Emergency Preparedness: Essentials for Business Continuity Planning For Community Health Centers

1. Emergency Preparedness: Essentials for Business Continuity Planning For Community Health Centers Presented by: Bernadette Johnson and H. Duane Taylor

2. Outline • Learning Objectives • Overview of Continuity of Operations Planning (COOP)/Business Continuity Plan • Special Considerations for Health Centers • Developing Your COOP -Elements of a Viable COOP • Implementing Your COOP • Test Your COOP • Self-Assessment Tool • Resources

3. Learning Objectives • To introduce participants to business continuity planning and the process by which organizations ensure maintenance of critical operations when confronted with adverse events. • To provide strategies to organizations regarding risk management as it relates to business continuity planning in order to minimize recovery time. • To provide essential elements in the design of an effective business continuity plan for health centers

4. Overview of COOP • Continuity of Operations (COOP) is a Federal Initiative, required by Presidential Directive, to ensure the Executive Branch departments and agencies are able to continue to perform their essential functions under a broad range of possible hazardous circumstances. • For Health Centers and other business entities, COOPs are called Business Continuity Planning and ensures that a business can maintain operations beyond an EP event. • FEMA is the lead agency that is mandated to provide training and technical assistance to agencies in developing and testing their COOP

5. Overview of COOP -2 • Federal Preparedness Circular (FP)-65 requires that all Federal Executive Branch agencies must have a COOP plan which includes some of the following elements: • Be operational no later than 12 hours after activation • Be able to maintain sustained operations for up to 30 days • Include regular testing, training and exercising of personnel, equipment, systems, processes, and procedures used to support the agency during an EP event • Locate alternative site facilities in areas where the ability to initiate, maintain and terminate COOP is optimal

6. Benefits of COOP • Business Continuity Planning is a good business practice for health centers. • It is part of the fundamental mission of health centers to be a central, responsible and reliable public institution that provide essential health services to communities. Moreover, HRSA has strongly encouraged that business plans for health centers include EP plans. It is critical that the EP plan include Business Continuity Planning. • In today’s changing environment, where EP disasters are not uncommon, the need for health centers to have a viable plan to determine how they will maintain and sustain their business is critical.

7. Special Considerations for Health Centers • As health centers, there are various precautions we must explore in Business Continuity Planning, including: • Pharmacy/Medications • Security of patients/staff • Medical Supplies • Interoperable Communications with Hospitals, Health Departments, PCAs, and the State • Family Support Planning for our staff • EP Insurance

8. Developing Your COOP • There are Nine (9) Essential elements for creating a viable COOP/Business Continuity Plan, which include: • Essential Functions • Delegations of Authority • Alternative Facilities • Interoperable Communications • Vital Records and Databases • Human Capital Management • Test, Training and Exercises • Devolution • Reconstitution

9. 1. Essential Functions • A central component of developing your COOP is to determine and prioritize the essential functions at your agency. Essential functions are the agency’s business functions that must continue with no or minimal disruption. • Essential functions are based on the agency’s customers and needs. It is important to remember that a broad brush approach should not be used when determining essential functions at your health center. • The continuity of essential functions will be driven by the availability of: Training personnel, Vital records/databases, Supplies and Equipment/Systems

10. Suggestions when determining essential functions • For health centers some suggestions in prioritizing essential functions are to examine the functions that enable an organization to: • Provide vital services • Maintain the safety of the general public and staff within your health center • Sustain your agency financially during a crisis and beyond.

11. 2. Delegation of Authority • Delegation of Authority is used for a specific purposes during an EP event for Business Continuity Planning. Delegations should be pre-determined and documented in writing. The document should specify any limitations on the delegated authority and should be as specific as possible. • Delegation of Authority specifies who is authorized to make decision are act on behalf of: • The Department or Agency Head • Other Key Individuals

12. 2. Delegation of Authority-Order of Succession • Orders of succession are provisions for the assumption of senior agency’ leadership positions during an emergency when the incumbents are unable or unavailable to execute their duties. Succession is the order of who is in charge where in delegation of authority is the responsible from one person to another.

