1 of 32

BUSINESS CONTINUITY PLANNING�Process, Key Concepts & Resources

Tamiza Teja, MPH, CPH

EM Consultant

CAHF

TZTconsulting

2 of 32

BCP RESOURCES FROM EMS

  • Past BCP Seminar Slides and Video
  • Department-Specific Sample Plans – LOTS!
  • BCP Templates and BCP Templates with Embedded Instructions
    • Clinical Department
    • Non-Clinical Department
    • Facility-wide

LA COUNTY HEALTHCARE COALITION WEBSITE

https://www.lacountyhcc.org/�business-continuity-planning-bcp

EMS Agency Contact

Darren Verrette

dverrette@dhs.lacounty.gov

3 of 32

MORE RESOURCES

CALIFORNIA HOSPITAL ASSOCIATION (CHA)

https://calhospital.org/calhospitalprepare/cha-tools-checklists/

Templates, checklists, and more, e.g., Hospital Continuity Program Checklist, Hospital Demobilization and Recovery Checklist, Hospital Repopulation After Evacuation Guidelines and Checklist

CALIFORNIA ASSOCIATION OF HEALTH FACILITIES (CAHF)

https://www.cahfdisasterprep.com/bcoop

Template, SNF webinar, and more

NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC)�https://www.nachc.org/wp-content/uploads/2020/11/Business-Continuity-Manual_Interactive-1.pdf

4 of 32

BCP TEMPLATES FROM EMS

BCP Templates and BCP Templates with Embedded Instructions

The Template with Embedded Instructions is an exact copy of the Template with the addition of instructions, tips, and information. You may use Template with Embedded Instructions as guidance only or use it as your actual BCP

​

    • Clinical Department
    • Non-Clinical Department
    • Facility-wide

5 of 32

USING TEMPLATE & SAMPLES

PERSONALIZE FOR YOUR FACILITY

  • Comprehensive template but designed to be personalized to your facility
  • Delete information not relevant to your facility

USE YOUR OWN DATA

  • Template includes sample assessments / data
  • Details provide examples of the type of information that should be included �in the tables and lists
  • As you complete the BCP, update �these details with the results of your BIA, BPA, and other assessments

6 of 32

BUSINESS CONTINUITY PLAN

    • To ensure the continuity of providing care to our patients

BIG PICTURE PURPOSE

    • Facilitate immediate, accurate, and measured service continuity activities after emergency conditions are stabilized
    • Reduce the time it takes to make critical decisions that personnel will need to make when a disaster occurs
    • Minimize the incident’s effect on daily operations by ensuring a smooth transition from emergency response operations back to normal operations
    • Expedite restoration of normal services

OBJECTIVES

7 of 32

BUSINESS CONTINUITY�PLANNING PROCESS

Create a Business Continuity Planning Team

Conduct a Business Impact Analysis (BIA) and Business Process Analysis (BPA)

Create & Update Continuity Plans: Dept, then Facility-Wide

Conduct Trainings and Exercises

Use HVA and past incidents / your response solutions as the basis for content of a BCP/COOP

Power outages, IT outages, flooding and relocation, fires

8 of 32

CONDUCT BIA AND BPA

BUSINESS IMPACT ANALYSIS – BIA

Identify essential services

  • Identify impacts if these essential services are interrupted
  • Determine the priority to bring these services back to full operational status

​

BUSINESS PROCESS ANALYSIS – BPA

Understand how these essential services and functions are performed by identifying their interdependencies and needed resources (staffing, supplies, facilities) to perform essential services

9 of 32

BCP ACTIVATION

The BCP is activated after

emergency conditions are stabilized

Disaster

Immediate Response

Activate EOP

Continuity Activation

Continuity Operations

Reconstitution

Short Term Recovery

​

Long Term Recovery

If you are not able to continue services as usual, use the details of the BCP/COOP to be able to resume services in a different location�and/or with different resources

Clinical Template w/Instructions

Page 9

10 of 32

INITIAL ACTIONS CHECKLIST

  • Notify employees of BCP/COOP activation
  • Document status of major equipment and critical supplies
  • Evaluate and document immediate staffing levels
  • Determine how long you can operate in current state
  • Assess need to close down department and/or relocate services
  • Communicate status, including resource needs, closure requirements, and staffing shortages to the Command Center
  • Communicate need to close down department and/or relocate services to the Command Center
  • Evaluate ongoing staff needs based on existing and predicted levels of human resources available
  • Implement alternative staff resource options, including contractor staffing options that may supplement staffing needs

