Business Continuity Planning

Tamiza Teja, MPH, CPH

LAC EM Consultant, CAHF

COO, Mozaik Solutions

BUSINESS CONTINUITY PLAN

BIG PICTURE PURPOSE

To ensure the continuity of providing care to our patients

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OBJECTIVES

Facilitate immediate, accurate, and measured service continuity activities after emergency conditions are stabilized

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Reduce the time it takes to make critical decisions that personnel will need to make when a disaster occurs

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Minimize the incident’s effect on daily operations by ensuring a smooth transition from emergency response operations back to normal operations

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Expedite restoration of normal services

BUSINESS CONTINUITY�PLANNING PROCESS

• Create a business continuity planning team
• Conduct a Business Impact Analysis (BIA) and Business Process Analysis (BPA)
• Determine the Continuity Plan
• For each department
• Then facility-wide
• Conduct Trainings and Exercises
• Use past incidents and your response solutions as the basis for content of a BCP/COOP, for example…
• Power outages, IT outages, flooding and relocation, fires

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

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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

BCP TEMPLATES FROM EMS

LA COUNTY HEALTHCARE COALITION WEBSITE

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

• 2023 BCP Seminar Slides and Video
• Department-Specific Sample Plans - LOTS!!
• 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

BCP ACTIVATION

The BCP is activated after

emergency conditions are stabilized

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

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

ENSURING DEPARTMENT�LEADERSHIP

Working in the template…

Department Description

Clinical Template w/Instructions

Page 10

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

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

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Clinical Template w/Instructions

Page 13

CHOOSE A DEPARTMENT

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• Identify at least 2 positions for Orders of Succession
• Clinical departments – be sure to identify both Business and Clinical Succession

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• Identify 3 specific purposes or duties to Delegate Authority

Template: Page 5

ENSURING DEPARTMENT�LEADERSHIP: ACTIVITY

Clinical Template w/Instructions

Page 11 & 13

MISSION-ESSENTIAL SERVICES

ACTIVITIES THAT CANNOT BE DEFERRED DURING AN EMERGENCY

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

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

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

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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

MISSION-ESSENTIAL SERVICES ASSESSMENT

RECOVERY TIME OBJECTIVE (RTO)

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

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MAXIMUM TOLERABLE DOWNTIME (MTD)

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

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RECOVERY POINT OBJECTIVE (RPO)

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

Clinical Template w/Instructions

Page 15

MISSION-ESSENTIAL SERVICES ASSESSMENT: TIERS

Clinical Template w/Instructions

Page 15

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

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

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Clinical Template w/Instructions

Page 18

STAFFING: ACTIVITY

FOR YOUR CHOSEN DEPARTMENT

• Identify your usual staffing levels
• Identify staffing levels needed during a crisis

Clinical Template w/Instructions

Page 18

INTERDEPENDENCIES – �FROM OTHERS

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

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• 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?

INTERDEPENDENCIES –�TO OTHERS

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

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• 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

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

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Clinical Template w/Instructions

Page 23

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

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Clinical Template w/Instructions

Page 25

MISSION-ESSENTIAL IT�APPLICATIONS

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DOWNTIME PROCEDURES

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

Clinical Template w/Instructions

Page 26

MISSION-ESSENTIAL �VITAL RECORDS

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

Clinical Template w/Instructions

Page 28

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

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

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• 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

RELOCATION TO CONTINUITY�FACILITIES: Activity

• What are the Requirements of a Continuity Facility location to ensure the department can continue its services? Be as detailed as possible.
• Are there Continuity Facilities that have already been identified for your department?

Clinical Template w/Instructions

Page 31

RELOCATION TO CONTINUITY�FACILITIES CHECKLIST

Clinical Template w/Instructions

Page 31

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

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Specific staff may remain to return the facility to operational status

Clinical Template w/Instructions

Page 31

RECONSTITUTION

RECOVERY AND RESUMPTION OF SERVICES

Four key phases of reconstitution

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• 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

Clinical Template w/Instructions

Page 33

RECONSTITUTION

Clinical Template w/Instructions

Page 33

APPENDIX A:�PLAN UPDATE SCHEDULE

BCP/COOP 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/COOP training or exercise
• Annual review

Clinical Template w/Instructions

Page 34

APPENDIX B:�BCP TRAINING/EXERCISE

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

Clinical Template w/Instructions

Page 35

BCP RESOURCES FROM EMS

LA COUNTY HEALTHCARE COALITION WEBSITE

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

• 2023 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

EMS Agency contact: Darren Verrette

(562) 378-2451, dverrette@dhs.lacounty.gov

USING TEMPLATE & SAMPLES

PERSONALIZE FOR YOUR FACILITY

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

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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

