement, and gaps in emergency management education for
healthcare administration faculty continue to exist.

Please address correspondence to: Department of Interprofessional Health Studies, Towson

University, 8000 York Road, Linthicum Hall 121D, Towson, Maryland 21252
Phone: (410) 704-3909, Email: mmcsweeneyfeld@towson.edu
86 The Journal of Health Administration Education Winter 2017

Introduction
The need for emergency preparedness training for healthcare administration
professionals has increased significantly in the wake of a plethora of weather
and man-made disasters throughout the United States that disrupted the con-
tinuity of healthcare organizations’ operations. In 2011, Presidential Policy
Directive 8 (PPD-8): National Preparedness introduced an integrated, layered,
nationwide approach to emergency preparedness (Federal Emergency Manage-
ment Association [FEMA], 2011, p.3). Recognizing the importance of this issue,
the Center for Medicare and Medicaid Services (CMS) introduced enhanced
emergency preparedness requirements for Medicare and Medicaid Partici-
pating Providers and Suppliers in December 2013, requiring an all-hazards
approach to emergency planning for healthcare systems, as well as expanded
training and testing requirements for acute care, home- and community-based
services, and long-term care facilities (Federal Register, December 27, 2013,
pp.79082-79200). The response of healthcare professional associations to these
provisions reiterates the importance of the new requirements. In an updated
statement, the American College of Healthcare Executives (ACHE) recognized
that “healthcare executives should actively participate in disaster planning and
preparedness activities, striving to ensure that their emergency operations plan
fits within overall community plans and represents a responsible approach to
the risks an organization might face” (ACHE, 2013, p. 91).
In light of these developments, a survey was conducted in the spring of
2014 to collect information on the extent to which graduate and undergradu-
ate healthcare management programs offer coursework and/or instruction
about the healthcare executive’s role in emergency preparedness. This study
used the results from an earlier 2006 study by Houser and Houser to inform
the content of the survey, as well as research on public health emergency pre-
paredness competencies as defined by the Center for Disaster Medicine and
Public Health at the Uniformed Services University of the Health Sciences in
Bethesda, Maryland. This paper summarizes the findings from the survey,
as well as implications for emergency preparedness education in healthcare
management programs.

Literature review
Research about emergency preparedness educational programs and curricu-
lum in healthcare disciplines has remained limited in scope, and focused on
clinical or public health initiatives. Academic preparation of clinicians has
seemingly advanced commensurate with practice readiness and the impact
of events after Sept. 11, 2001, particularly in the area of nursing education
 Emergency management education in healthcare education programs 87

(American Association of College of Nursing, 2008; Austin, Hannafin, & Nel-

son, 2013; Bernardo, Beach, Mitchell, & Zoldos, 2006; Strong & Sullivan, 2006;
University of Virginia School of Medicine, 2013; Danita et al., 2015). In 2002,
an organization of 50 Geriatric Education Centers formed the Bioterrorism and
Emergency Preparedness in Aging (BTEPA) Committee which collaboratively
developed, disseminated, and evaluated curricula and training activities for
healthcare providers of frail elders to allow them to respond quickly and
effectively in the event of bioterrorism or other emergencies (Johnson et al.,
2006). A set of core competencies for education and practice of disaster medi-
cine and public health were identified in 2012 by an interdisciplinary group
of experts representing clinical medicine, public health, adult education, and
emergency management (Walsh et al., 2012). The increased magnitude and
incidence of large-scale mass-casualty incidents also triggered awareness of
the need for emergency preparedness education in the realm of public health
administration (Rottman, Shoaf, & Stratton, 2010). However, little is known
about healthcare administrator emergency management education. Only
one study by Houser and Houser (2006) has assessed the extent to which
university healthcare administration programs offered coursework to prepare
leaders for management of emergencies and disasters. They found that, prior
to 9/11, only one university program offered any didactic disaster manage-
ment training, and that only 31% (n=18) of the 59 Association of University
Programs in Health Administration (AUPHA) programs (14 graduate and 4
undergraduate) that were respondents in their survey offered any emergency
management coursework.
In order to understand these trends, it is also useful to review emergency
preparedness pedagogical activities and trends through Downs (1972) eco-
logically based issue attention cycle, which has been used to predict disaster
threat agenda behaviors (among other social phenomena) by planners, re-
searchers, educators, and other actors who are defensively motivated by the
threat or impact of a large-scale crisis (Nelson et al., 2013). The model theo-
rizes that major national catastrophes trigger issue attention by multi-level,
multi-jurisdictional, private- and public-sector actors who mobilize to reduce
risk. The framework predicts that action or policy attention unfolds in a five
phase cycle: (a) pre-problem phase (apathy or non-awareness); (b) alarmed
discovery phase (widespread euphoric or shocked threat reaction); (c) grow-
ing awareness phase (questioning the costs and feasibility of the priority); (d)
decline of intensity phase (interest diminishes) and (e) the post-problem phase
(return to apathy, although at a higher level of institutional awareness than
the pre-problem phase) (Peterson, 2009). This has been used as an analytical
framework to begin to assess and predict regulatory and advocacy-oriented
88 The Journal of Health Administration Education Winter 2017

