Berwick Hospital Case Study

To: John Wilkesboro, Chief Operating Officer, Berwick Hospital System

From: Po Hattan, Chief Continuity Manager, Berwick Hospital System

Re: Continuity plans for operations and associated risks relating to catastrophic disruption due to environmental causes

Date: January 27, 2007

A medical center with over 500 beds located in an urban area provided the majority of charity service in the city, although it was known for quality patient care. The staff valued this reputation, had pride in the physical facilities, and placed value on education. The hospital placed great value on innovative boundary-spanning activities, community outreach and marketing, and enjoyed "comfortable" staffing levels and large investments in technology. Unfortunately, when struck by a severe flood in the region the hospital did not utilize its "adequate" disaster recovery plan, but fell back on a "learn as we go" mentality. The result: while the medical center suffered no internal damage, it sustained severe alterations in its patient services and care delivery. It faced critical staffing shortages, and was forced to cope with a lack of easily accessible potable water for almost three weeks. (1) As this and other medical facilities throughout the U.S. and the world have discovered, it is one thing to simply have an emergency plan on file with authorities and an entirely different matter to adequately plan, practice, and successfully implement an effective disaster recovery/continuity plan.

Maintaining continuity of operations at Berwick Hospital is of critical importance in the face of an environmental catastrophe. Successfully coping with a disaster, whether natural, man-made, or terrorist attack, incorporates several key elements. The National Incident Management System (NIMS) published by the Department of Homeland Security in March, 2004, describes several key elements of emergency preparedness.

According to NIMS publications, effective emergency management begins with a host of preparedness activities conducted on what is described as a "steady-state" basis, well in advance of any potential incident. NIMS documents state that preparedness involves a combination of planning, training, exercises, personnel qualification and certification standards, equipment acquisition with corresponding certification standards, and publication management processes and activities. (2)

The Federal Emergency Management Agency (FEMA) describes emergency management as "the process of preparing for, mitigating, responding to, and recovering from an emergency."(4) The old adage still holds true that those who fail to plan, plan to fail. However, while preparation (or planning) is a critical component to the overall management process, it is not the only component. It is just as important for an emergency management plan to educate and train personnel on how to respond in an emergency situation, and to follow up that training with extensive practice through regular drills.

Berwick Hospital System would be well-served to create and implement a formalized continuity plan which takes into account an environmental catastrophe for several reasons. First, and perhaps most importantly, it helps to ensure that BHS is doing everything possible to fulfill our moral and ethical responsibility to our community, and to protect and serve our employees as well.

Secondly, by implementing a continuity plan based on environmental disasters, BHS will be in compliance with Federal, State and local agencies, and will be better positioned to receive funding by these agencies. For hospitals to receive federal funding they must comply with guidelines developed by the NIMS. (3)

Being prepared for an environmental disaster will also improve our ability to recover financially from the impact that such a catastrophe would bring, helping to minimize financial losses, fines due to regulatory noncompliance, lawsuits, and damage to our equipment and personnel. Having an environmental emergency plan will also assist in improving our image within the community, both during our planning and preparation stage, and in the event of an eventual implementation of our emergency preparedness plan.

Since compliance with NIMS is required for continued federal funding, I've detailed the guidelines for preparedness as defined by NIMS is included below. This skeleton plan can serve as the foundation for our Environmental Catastrophe Plan.

(1) Planning

Plans describe how personnel, equipment, and other resources are used to support incident management and emergency response activities. Plans provide mechanisms and systems for setting priorities, integrating multiple entities and functions, and ensuring that communications and other systems are available and integrated in support of a full spectrum of incident management requirements.

(2) Training

Training includes standard courses on multi-agency incident command and management, organizational structure, and operational procedures; discipline-specific and agency-specific incident management courses; and courses on the integration and use of supporting technologies.

(3) Exercises

Incident management organizations and personnel must participate in realistic exercises--including multidisciplinary, multi-jurisdictional, and multi-sector interaction--to improve integration and interoperability and optimize resource utilization during incident operations.

(4) Personnel Qualification and Certification

Qualification and certification activities are undertaken to identify and publish national-level standards and measure performance against these standards to ensure that incident management and emergency responder personnel are appropriately qualified and officially certified to perform NIMS-related functions.

(5) Equipment Acquisition and Certification

Incident management organizations and emergency responders at all levels rely on various types of equipment to perform mission essential tasks. A critical component of operational preparedness is the acquisition of equipment that will perform to certain standards, including the capability to be interoperable with similar equipment used by other jurisdictions.

(6) Mutual Aid

Mutual-aid agreements are the means for one jurisdiction to provide resources, facilities, services, and other required support to another jurisdiction during