Business Continuity Plan Table Top Exercise (TTX) Participant Manual

Transcription

1 Business Continuity Plan Table Top Exercise (TTX) Participant Manual Rolling Blackout Determining Essential Functions Presented to CPCA CEPPN and COPN Conference February 5, 2015 Daniel Campbell CCM Emergency Preparedness Coordinator Community Health Partnership

2 PREFACE This Participant Manual is an unclassified exercise document and is intended FOR EXERCISE USE ONLY. Due to the nature of the information discussed, special considerations may be applicable for document access and storage. All exercise participants should use the appropriate guidelines to protect this material in accordance with their jurisdictional directives. HANDLING INSTRUCTIONS 1. The title of this document is the Business Continuity Plan TTX Participant Manual. 2. This Participant Manual is intended FOR EXERCISE USE ONLY. This document should be safeguarded, handled, transmitted, and stored in accordance with the appropriate security directives. 3. At a minimum, the attached materials should only be disseminated on a need-to-know basis to applicable partners. Table of Contents Preface... 1 Handling Instructions... 1 Exercise Agenda... 1 Introduction... 2 Essential Functions and Critical Processes... 4 Scenario:Blackout Hot Wash List of Acronyms..18 Exercise Agenda 1. Introduction: 2. Essential Functions and Critical Processes i. Identify Functions ii. Identify Essential Functions iii. Identify Critical Processes iv. Determine Essential Function Resource Requirements 3. Rolling Blackout Scenario: i. Pre Blackout ii. Post Blackout 4. Hot Wash Community Health Partnership 1

3 This TTX is composed of a workshop module and a TTX module. Each TTX module begins with a scenario update that summarizes the key events occurring within that time period. A series of general questions following the scenario summary will guide the facilitated discussion of critical issues in each of the modules. Introduction Exercise Objectives Exercise design objectives are focused on improving the understanding of information sharing and incident management activities, and developing recommended actions and procedural adjustments to address potential problem areas. 1. Familiarize clinics with the CPCA plan, and assist clinics in preparing their individual BCP plans. 2. Familiarize clinics with identifying Essential Functions, Services, Processes and Surge Capacity to facilitate recovery from a business disruption. 3. Identify the resources needed to continue patient care in the event of a heat wave and blackout. 4. Discuss and validate the effectiveness of BCP functions in directing and controlling recovery activities in accordance with existing plans and procedures. 5. Identify gaps, redundancies, developmental activities, and best practices in the event of a catastrophic incident. Exercise Guidelines 1. This is an open, low-stress, no-fault environment. Varying viewpoints, even disagreements, are expected. 2. Responses should be based on knowledge of current plans and capabilities (i.e., use only existing capabilities) and insights derived from training. 3. Decisions are not precedent setting and may not reflect your organization s final position on a given issue. This is an opportunity to discuss and present multiple options and possible solutions. 4. Problem-solving efforts should be the focus. Identifying issues is not as valuable as suggestions and recommended actions. 5. The situation updates, written material, and resources provided are the basis for discussion; there are no hidden materials or scenarios. Exercise Assumptions and Artificialities In any exercise, a number of assumptions and artificialities may be necessary to complete play in the time allotted. During this exercise, the following apply: 1. The scenario is plausible, and events occur as they are presented 2. There are neither hidden agendas nor any trick questions 3. The scenario is completely artificial 4. Assume you have cooperation from other organizations and agencies Community Health Partnership 2

4 What is Business Continuity Management? 1. Keep the clinic doors open to see patients after a disruption, in order to continue generating revenue 2. Determine the most Essential Services (or Functions), your clinic provides to the public 3. Restructure your Priorities, your Staff and your Workplace to provide the Essential Function(s) 4. Only provide that Service, or those Services, during a disruption CPCA COOP Toolkit Contents 1. Hazard Vulnerability Analysis (HVA) 2. Business Insurance 3. Data Collection 4. Delegation of Authority 5. Essential Functions 6. Recovery and Improvement Planning Importance of Business Continuity Planning 93 percent of companies that suffer a significant data loss are out of business within five years - U.S. Bureau. of Labor 43 percent of U.S. businesses never reopen after a disaster, and 29 percent (or more) close within two years. - University of Wisconsin Two out of five companies that experience a catastrophe or an extended system outage never resumes operations, and of those that do, one-third go out of business within two years - Gartner Group More than 60% of businesses in the U.S. do not have a basic plan to mediate the effects of a disaster should they occur. Gartner Group Community Health Partnership 3