programmatic disaster planning and training priorities (Nelson et al., 2013),

and public opinion trends about terrorism threat salience (Peterson, 2009). The
model is helpful in understanding that, prior to 9/11 and events such as Hur-
ricane Katrina, disaster threats were non-focused, constituting scenarios such
as predictable weather events and seasonal flu epidemics. After 9/11, events
moved to the second or alarmed discovery phase which sharply expanded
emergency risk management nationally, as well as hospital disaster precau-
tions (Bellavita, 2005; ECRI Institute, 2012; Sylves, 2008). In response, five
healthcare management programs increased their disaster risk management
education, followed by the 2005 AUPHA/ACHE Congress focus on disaster
preparedness (Houser & Houser, 2006). It is almost certain that the Katrina
crisis spurred ACHE’s first policy statement on emergency preparedness in
November of 2006, followed by the advent of Hurricane Sandy, another focus-
ing event that pushed ACHE policy statement revisions in November 2013
and again in August of 2014 (Fink, 2014).
In the vein of Houser and Houser (2006), this study also probed the extent,
if any, that health administration curricula responded to nearly 10 years of
tougher regulations, enduring issue attention, and new, post-Hurricane Sandy
policy action and funding (AHA News, 2013; FEMA, 2011; Rogers, 2013). The
survey was further adapted to assess the nature of public health emergency
preparedness competencies as defined by Walsh et al. (2012) as many health-
care management programs reside in colleges or schools of health or public
health.

Methods
The purpose of this study was to obtain information from directors of health-
care administration programs and long-term care administration programs
concerning healthcare emergency preparedness course content. Houser and
Houser’s (2006) assessment of academic health administration programs’ cov-
erage of bioterrorism and mass-casualty management framed our adoption
of a cross-sectional survey design chosen for its economic construction and
for rapid data collection. The survey instrument contained 29 questions (24
quantitative and 5 qualitative items) that collected information on program
directors’ assessment of the importance of emergency preparedness educa-
tion; coverage of public health emergency preparedness competencies (as
defined by research from the Center for Disaster Medicine and Public Health
at the Uniformed Services University of the Health Sciences in Bethesda, MD)
in healthcare administration course content; and faculty training in emer-
gency preparedness course content in healthcare management programs.
The inquiry also solicited characteristics of current emergency preparedness
 Emergency management education in healthcare education programs 89

course content and training, and the rationale for not having course content
if applicable. Responses were solicited in multiple ways to maximize the
response rate by distributing the questionnaire both electronically and by
mail in two phases. First, an electronic cover letter and link to the survey was
sent to a convenience sample of 82 AUPHA undergraduate member program
directors and 126 graduate program directors, as well as the directors of 11
undergraduate and graduate programs (total n = 219). One month later, an
email follow-up request was sent to the target population. The second phase
included a hard-copy follow-up cover letter and survey sent via mail to pro-
grams in geographical areas with low responses to the electronic process. A
total of 61 program directors responded representing an overall response rate
of 34%. However, not all respondents answered all questions in the survey.
It is pertinent to note that these 61 respondents administered 74 programs.
These 74 programs are the units of analysis for this study. Survey respondents
included 31 undergraduate programs (42% of responding programs) and
36 graduate programs (48% of responding programs) as well as 7 programs
with undergraduate and graduate programs (9% of responding programs).
In addition, 13 of the 61 directors were responsible for both undergraduate
and graduate programs (23%).