13. 3. Alternative Facilities • During an EP event, if necessary, an alternative facility may need to be established. The alternative facility should be pre-determined. All health centers should examine if they had to have bare bones operations and could not utilize their primary site location could they create an alternative site location in the community. Moreover, how long would it take to be operational at that alternative site location. Any staff that requires relocation to the alternative facility are part of the Emergency Relocation Group (ERG). • Alternate facility sites may include: • Other health centers • Community Locations (e.g. library) • Telecommuting for your staff

14. 4. Interoperable Communications • Interoperable Communications are communications that provide the capacity to perform essential functions, in conjunction with other agencies, until normal operations can be resumed. • In order to have effective interoperable communications an agency must be able to communicate: • Externally with the organization’s customers and business partners • Internally with the organization’s leadership and co-workers • The KEY to interoperable communications is Connectivity

15. 4. Interoperable Communications-2 • Interoperable communications must also be: • Redundant • Available within 12 hours of activation, or less, depending on the mission and requirements of the organization. • Sustainable for up to 30 days

16. 5. Vital Records and Databases • In Business Continuity Planning or COOP, there are 2 main types of records: • Emergency Operating Records-which includes plans, directives, delegations of authority, or staffing assignments and orders of succession in order to implement your Business Continuity Plan. • Legal and Financial Records-which includes, medical records, personnel records, payroll records, insurance records and contractor records (e.g. agreements). Copies of medical records as well as offsite computer file storage is strongly recommending.

17. 6. Human Capital Management • During COOP activation, health centers will have to perform their essential functions with reduced staffing. Human capital, then, is critical to ensuring the flexibilities required of ERG personnel. Agencies should ensure that all ERG personnel are adequately trained and cross-trained to enable the performance of all essential functions. • All employees, ERG and non ERG need to be kept informed during the course of an emergency • Family Emergency Planning is important for any emergency but is strongly to be encouraged for a COOP event

18. Family Emergency Planning • A COOP situation will affect you and your team’s families: • There will be a period of uncertainty about what is happening, how bad the situation is, and what you should do to protect yourself and your loved ones. • You may feel unsure of your job security, particularly if the threat is severe • You may also be concerned for your financial well being. • It is imperative that your agency develop a family emergency plan. At a minimum the plan should include: • Contact and communication information • An immediate emergency checklist that includes medical, financial and legal information and other important documents. • Supplies, including medication, for at least 72 hours

19. 7. Test, Training and Exercises • Test, Training and Exercises (TTE) include measures to ensure that agencies COOP program is able to support the continued execution of its essential functions throughout an EP event. • Health Centers perform TTE to ensure that: • All equipment and systems work as required • Employees are able to deploy to the alternative facility within the required time frame. • The alternate facility includes everything that is needed for the ERG to perform essential functions.

20. 8. Devolution • Devolution is the capability to transfer and delegate authority to other members of the team in order to carry out essential functions when primary team members are incapable of performing necessary functions. Remember that this is generally for a specified time period and limited authority that has been delegated. • Think of it is brining in the reserve players!

21. 9. Reconstitution/Recovery • Reconstitution is the process by which agency personnel resume normal operations from the original or replacement primary operating facility. • Agencies must identify and outline a plan to return to normal operations. This plan should have time lines, resources needed (including $$$) and be as specific as possible. • It is encouraged that health centers appoint a Reconstitution Manager to oversee the reconstitution process.

22. Other Considerations for Developing Your Plan • Utilize Your Hazard Vulnerability Assessment in your planning. • Perform a Business Impact Analysis-which identifies the process of confirming what the critical functions are and prioritization of business services. • Examine Key Leadership-Roles and Responsibilities and create an outline and staffing chart. • Create an Activation Plan-describes the specific events or conditions that will trigger or invoke the plan. • Communications Planning- include internal/external communications as well as personnel notification and media.

23. Recap of Developing an Business Continuity Plan • Utilize the 9 Essential Elements for COOP • Use Elements of Your EP plan to drive the continuity plan • Remember Risk Management as a critical component • Time Specific • Test and Train on the COOP

24. Continuity of Operations Self Assessment Tool • This tool is designed to assist in the development of your COOP Plan and to assess the plan for all considerations. • The Self Assessment is promulgated on FPC 65 guidance so we need to make it apply to health centers. • Utilize it as a broad based template for planning and exercise purposes.

25. Resources • Your PCA • NACHC • FEMA-great online course-http://www.training.fema.gov/EMIWeb/IS/is546.asp

26. Quiz-Question 1 • For Agencies at the beginning stage of COOP planning, determining ________ must be completed before moving onto any other area of COOP planning. • A. Essential Functions • B. Orders of Succession • C. Delegation of Authority • D. Communication Needs

27. Quiz-Question 2 • 2. Essential functions include all functions that have been explicitly assigned by law or by order of the President in a COOP plan. (True or False) • A. True • B. False

28. Quiz-Question 3 • 3. Interoperable communications include access to data, systems, and services. (True or False) • A. True • B. False

29. Quiz-Question 4 • 4. Business Continuity Planning only considers Terrorist threats. (True or False) • A. True • B. False

30. Quiz-Question 5 • 5. The term ERG stands for: • A. Emergency Redesign Graphics • B. Emergency Redundancy Group • C. Emergency Regrouping Guidelines • D. Emergency Recovery Group

31. Quiz-Question 6 • 6. Family Emergency Planning is not a consideration in COOP. (True or False) • A. True • B. False

32. Thank You!