BMC Public Health Study protocol Public health preparedness in Alberta: a systems-level study Douglas Moore*1,4, Alan Shiell1,2, Tom Noseworthy1,2, Margaret Russell2 and Gerald Predy3 BioMed Central Open Access Address: 1Centre for Health & Policy Studies, Dept. of Community Health Sciences, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada, 2Dept. of Community Health Sciences, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada, 3Capital Health Region, University of Alberta, Edmonton, AB, Canada and 43875 St. Urbain, Bureau 3-02, Montreal, QC H2W 1V1, Canada Email: Douglas Moore* - spencer.moore@umontreal.ca; Alan Shiell - ashiell@ucalgary.ca; Tom Noseworthy - tnosewor@ucalgary.ca; Margaret Russell - mlrussel@ucalgary.ca; Gerald Predy - gpredy@cha.ab.ca * Corresponding author Published: 28 December 2006 BMC Public Health 2006, 6:313 doi:10.1186/1471-2458-6-313 This article is available from: http://www.biomedcentral.com/1471-2458/6/313 Received: 18 October 2006 Accepted: 28 December 2006 © 2006 Moore et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Recent international and national events have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. This article describes the study design and methods being used to conduct a systems-level analysis of public health preparedness in the province of Alberta, Canada. The project is being funded under the Health Research Fund, Alberta Heritage Foundation for Medical Research. Methods/Design: We use an embedded, multiple-case study design, integrating qualitative and quantitative methods to measure empirically the degree of inter-organizational coordination existing among public health agencies in Alberta, Canada. We situate our measures of inter- organizational network ties within a systems-level framework to assess the relative influence of inter-organizational ties, individual organizational attributes, and institutional environmental features on public health preparedness. The relative contribution of each component is examined for two potential public health threats: pandemic influenza and West Nile virus. Discussion: The organizational dimensions of public health preparedness depend on a complex mix of individual organizational characteristics, inter-agency relationships, and institutional environmental factors. Our study is designed to discriminate among these different system components and assess the independent influence of each on the other, as well as the overall level of public health preparedness in Alberta. While all agree that competent organizations and functioning networks are important components of public health preparedness, this study is one of the first to use formal network analysis to study the role of inter-agency networks in the development of prepared public health systems. Background International and national events have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of con- temporary public health threats. Whether those threats result from emerging infectious diseases or bioterrorism, the public health system is responsible for protecting the health of the population. Outbreak response occurs first Page 1 of 5 (page number not for citation purposes)