Findings
Emergency preparedness importance and coverage
Program characteristics show nearly two-thirds of respondents located in urban
areas, with 62% of programs in public health settings and 77% of programs
with AUPHA certification or CAHME accreditation (Table 1). Program loca-
tion of respondents by FEMA region showed a relatively even distribution of
respondents, with a slightly higher number of respondents in the Northeast.
Given that the field of public health and disaster medicine has identified
emergency preparedness core competencies (Walsh et al., 2012), and that a
majority of respondent programs tend to be located in public health programs,
responses to the question of importance of emergency preparedness train-
ing as well as the extent of emergency preparedness course content should
demonstrate interest in this topical area (see Table 2). Of those responding,
39 (72%) felt that Emergency Preparedness (EP) was an important area of
managerial study. However, 15 PDs (28%) did not, including 11 of 36 gradu-
ate PDs (30%) and 4 of 31 undergraduate PDs (15%). However, the number
of program directors actually offering some type of emergency preparedness
instruction was evenly split, with 30 PDs reporting some sort of EP instruction
(including two who deemed such content unimportant), and 30 PDs reporting
90 The Journal of Health Administration Education Winter 2017

no EP instruction – although more than half of these (n = 15; 54%) thought

that such material would be valuable. The remaining person saw no value in
collegiate-level disaster education. The majority of responding programs (n
= 23 or 72%) offered lectures as the key vehicle for emergency preparedness
information dissemination, and the average number of hours of instruction
across all types of programs was three hours. These results are remarkably
similar to findings from Houser and Houser’s survey (2006) a decade earlier,
where three hours of instruction on emergency preparedness was the norm.

Table 1
Program Characteristics

Characteristics Subgroup n % of sample

Urban/Suburban Undergraduate 13 30%
Graduate 20 20%
Undergraduate/
11 24%
Graduate*
Rural Undergraduate 5 50%
Graduate 4 40%
Undergraduate/
1 10%
Graduate
Program setting
Public Health/Health/
Undergraduate 9 29%
Medicine
Graduate 13 42%
Undergraduate/
- -
Graduate*
Business Undergraduate 4 36%
Graduate 7 64%
Undergraduate/
- -
Graduate*
Arts/Sciences/
Undergraduate 4 50%
Professional Studies
Graduate 2 25%
Undergraduate/
2 25%
Graduate*
 Emergency management education in healthcare education programs 91

Table 1, cont.
Accredidation/
Subgroup n % of sample
certification
AUPHA Undergraduate 12 48%
Graduate 6 24%
Undergraduate/
7 28%
Graduate*
CAHME Undergraduate - -
Graduate 16 76%
Undergraduate/
5 24%
Graduate*
AACSB Undergraduate - -
Graduate 1 13%
Undergraduate/
7 87%
Graduate*
CEPH Undergraduate - -
Graduate 4 67%
Undergraduate/
2 33%
Graduate*
NOTE: *indicates program directors who manage both undergraduate and
graduatre programs.

Table 2

Importance and coverage

Response Subgroup n % of sample

Do you view Healthcare Emergency Preparedness as an impor-
tant content item for your healthcare administration program?
Yes Undergraduate 14 36%
Graduate 14 36%
Undergraduate/
11 28%
Graduate**
No Undergraduate 4 27%
Graduate 10 67%
Undergraduate/
1 6%
Graduate**
92 The Journal of Health Administration Education Winter 2017

Table 2, cont.
Response Subgroup n % of sample
Does your program offer course content/ community service
hours in healthcare emergency preparedness in your healthcare
management program?
Yes Undergraduate 8 30%
Graduate 10 37%
Undergraduate/
9 33%
Graduate**
No Undergraduate 10 39%
Graduate 14 54%
Undergraduate/
2 7%
Graduate**
What types of healthcare emergency preparedness course con-
tent do you offer?
Lectures Undergraduate 5 22%
Graduate 9 39%
Undergraduate/
9 39%
Graduate**
Specialized
Undergraduate 1 20%
courses
Graduate 1 20%
Undergraduate/
3 60%
Graduate**
Community Ser-
Undergraduate 2 50%
vices
Graduate 2 50%
Undergraduate/
- -
Graduate**
How many credit hours of educational instruction, fieldwork or
community service training in healthcare emergency prepared-
ness do you offer?*
Undergraduate 3
Graduate 3
Undergraduate/
3
Graduate**
NOTES: *most frequent response; **indicates program directors who
manage both undergraduate and graduate programs.
 Emergency management education in healthcare education programs 93

Emergency preparedness coverage patterns

Of the 30 PDs offering EP instruction, 25 (78%) reported that disaster mitiga-
tion material was infused into pre-existing courses through lecture, or, in one
instance, via case study. Six of these programs also offered EP internships with
two additional PDs reporting internship opportunities as the sole means of
providing disaster education. Nine programs offered specialized EP courses,
six of which were in addition to augmenting existing curricular offerings. How-
ever, three of these specialized courses were the only EP education mode cited.
Six programs promoted EP community service in conjunction with covering
EP topics in other courses. Only one program offered a complete EP degree.

