BUSINESS CONTINUITY WORKSHOP

1. BUSINESS CONTINUITY WORKSHOP ROAD TO RECOVERY THURSDAY, March 21, 2019

2. ROAD TO RECOVERY Business Continuity Workshop WELCOME

3. ROAD TO RECOVERY Housekeeping • To better keep today’s workshop free from distractions: • Please silence or set your phones to vibrate. • Please No talking on phones during presentations. • Please feel free to step outside if you need to take a call. • Wi-Fi • rfGuest • Restrooms • Emergency Exits/Routes Thank you

4. ROAD TO RECOVERY Business Continuity Workshop https://vimeo.com/149822292

5. ROAD TO RECOVERY Sutter Health Our Journey with Business Continuity Planning Tracy Robles, MA Director of Environmental Risk Sutter Health Risk Services

6. ROAD TO RECOVERY Session Objectives • Discuss the need for Business Continuity • Describe Business Continuity efforts taken by Sutter Health • Share Future State of Sutter Health’s Business Continuity Planning

7. ROAD TO RECOVERY Sutter Health Overview Sutter Health primarily serves Northern California • 24 Hospitals (4311 licensed beds) • 200+ Physicians Offices and Clinics • 35 Ambulatory Surgery Centers • 53,000 Employees • 5,500 Physicians The Sutter Health Emergency Management System (SHEMS) provides system support for emergency management response and recovery activities.

8. ROAD TO RECOVERY Sutter Health Emergency Management System (SHEMS)

9. ROAD TO RECOVERY Need for Business Continuity • Continuation of patient services • Fulfill moral responsibility to protect • The patients/staff/visitors • The community • The environment • Facilitates compliance with regulatory requirements

10. ROAD TO RECOVERY Need for Business Continuity • Enhances ability to reduce: • Disruptions to service delivery • Financial losses • Regulatory fines • Loss of market share • Damages to equipment

11. ROAD TO RECOVERY Our Journey • 2008 • Created Business Continuity Department Profiles • Various Service Lines • Documented • Critical Business Processes • Critical Equipment and Resources • IS Applications • Staff Positions • Critical Records • Departmental Dependencies

12. ROAD TO RECOVERY Our Journey BC Profile segmented: • Tier Tabs (Critical Processes) • Department Tabs • List specific critical business processes and resources needed to provide patient care and continue operations

13. ROAD TO RECOVERY Our Journey: Revisions • 2016 • Partner with Wakefield Brunswick to revise Business Continuity Department Profiles • 30 mission critical departments identified • Revised format – combined information • Included a methodology to validate critical processes and outline step by step recovery actions

14. ROAD TO RECOVERY New BC Profile Format

15. ROAD TO RECOVERY Validation Methodology: Critical Processes

16. ROAD TO RECOVERY Validation Methodology: Scoring

17. ROAD TO RECOVERY Ranking of Critical Processes

18. ROAD TO RECOVERY Recovery Actions • Respond – Actions to Assess Impact • Assess safety – Is it safe to continue operations? • Assess staffing levels – Do you have enough staff to continue operations? • Assess services – Do you have the resources and supplies needed to continue operations and critical processes?

19. ROAD TO RECOVERY Recovery Actions • Manage – Actions to Continue or Relocate Services • Notify command center, departments and vendors about status and strategy for continuation • Identify alternate location for continuity of services • Determine which patients will be relocated and call scheduled patients regarding changes

20. ROAD TO RECOVERY Recovery Actions • Recover – Actions to Recovery Department’s Mission Critical Processes and Services • Ensure proper and adequate supplies • Collect vital records • Communicate resumption of services to command center, ancillary services and patients

21. ROAD TO RECOVERY SHEMS Events • H1N1 • Ebola • Wildfires • Oroville Dam Spillway Failure • Floods • Nuance eScription Outage

22. ROAD TO RECOVERY Lessons Learned – Common Themes • Establish enterprise level governance with authority and accountability for system-wide resiliency. • Implement an integrated approach for emergency management and business continuity across all service lines. • Strengthen response and recovery capabilities.

23. ROAD TO RECOVERY Lessons Learned – Common Themes • Improve crisis communication. • Develop and implement a robust education and training program. • Establish resiliency metrics to routinely measure and improve preparedness, response and recovery capabilities at the affiliate and system levels.