Clinical Template w/Instructions

Page 10

11 of 32

ENSURING DEPARTMENT�LEADERSHIP

Working in the template…

Department Description

Clinical Template w/Instructions�Page 10

12 of 32

ENSURING DEPARTMENT�LEADERSHIP: ORDERS OF SUCCESSION

For key positions - the designation enables the successor to serve in the same position as the principal in the event of that principal’s death, incapacity, or resignation

Clinical Template w/Instructions

Page 11

13 of 32

ENSURING DEPARTMENT LEADERSHIP: ��DELEGATIONS OF AUTHORITY

Provide successors the authority to act on behalf of a department for specific purposes, and to carry out specific duties

  • Takes effect when normal channels of direction are disrupted and terminate when these channels are reestablished

Clinical Template w/Instructions

Page 13

14 of 32

MISSION-ESSENTIAL SERVICES

ACTIVITIES THAT CANNOT BE DEFERRED DURING AN EMERGENCY

These activities must be performed continuously or resumed quickly following a disruption

​

Any function which does not need to be performed for 3 days is not considered essential

​

THE REASON THE ORGANIZATION DEFERS ACTIVITIES UNTIL LATER IS TO FREE UP RESOURCES TO ALLOW IT TO FOCUS ON THOSE ACTIVITIES THAT CANNOT BE DEFERRED

​

It is just as important to identify non-essential functions (which can be deferred) as it is to identify essential functions (which cannot be deferred)

​

Clinical Template w/Instructions

Page 15

15 of 32

MISSION-ESSENTIAL SERVICES ASSESSMENT

Clinical Template w/Instructions

Page 15

The length of time (in hours or days) of how long a function or service can be down … how soon do you need this service up and running

RECOVERY TIME OBJECTIVE (RTO)

The maximum length of time (in hours or days) that the service or function can be discontinued without causing irreparable harm to people (staff, patients, visitors) or operations

MAXIMUM TOLERABLE DOWNTIME (MTD)

Time-based measurement of the maximum amount of data loss that is tolerable to an organization

RECOVERY POINT OBJECTIVE (RPO)

16 of 32

MISSION-ESSENTIAL SERVICES ASSESSMENT:

TIERS

Tier 0 = Immediate

Tier 1 = 4 hours or less

Tier 2 = 12 hours or less

Tier 3 = 3 days or less

Tier 4 = 3 days or more

Clinical Template w/Instructions

Page 15

17 of 32

STAFFING

If it becomes necessary to relocate services to another location, this list can be used as a starting point to ensure staffing resources and functions are complete

​

Position Title

Essential �Service / Function

FTEs required during normal conditions

Minimum FTEs required during crisis

FTE who may be available for re-assignment

Manager

Administration

1

1

0

Assistant Manager

Administration

1

1

1

Admin Assistant

Administration

1

1

0

Charge Nurse

Patient Care

2

1

1

Senior RN

Patient Care

6

5

1

Staff RN

Patient Care

2

0

2

LVN

Patient Care

6

3

3

Resident/Fellow

Patient Care

2

0

2

Student

Clerical support

2

0

2

Volunteer

Clerical support

2

0

2

​

​

​

​

​

​

​

​

​

​

Clinical Template w/Instructions

Page 18

18 of 32

INTERDEPENDENCIES – �FROM OTHERS

In order for your department to perform its mission-essential services and functions, who do you rely on?

​

    • Internal: What and who do you rely on from within the hospital?

Clinical Template w/Instructions

Page 20

    • External: What and who do you rely on that comes from outside of the hospital AND that your department has direct contact with to procure these services?

19 of 32

INTERDEPENDENCIES –�TO OTHERS

In order for other departments in the facility to perform their mission-essential services and functions:

​

  • How do they rely�on you?
  • What service or�function do you do �that others rely on �you still being able �to do?