Emergency preparedness level of instruction

Of the 30 programs offering some sort of EP instruction, 16 (52%) added EP
content to undergraduate lectures while 6 provided emergency service-related
undergraduate internships (17%) (See Figure 1). Thirteen graduate programs
(45%) offered some disaster management course coverage, but only three gradu-
ate programs offered a health disaster-related internship experience (10%). In
all, 58 directors responded to the question about the most appropriate level of
instruction. A total of 43 (74%) pegged both graduate and undergraduate levels
as important (including, somewhat incongruously, 5 directors who didn’t see
EP content as important). Seven preferred graduate-level instruction (12%),
(including two who negated the value of EP education). Finally, two direc-
tors believed undergraduate instruction to be the only important venue (3%).

Figure 1

Level of instruction offered in healthcare emergency preparedness

94 The Journal of Health Administration Education Winter 2017

Curricular content
In all, 32 respondents addressed areas of course content derived from the
public health emergency preparedness core competencies identified by the
Center for Disaster Medicine and Public Health (Table 3). The four top content
areas were paying greater attention to organizational and community response
plans (n=24, 81%); administrator disaster roles (n=21,72%); the need for effec-
tive partner communication (n=19, 66%); and continuity of operations plans
(COOP), (n=17, 60%). Ten other subjects received between 18 and 12 responses
(from 54% to 36%), affirming instruction in the following areas: disaster public
health issues; disaster situational awareness (e.g. local vulnerabilities); legal
and ethical issues; knowledge of surge capacity resources; clinical practice
knowledge for diverse populations; and knowledge of short- and long-term
recovery needs and principles. Incorporating administrative preparedness
competencies appears to be the focus of responding program directors in
this study, as opposed to more clinically-based public health competencies
in emergency preparedness.

Table 3
Emergency preparedness coverage patterns - course content

Characteristics Subgroup n % of sample

Organizational and community response plans
Undergraduate 4 17%
Graduate 11 46%
Undergraduate/
9 35%
Graduate*
Knowledge of one’s expected role(s) in organizational and com-
munity response plans activated during a disaster or public health
emergency
Undergraudate 6 39%
Graduate 8 38%
Undergraduate/
7 33%
Graduate*
Effective communication with others in a disaster or public health
emergency
Undergraduate 4 21%
Graduate 7 37%
Undergraduate/
8 43%
Graduate*
 Emergency management education in healthcare education programs 95

Table 3, cont.
Characteristics Subgroup n % of sample
Continuity of operations in disaster or public health emergency
Undergraudate 2 12%
Graduate 6 35%
Undergraduate/
9 53%
Graduate*
Knowledge of public health principles and practices for manage-
ment of all ages and populations affected by disaster or public
health emergency
Undergraduate 4 25%
Graduate 5 31%
Undergraduate/
7 44%
Graduate*
NOTE: *indicates program directors who manage both undergraduate and
graduatre programs.

Reasons for teaching or not teaching emergency preparedness

All 30 PDs who offered some EP instruction responded to the question of why
they offered disaster management education (Table 4). Of these, 27 directors
responded that faculty thought it was important (93%). This was distantly
followed by “incidents in the area” (n=11, 38%) and having trained faculty (n =
10, 38%). Regarding the latter point, 23 PDs reported having full- or part-time
faculty trained in EP (43% of the 53 who answered this question), compared
to 25 who had no such trained faculty (n = 53, 47%). Five PDs weren’t sure
of their faculty’s training in this area (9%). Seven PDs offered EP education
because area health providers desired it (22%); or due to ongoing collabora-
tion with other campus EP programs (n = 5, 16%); or because area emergency
service agencies wanted it (n = 4, 13%).
96 The Journal of Health Administration Education Winter 2017

