BMC Public Health 2006, 6:313 http://www.biomedcentral.com/1471-2458/6/313 at the local or regional levels and thus the potential impact that a threat will have on the overall Canadian population can differ significantly depending on the capacity of public health systems to respond[1]. For exam- ple, following the SARS outbreak in Toronto, the Cana- dian National Advisory Committee (NAC) on SARS and Public Health held it as fortunate that the SARS outbreak struck primarily in Toronto and not in other parts of Can- ada where the capacity to combat public health threats is limited[2]. While a "general renewal of the public health infrastructure" and its capacity to respond are in order the effective coordination of all agencies at regional, provin- cial, and federal levels is necessary to assure a comprehen- sive surveillance and management of public health threats. As Ralph Klein, the Premier of Alberta, com- mented: "Albertans and all Canadians understand a dis- ease outbreak like SARS or West Nile virus in one region affects other parts of the country. Coordinated approaches will help deal with public health threats." Despite the commitment of federal and provincial agen- cies in Canada to improve public health system perform- ance and develop overall public health preparedness, little is still known about the current systems-level state of pub- lic health preparedness in Canada. While coordination is seen as a necessary element for public health prepared- ness, few measures of inter-organizational collaboration relevant to public health preparedness have been devel- oped and assessed in relation to other features of the organizational and inter-organizational environment. This study protocol presents the premises, conceptual model and methods used to measure and assess public health preparedness in Alberta, Canada. Although provin- cial public health agencies are themselves embedded within federal and global public health preparedness sys- tems, we focus primarily on the organizational environ- ment of public health preparedness in Alberta so as to develop contextually-relevant measures and evaluation techniques as well as address issues related to potential cross-Alberta variations in public health preparedness. In Alberta, public health and emergency response proce- dures are primarily governed under the Disaster Services Act [3] and the Public Health Act[4]. Provincial response to a public health disaster event may thus call into action organizations and units under the jurisdiction of local municipalities, regional health authorities, emergency management districts, and/or the provincial government. There are a number of organizational actors that may be involved in preparation, response, or recovery phases of a public health disaster, including departments or portfo- lios within agencies. Each of which are potential actors in the provincial public health and emergency response net- work. While we consider the overall public health and emergency management network to consist of all poten- tial organizational actors involved in responding to public health threats, the precise set of organizations that come together around a particular public health threat depends on the nature of that threat. For example, pandemic influ- enza and the West Nile virus are both emerging infectious diseases but the nature of their transmission differs and distinctive sets of organizational actors must be in place to confront them. In the case of West Nile Virus, Alberta's Department of the Environment and Sustainable Resource Development would be integrally involved for mosquito surveillance and control whereas it would not be as integral in the event of a pandemic influenza out- break[5]. To assess potential differences by public health threat in Alberta public health preparedness, we examine and compare two potential public health threats: pan- demic influenza and West Nile Virus. Methods/Design Conceptual model Using an embedded multiple-case study design[6] and integrated qualitative and quantitative methods, the project proposes to measure empirically the degree of seamless coordination existing among municipal, regional or district-level and provincial public health and emergency management agencies in Alberta. Although federal authorities and agencies play an important role in provincial-level responses to public health emergencies, for the purposes of this research, the focus will be on the inter-organizational linkages and organizational environ- ments of provincial and sub-provincial actors; relevant federal-level organizations will be identified for future investigation. The seamless coordination of activities and tasks that should characterize the overall federal-provin- cial-regional linkages should also characterize the intra- provincial linkages. Fluid communication and resource flows among such diverse organizations and administra- tive authorities require an integrated and coordinated net- work of actors. Our research is premised on empirical research that has shown that effective and coordinated approaches to public health threats require a well-inte- grated and responsive inter-organizational system and that the most appropriate method in which to analyze inter-organizational relations and the degree of integra- tion is one based on network analysis [7]. Yet, strong inter-organizational ties are not enough for effective pre- paredness if the organizations involved do not have the necessary individual capacity to respond to public health threats. In this regard, fluid communication and inte- grated organizational connections are but one element in an overall systems-level approach to assessing public health preparedness. As shown in Figure 1, we view public health preparedness to be a product of several interrelated factors: 1) individual organizational attributes, 2) the inter-organizational networks existing among relevant organizational actors, 3) the institutional environments Page 2 of 5 (page number not for citation purposes)