Clinical Template w/Instructions

Page 23

20 of 32

MISSION-ESSENTIAL EQUIPMENT�AND SUPPLIES

  • If it becomes necessary to relocate services to another location or facility, this list can be used as a starting point to ensure resources will be available
  • Be as specific as possible so that the Command Center can get you the resources that you need
  • Be sure to revisit this section when you do your regular BCP updates

​

​

Clinical Template w/Instructions

Page 23

21 of 32

VENDORS AND RESOURCES�CONTACT LIST

Identify vendors that are relied upon for interdependent services

    • If you do not directly contact or do not know your external vendors and resources, you may not need to complete the table, however you should indicate not applicable

​

​

Service

Company

Point of Contact

Emergency Phone Number

Emergency Contract in Place?

Maximum Tolerable Downtime

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

Clinical Template w/Instructions

Page 25

22 of 32

MISSION-ESSENTIAL �IT APPLICATIONS

DOWNTIME PROCEDURES

Clinical Template w/Instructions�Page 26

Recovery Time

Software Application

0-2 Hours

  • Ventilator alarms
  • Electronic medical records

2-12 Hours

  • Electronic pharmacy system
  • Lab information system
  • Nurse call system

12-72 Hours

  • Email
  • Payroll

Specifies the alternative processes that are to be activated to assure continuity of services

23 of 32

MISSION-ESSENTIAL VITAL RECORDS

Clinical Template w/Instructions

Page 28

Identification, protection, and ready availability of electronic and hardcopy documents, references, records, information systems, and data management software and equipment (including classified and other sensitive data) needed to support essential functions during emergency response, service continuity, and recovery

24 of 32

DEPARTMENT CLOSURE

  • If a primary department location is deemed to be inoperable or unsafe, the Department Manager (or designee, or successor) will
    • Initiate department closure procedures
    • Prepare for relocation to the alternate location which may provide full or limited operational capability
  • The decision to close and the activation of the alternate operating facility and relocation will be coordinated with the Command Center

Clinical Template w/Instructions

Page 30

25 of 32

CONTINUITY FACILITIES

Overall business continuity strategy is based upon using existing internal resources for continuity of services and operations impacted by a disruptive incident whenever possible

​

Primarily, this involves the relocation of departmental services to one of three alternates:

    • The designated department staff would relocate to an alternate location
    • Designated department staff may be assigned to other departments
    • Staff equipped to work at home may be assigned to continue to work at home

Clinical Template w/Instructions

Page 30

26 of 32

RELOCATION TO CONTINUITY�FACILITIES CHECKLIST

Clinical Template w/Instructions

Page 31

27 of 32

DEVOLUTION

Takes place when an organization’s primary and alternate facilities, staff, or both are unavailable and essential functions must be transferred to someone else at a different facility

​

    • Unable to provide patient care (to a single department up to the whole facility)
      • Sister facilities and community response partners to transport patients to another healthcare facility
      • Evacuation Plan

​

Specific staff may remain to return the facility to operational status

Clinical Template w/Instructions

Page 31

28 of 32

RECONSTITUTION

RECOVERY AND RESUMPTION OF SERVICES

Four key phases of reconstitution

​

​

​

    • Re-enter the physical space - ensure safety
    • Re-open the physical space - replenish supplies, equipment, and staff
    • Repatriation of patients, if a patient care area
    • Resumption of normal service delivery

Re-Enter

Re-Open

Repatriate

Resume

Clinical Template w/Instructions

Page 33

29 of 32

RECONSTITUTION

Clinical Template w/Instructions

Page 33

30 of 32

APPENDIX A: PLAN UPDATE SCHEDULE

BCP UPDATES MAY OCCUR WITH:

    • The addition of new employees or transferred employees
    • The relocation of employees, supply areas, other resources
    • Changes in downtime procedures
    • Changes in management or reporting structure
    • New computer systems
    • Changes in vendors
    • After an actual disaster/downtime occurs
    • Lessons learned from a BCP training or exercise
    • Annual review

Clinical Template w/Instructions

Page 34

31 of 32

APPENDIX B:�BCP TRAINING & EXERCISE

Trainings and exercises should occur prior to the required plan update in order for lessons learned to be reflected in the update

​

Clinical Template w/Instructions

Page 35

32 of 32

Questions, Thoughts, Comments?

Tamiza Teja, MPH, CPH

LA County EM Consultant for CAHF

TZTconsulting

tamiza@tztconsulting.net

c: 310-561-6501