Table 4
Emergency preparedness course content rationale
Response Subgroup n % of sample
Why do you offer healthcare emergency preparedness content/ training?
Undergraduate 6 22%
Faculty thought it Graduate 10 37%
was important Undergraduate/
11 40%
Graduate*

Incidents in our Undergraduate 2 20%

geographical area Graduate 5 30%
created interest in Undergraduate/
this coursework 4 5%
Graduate*
Undergraduate 2 20%
We have trained faculty to Graduate 3 30%
offer this coursework Undergraduate/
5 50%
Graduate*
What are the reasons why you do not offer emergency preparedness
course content?
Undergraduate 7 35%
Graduate 11 55%
Not enough resources
Undergraduate/
2 10%
Graduate*
Undergraduate 5 50%
No faculty trained to offer Graduate 4 40%
this coursework Undergraduate/
1 10%
Graduate*
Undergraduate 3 21%
Not necessary to offer this Graduate 11 78%
coursework Undergraduate/
3 38%
Graduate*
Undergraduate 4 44%
Not enough time to de- Graduate 5 57%
velop course/materials Undergraduate/
- -
Graduate*
Undergraduate 2 33%
Other organizations in
Graduate 4 67%
offer this coursework/
training to our students Undergraduate/
- -
Graduate*
NOTE: * program directors manage both undergraduate and graduate programs.
 Emergency management education in healthcare education programs 97

The top-ranked reasons (of 41 responses) for not offering disaster manage-
ment education were lack of resources (n = 20, 39%); content not applicable
(n = 14, 31%); lack of trained faculty (n = 10, 21%); and not enough time to
develop the curricula (n = 9, 34%). It appears that faculty interest, resource
availability, and training emerge as important components in the decision to
offer emergency preparedness training in healthcare administration programs.
Student demand did not emerge as an important EP course content driver. A
total of 42 PDs (of the 54 responding to this question) said they had no stu-
dents working in government organizations requesting such content (78%).
Ten PDs didn’t know (18%), and only two said that they had such students
(4%). When asked if they had students who were employees of healthcare
organizations who had requested this work, 40 PDs said no (74%), 8 weren’t
sure (15%), and only 6 said that they did (11%).
Accreditation and/or certification criteria did not drive EP training. In
all, 33 directors (of the 55 answering this question) said they had no such en-
dorsement obligation (60%). Surprisingly, 11 weren’t sure whether they did
or did not (20%). A total of 11 respondents cited the need for their graduates
to be in compliance with the Joint Commission emergency standards as the
impetus for providing training (21%), while 17 discounted this incentive (33%)
or felt that such standards did not apply (32%). Further, seven admitted to
not knowing if the Commission mandated EP quality standards (13%).
Five programs (9%) taught EP material because of state health facility
licensing requirements, although 25 respondents (47%) said that these were
not important and another 16 (30%) said such standards were not applicable.
Seven respondents (13%) didn’t know if state healthcare licensing requirements
imposed emergency standards. Only two program directors cited student
demand as an important driver of health disaster readiness education.

Discussion
Our study assessed the scope of healthcare management studies designed
to introduce aspiring healthcare managers to the nature and scope of their
emergency preparedness roles, and how these fit into the whole-community
approach to health infrastructure resilience. Our findings suggest wrinkles
in this fabric.
Our research did not expressly analyze (longitudinally) any unfolding
or growth in the nature or extent of disaster management education since
Houser and Houser’s (2006) study. Nevertheless, this research suggests that
Houser and Houser’s hope that “minimum curricular requirements, content
and mechanisms for inclusion” (p. 169) would be shortly developed failed to
materialize in any major way. Instead, our findings surprisingly (if tentatively)
98 The Journal of Health Administration Education Winter 2017