5 RS 4 Clinic Medical Surge Approach Relates closely with Business Continuity Planning 1. Reprioritize Services (Determine Essential Functions) a. Assess the need and how your facility fits into the picture b. Assess the resources you have available for the need 2. Reassign Staff a. Based on your reprioritized service goals, reorganize staff into new duties or teams 3. Rethink use of Space a. Based on service priorities and reorganization of staff, what is the best patient flow and use of space? 4. Recovery Strategy a. Even in the middle of a response, how will this response transition back toward regular services, regular staff assignments and restoration of the facility? Barbara Morita Essential Functions and Critical Processes 1. Essential Functions and Critical Processes (definition) Essential Functions - Services the Clinic provides to the public, which must be sustained in an emergency in order to achieve the organization s mission, such as Primary Care, Dental, Acute Care, Mental Health, Perinatal etc. Critical Processes - Processes and activities that support Essential Functions, which if interrupted, will cause an organization to sustain a severe economic loss, or jeopardize the continued existence of the organization, or cause adverse effects to their clients. Processes are the steps needed to accomplish a function. Each Essential Function consists of multiple Critical Processes For example, the Function provide meals for residents of university housing is accomplished through the processes of food buying, food storage, cooking, serving, and cleanup. - UC Irvine PD Community Health Partnership 4

6 2. What characteristics help identify an Essential Function? The function directly helps achieve the company s mission It generates a significant proportion of the company s revenues It provides a vital service to clients It provides vital support to another Essential Function It has political ramifications or legal liabilities 3. Answers the questions: Is this Function critical, important, or deferrable? Who will be impacted internally and externally if we cannot perform this function? What are the costs of not doing this today? o Loss of income? o Legal fees or regulatory penalties? What would be the reputational impact if we were to miss this process? Identifying Essential Functions 1. List and rank functions (services) provided to the public, to identify and prioritize the Essential Functions your clinic must conduct under any circumstances. Your Clinic s Essential Functions will be the basis for determining resource requirements staff, vital information/critical systems, equipment, supplies, etc. during an activation of your BCP. Community Health Partnership 5

7 Function Ranking Form 1. List ALL of the Functions (Services) your clinic Provides to the Public 2. Rank Them by Priority H/M/L H Means Essential Important Read all the way to the bottom of the page before you begin Function Rank 1. Primary Care 2. Dental 3. Mental Health We re not really going to do this today 20. Community Health Partnership 6

8 For this Exercise, we are going to pre-define the Essential Function Function Rank 1. Provide Primary Care Essential Community Health Partnership 7

9 2. Clinic Processes Identify the top Clinic Processes that need to remain functioning in a disruption event, in order to support the Essential Function Provide Primary Care List every process a patient would go through for a Primary Care appointment from the time they entered the facility until the time they left. Add Processes that keep the clinic functioning. (The Essential Function can t work if the clinic is not functioning) A sample of Health Care Processes is on the next page Processes Priority: H/M/L 1. Scheduling H 2. Registration H 3. Triage H 4. Blood Pressure H 5. Payroll H Community Health Partnership 8

10 Health Care Processes Sample List Legal and Regulatory Requirements Clinical o Patient Care o Customer / Patient Service o Clinical Orders o Protocols o Treatment Plans o Clinical Decision Support o Medical and Clinical Documentation Financial Accounting o Insurance Claims Processing o Account Receivable o Accounts Payable o Health Care Center Insurance Administration o Scheduling o Registration o Documentation of Patient Encounters o Patient Records Management o Procurement o Inventory o Supply Chain Processes Human Resources o Payroll o Staffing Information Technology o Hardware o Software o Back ups o Communications: online, wireless, POTS, PBX Facility Maintenance o HVAC o Utilities o Housekeeping Data Warehousing o Medical Treatment Results o Lab Data o Billing Data o Patient Files Community Health Partnership 9

11 3. Essential Functions, Critical Processes and Services, Physical Requirements and Essential Personnel Directions: Use this template to help your Clinic set priorities for the services it expects to offer during BCP activation and to capture data on the key physical requirements needed to continue doing business. 1. List the functions identified as essential (In this case we are only using Provide Primary Care). 2. Prioritize the essential functions. (In this case, Provide Primary Care is our top priority) 3. Describe the essential function in terms of what Critical Processes and Services are necessary to perform that function. For example, providing primary care includes the patient check-in process. (Keep in mind that a very simple essential function may need little description, so the critical process or service may be the same as the essential function.) 4. Identify the new or changed Physical Requirements needed to continue that process after the disruption. 5. List Personnel responsibilities. Example: 1. Essential Function 2. Priority 3. Critical Processes 4. Physical Requirements 5. Essential Personnel (Name / Position) Provide Primary Care H Continue to see patients shortly after the blackout hits Reprioritize Services, Staff and Use of Space Tom Mabe Director of Operations Scheduling Cancel schedules and serve walk-in patients only Jane Doe Office Manager Registration Need paper records Triage Assign staff to front door for triage Blood Pressure Manual Blood Pressure cuffs Payroll Need paper checks Community Health Partnership 10