MORE RESOURCES

CALIFORNIA HOSPITAL ASSOCIATION (CHA): templates and more

• https://www.calhospitalprepare.org/continuity-planning

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CALIFORNIA ASSOCIATION OF HEALTH FACILITIES (CAHF): template and more

• https://www.cahfdisasterprep.com/bcoop

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NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC):�manual and fill in PDF

• https://www.nachc.org/wp-content/uploads/2020/11/Business-Continuity-Manual_Interactive-1.pdf

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How to Perform a Business Impact Analysis

Presented by:

Brenda Smith, MPH, CHEP

Program Manager II EOC/EM

Northeast Valley Health Corporation

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Introduction

• 15 Health Centers and 1 Mobile Health Center
• Services include:
• Adult Medicine
• Pediatrics
• Dental
• Women’s Health
• Behavioral Health
• 9 WIC Facilities
• 4 Administrative Offices
• 2 Corporate
• Warehouse
• WIC Administrative Offices

Business Impact Analysis – Intro

What is a Business Impact Analysis?

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• An analysis/ assessment that predicts the consequences of disruption of a business function and process and gathers information needed to develop recovery strategies.

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• Source: https://www.ready.gov/business-impact-analysis

Main impacts: staffing shortages & supply shortages

Limiting exposure and improve infection prevention strategies

Essential servi

Identify Essential Functions

• Bring together key stakeholders to identify essential functions
• Department Managers/ Supervisors
• Executives
• Program Managers

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• Meet with them one on one

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• Prior to meeting with them instruct them to have a list of essential functions for their department/program

Main impacts: staffing shortages & supply shortages

Limiting exposure and improve infection prevention strategies

Essential servi

Essential Functions Continued

Sample Essential Functions

Activity Time-Identification of Essential Departmental Function (5 minutes)

Prioritization of Essential Functions

• Once you have identified all essential functions in each department you need to prioritize.

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• Recovery Time Objective (RTO) – The maximum amount of downtime that is allowable for a critical process before the impact becomes severe enough to drastically hinder patient safety and/or stop the continuation of business services.

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• Recovery Point Objective (RPO) – The point in time to which data must be restored after systems go down.

Main impacts: staffing shortages & supply shortages

Limiting exposure and improve infection prevention strategies

Essential servi

Activity Time- Business Impact Analysis Form

NEVHC – BIA

• Met with each department for 1-2 hours to discuss essential functions

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• Meetings included: Department Manager, COO, and Program Manager II EOC/ EM

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• Would involve Finance Department as needed

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• Developed an organizational list with all essential functions and is currently an annex to our BCP

Main impacts: staffing shortages & supply shortages

Limiting exposure and improve infection prevention strategies

Essential servi

2019 Saddleridge Wildfire

• The Saddleridge Fire broke out on 10/10/19 around 9:02 pm.
• The fire spread quickly overnight due to high winds and dry terrain.
• As a result of the fire the 210 freeway and 5 freeway were shut down.

2019 Saddleridge Wildfire Impacts

• The wildfire cut off main roadways to our facilities which affected both staff and patients.
• Operations continued and BCP was activated.
• Staff received an Everbridge message to report to their nearest facility.
• Continuous messages were sent to staff to keep them updated.
• Site Admins were notifying Corporate ICS of any immediate needs.
• Services that were not essential and not staffed were cancelled/rescheduled.

COVID-19

• Main impacts: staffing shortages & supply shortages
• Limiting exposure and improve infection prevention strategies
• Essential services were continued and staffed
• Non-essential services were cancelled/rescheduled
• Limited PPE- used decontamination services to reuse PPE
• Reached out to non-traditional vendors because allocations
• Remote work options
• Remote services for patients/clients

Lessons Learned

• Understand the difference between EOP and BCP
• Find a template that works for your site
• Make sure to meet with all departments but before meeting them have them create a list of essential functions
• Drill and test!

Main impacts: staffing shortages & supply shortages

Limiting exposure and improve infection prevention strategies

Essential servi

Business Continuity Planning

Tamiza Teja, MPH, CPH

LAC EM Consultant, CAHF

COO, Mozaik Solutions

tamiza@mozaiksolutions.com

c: 310-561-6501

Brenda Smith, MPH, CHEP

Clinic Administrator I – Special Projects

SCV Dental & Wellness Center

brendasmith@nevhc.org

o: (661) 673-8888 ext. 51330

c: (818) 441-6388