suggest relative developmental stasis, or limited growth in content coverage

at best. Only 30 programs in our study offered such training. These results
were unexpected given the increase of specific disaster management academic
programs, increased college and university disaster plans, emergency response
training, and information (Sullivan, 2011). It seems almost implausible that
coursework coverage has stagnated despite greatly increased policy and public
health attention (ECRI Institute, Health Risk Control), including persuasive
calls for even tighter health facility standards (AHA News, 2013; FEMA, 2011;
Fink, 2014; Rogers, 2014; Schneider, 2012) and updated policy statements by
the American College of Healthcare Executives about the “vitally important”
(ACHE, 2014, p. 90) need for healthcare leaders to engage as full partners in the
whole-community approach to disaster threat mitigation in the pre-incident,
acute impact, and short- and long-term recovery phases of threat reduction.
Our findings show that a majority of responding healthcare management
program directors see emergency preparedness as an important topic (70%)
with 30 programs offering some sort of didactic material. This may suggest
some increase in curricular offerings since 2004. It might be interpreted that
we are still in – or perhaps the tail end – of the alarmed discovery stage for
emergency planners and related actors nationally, although this is entirely
speculative. Certainly, nothing suggests that the nation is deep into Down’s
(1972) third “growing awareness” stage, where preparedness activities are
dampened by planners’ perceptions that disaster management is too complex,
too taxing, politically unpopular, or that effective disaster risk management is
unrealistic or is even an overreaching goal (Petersen, 2009). Much experience
and evidence shows that social interest in healthcare disaster readiness is ro-
bust (Funk, 2014). It is also self-evident that the nation is not in Down’s fifth
phase, the post-problem stage, where health disaster preparedness is widely
deemed irrelevant and marked by stakeholder indifference. (Bellavita, 2005;
Petersen, 2009; Sylves, 2008).
The limited expansion of collegiate emergency preparedness course content
in health administration programs suggested in our study raises the question
of whether healthcare management emergency preparedness education is out
of synch with the urgent demand by national disaster planners that closer
attention be paid to emergency preparedness preparation. If our findings do
not suggest apathy on the part of healthcare management program directors, it
does seem to suggest at best, interest that is only of a low intensity. Consider,
for example, how just under half (n = 19, 30%) of the responses in our survey
cited the reason for not offering EP education was because the subject was
“not applicable” or “unnecessary.”
 Emergency management education in healthcare education programs 99

These views should be probed in future research. Do these directors

deem emergency preparedness risk management coursework inherently un-
important? Seventeen of the 61 respondents to this question said it wasn’t,
but perhaps they believe that disaster knowledge will be learned on the job,
or will be handled by subordinate facility disaster specialists. Six respondents
suppose that outside organizations will offer their health care administration
students sufficient coursework and extra-curricular education. It is true that
such training is widely available in multiple venues, in various online and
brick-and-mortar formats, and under multiple governmental auspices at the
local, state, regional and national levels.
Some program directors may simply be unaware of the healthcare man-
ager’s disaster responsibilities due to limited education or resources in this
area. Eleven directors seemed unfamiliar with their own program accreditation
/certification requirements in this area and seven respondents weren’t sure
about Joint Commission implications. Certainly, subject engagement continues
to be dampened by poor resources, lack of faculty training, and insufficient
time for competing curricular priorities. For example, the implications of the
Affordable Care Act are among many other fast-paced changes that mark
healthcare planning, policy, and administration.

Study limitations
Findings from the study are limited due to small sample size, survey response
rate, lack of follow-up interviews, and limited information from the survey’s
qualitative responses. More information on program director characteristics and
experience with disasters, as well as the existence of emergency preparedness
certificate program outside the regular curriculum, could have been probed.

Conclusions and recommendations

Our findings suggest little to no change in the scope and focus of healthcare
emergency management collegiate education, which strongly echoes Houser
and Houser’s (2006) findings from a decade earlier. The new national disaster
mentality “reality” (p.177) that Houser and Houser correctly heralded has
simply not driven healthcare management curricular augmentation, nor did
the Joint Commission’s post-Katrina actions spur a sharp increase academic
engagement. There are still no widely accepted standards or national recom-
mendations for even a modest baseline of introductory healthcare manage-
ment disaster education content as even a small part of a preexisting course.
In addition, while licensure requirements for long-term care administrators
would seem to push emergency preparedness training in these programs,
100 The Journal of Health Administration Education Winter 2017

the majority of programs in this area saw the importance of the topic but did
not commit resources for course content or training. There will likely be no
substantive progress on integration of emergency preparedness competencies
into health administration programs unless accreditation and certification
competencies for health care administration and other related programs are
changed to lead the way in this effort. Growth in certificate and training pro-
grams outside healthcare management programs for mid-career practitioners
may also address this need. However, the ongoing incidence of man-made
and natural disasters affecting healthcare organizations throughout the US
may spur greater attention in this area of healthcare management education.
Availability of training resources for program directors and faculty may change
this situation, as well as a growing awareness among healthcare organiza-
tions of the importance of emergency drills and exercises demonstrating the
importance of the whole-community approach to preparedness.

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