12 Saturday; 9:00 am Scenario: Blackout Temperatures have reached record highs in the region for four straight days. As a result, people are constantly running their air conditioning which is straining an already over-worked power grid. Officials have asked local residents to conserve power whenever possible. Monday; 10:00 am A rolling blackout leaves many neighboring cities and towns in the dark at various times. The surrounding region is at a standstill. Local officials are struggling to get emergency information to thousands of people who now have no TV or Internet service. So far, the blackouts have not affected your immediate area, but local officials are preparing for the worst and are urging citizens to prepare their homes and businesses for a possible loss of power. Your company has not yet been directly affected, but could be very soon. Non-Patients are coming into the clinic looking for air conditioning and water, some are overheated and faint. Older people are the most vulnerable. Scheduled patients remain coming in to the Clinic. Pre-Blackout Discussion Questions 1. In this case, what preparations would you take first to prepare for possible blackout? 2. How will management, key staff and employees be able to remain in contact with one another? With the MHOC? a. Are alternate and resilient means of communication available? 3. Does your facility have a backup generator and fuel? If so, how long is emergency power available? a. What kind of arrangements do you have with i. Your fuel supplier? ii. Your water supplier? Community Health Partnership 11

13 iii. Your equipment/supplies vendors? iv. Other Clinics? 4. What data is most important to business operations? a. Do you store backup data at an Offsite Storage Site? If so, where is this site located? 5. How much downtime is acceptable without significantly affecting business operations? 6. Can anything be done to extend this period of time? Community Health Partnership 12

14 Now, knowing that you are planning for providing Primary Care in a blackout; 1. How would you reprioritize your Services and Processes? a. Registration, scheduling etc. 2. How would you reassign your Staff? a. Assign to other duties, triage etc. 3. How would you rethink the use of Space? a. Utilize rooms with windows etc. Tuesday; 12:00 pm Transportation in the region has been severely impacted. The regional airport has been shut down and dozens of outbound and inbound flights have been cancelled, stranding thousands of passengers. Public transportation operating on the power grid is inoperable. Without power, gas stations are unable to pump fuel, leaving motorists and long-haul truckers low on fuel. Roads and highways are becoming clogged with vehicles stranded due to lack of fuel. Cell phone service is spotty at best; providers are struggling to restore service. Your facility loses power Patients are still arriving for scheduled appointments. Both patients and non-patients are arriving in greater numbers looking for relief. Community Health Partnership 13

15 Post-Blackout Discussion Questions 1. Once the blackout occurred, what would your organization do first? 2. What initial damage assessments, if any, could be conducted at this time? a. Who will conduct these assessments, and what roles, responsibilities, and qualifications do these personnel have in conducting these assessments? b. Does your Facilities Management/Security Team have any specific rules regarding security and possibly re-entry into the facility? c. What are the priorities with regard to staff safety? 3. How are you able to communicate with patients, suppliers, outside agencies and the public? 4. How are you gathering information about the current situation? 5. Are policies in place to provide flexibility to displaced employees, such as policies for working alternate schedules and/or teleworking? 6. What steps are being taken to account for, and assist the clinic s personnel and their families? 7. Does your company carry business interruption insurance? 8. At what point would the organization declare a disaster and activate the Business Continuity Plan? a. How would this be done? Who makes this decision? Community Health Partnership 14

16 b. How would the employees be notified of a disaster declaration and by whom? c. What criteria or conditions determine that your facility/organization cannot continue to operate? d. Who makes the decision that operations must be slowed or ceased? e. What notifications need to be made if your organization s operations are slowed or cease? How is this information communicated to your customers? f. If operations are slowed or ceased, will your employees continue to be paid or do they need to take leave? 9. If your organization operates an EOC, would it be stood up? a. How? Who makes that decision? b. Where is it located? Do the appropriate people know its location? c. How would your organization deal with travel restrictions or impassibility? What if personnel cannot get there? Are there alternatives? 10. Would you relocate to your Alternate Site? a. How would your Alternate Site be activated and by whom? b. What functionality is available at the Alternate Site? Does it have full telecommunication capabilities? c. What kinds of logistical arrangements might be needed if staff needs to stay at the site for an extended period? Community Health Partnership 15

17 Friday; 2:00 pm Authorities begin restoring power on a rolling basis throughout the region. Sunday; 12:00 p.m. Your facility has its power restored, as well as phone and Internet capability. Paper files, notes, reports, records etc. are piled up in the offices. No equipment requiring electricity has been used since the blackout. 1. How will you restore disrupted services? 2. What would be your business short term prospects in the face of this kind of disaster? 3. What kinds of strategies might be needed in order to improve your resilience? Hot Wash 1. What key strength(s) did you identify during the exercise? 2. What key area(s) for improvement did you identify during the exercise? 3. What suggestions or next steps do you have for addressing the issue(s) you identified? Community Health Partnership 16

18 List of Acronyms 1. Alternate Site A separate Facility from which to perform Essential Functions until the primary site is available, or a permanent alternate 2. BCP Business Continuity Pan 3. CPCA California Primary Care Association 4. EOC Emergency Operations Center 5. Essential Functions Services the Clinic provides to the public, which must be sustained in an emergency in order to achieve the organization s mission, such as Primary Care, Dental, Acute Care, Mental Health, Prenatal etc. 6. Critical Processes Critical Processes are the steps needed to accomplish Essential Functions. Each Essential Function consists of multiple Critical Processes 7. Hot Wash Discussion immediately after the exercise, to reinforce results 8. MHOC Medical/Health Operations Center Community Health Partnership 17

19 NOTES Community Health Partnership 18