24. ROAD TO RECOVERY Future State – Integrated Resiliency • Sutter Health has committed to being a High Reliability Organization • Resilience is one of the 5 key characteristics of an HRO • Dedicated resiliency focus * Wakefield Brunswick Model

25. ROAD TO RECOVERY Future State – Integrated Resiliency

26. ROAD TO RECOVERY Questions & Answers • Tracy Robles roblest@sutterhealth.org916-286-6854 • Thank you

27. ROAD TO RECOVERY Mix and Mingle

28. ROAD TO RECOVERY Kaiser Permanente Code Silver Event September 11, 2018 BCPs Really Do Come in Handy! Ken Hartwell Disaster Resource Center Coordinator Kaiser Permanente Downey Medical Center

29. ROAD TO RECOVERY The Kaiser - Downey Location

30. ROAD TO RECOVERY What A Surprise! • Awareness arrived quickly but not evenly • Responses are dependent on prior training and understanding • ‘PLATOONING’ • Own your space and responsibilities • Take care of your own needs – Be realistic! • Don’t expect delivery of help on a ‘silver plate’ • Have your ‘STUFF’ ready to go! No time to gather toys • Situational control shifts immediately to outside responder agencies • Very difficult to form an HCC group when locked-down or sheltering • Leadership Chaos for ½ hour • The CURSE of (anti) Social Media

31. ROAD TO RECOVERY What Now? • The City of Downey was in control! • HCC had to work under DPD EOC at different location • This is where BCPs really do matter • Plans should include independent recovery and sustainment elements • Plans shouldn’t rely on always being in familiar surroundings or having your regular supply of tools and support structures • Business continuity also requires maintaining unity and order in strange surroundings • Evacuation (behind Jack-In-The-Box) under control of Parks and Recreation • Immediate needs had to be anticipated – Food & Water? • Patients (and returning staff) kept arriving during lockdown

32. ROAD TO RECOVERY Re-Population • Staged plans for re-entry and re-activation are important • Working with stressed patients and stressed staff is tricky! • Reality vs Presumptions • Every Part of Every Building had to be cleared FIRST • Parking Lots were also Off Limits ‘till Cleared • Patients and Visitors were ANGRY with the delays! • Proper Messaging is a HIGH PRIORITY….. It’s HARD to learn the facts! • Communication is important at every level….. NOT just PAO! • Special Needsare not always there • Take Care of Stress-Related recoveries

33. ROAD TO RECOVERY Questions & Answers • Ken Hartwell Kenneth.L.Hartwell@kp.org • Thank you.

34. ROAD TO RECOVERY Henry Mayo Newhall Hospital Erik Pinnell Safety and Business Continuity Henry Mayo Newhall Hospital

35. ROAD TO RECOVERY Power Outage • August 27, 2018 • Start: 3:48p.m. • End: 7:45p.m. • Blown fuse in underground vault along McBean Pkwy. • Various Medical Office Buildings (6) and services affected throughout the 30 acre campus

36. ROAD TO RECOVERY Event Complete Loss of Power ● Urgent Care ● Breast Imaging Center ● MS 4 and MS 5 ● IV Pumps, vitals, lighting ● HIM ● Parking structure (lights & elevator) ● Pavilion had generated power, but the HVAC was not on emergency generated power ● HMNH’s back up for MRIs/CT was down (Tower Imaging) Partial Loss of Power ● BHU lost power to security cameras & bathroom alarms ● NICU security cameras down for HUGS system ● Emergency Dept. had no power to security cameras ● Security could not utilize any of their CCTV monitoring equipment ● Increased temperatures ● Many offices were near closing time and closed early.

37. ROAD TO RECOVERY Activation of the BCP • Disaster/Safety/Engineering performed physical rounding of departments • Two-way radio checks • Received Dept. Status Reports from units • Incident Command established by Nursing Admin • BCP’s activated by BC Coordinator after recognition of seriousness of situation • Via e-mail & 2-way radio • EverBridge Mass Notification System

38. ROAD TO RECOVERY Department Status Report

39. ROAD TO RECOVERY BCP Utilization • Mission Essential Services • Tiers • 0 Immediate • 1 <4 hours • 2 <12 hours • 3 <3 days • 4 >3 days • Criticality (function) • Maximum Tolerable Downtimes

40. ROAD TO RECOVERY BCP Utilization • Interdependencies • Examples: • Lights • Communication • Temperature • Action if Dependency is unavailable • Manual resuscitation • Lanterns/flashlights • Fans (2) portable AC’s • Runners/2-way radios

41. ROAD TO RECOVERY Other Actions Performed Utilizing the BCP • Urgent Care • Evacuated with 2 employees staying behind just in case • ED/BHU • Security increased foot patrol in these high risk areas • Staff encouraged to be safety conscious in areas of downed cameras/power loss • Parking structure • Escorted by security or volunteers (with flashlights) • Pavilion • Open curtains/blinds • Portable fans/AC units

42. ROAD TO RECOVERY Other Action Performed Utilizing the BCP • Breast Imaging • Rescheduled patients for late afternoon and evening • Used cell phones • Flexed off employees • HIM • 2nd shift was flexed off after downtime exceeded 2 hours • Remote staff continued to work from home • Back up Imaging Valencia • Used HMNH in-house and notified other imaging services of potential need for services • Ambulance on-call for transport if needed • Many offices were near closing time and closed early

43. ROAD TO RECOVERY Lessons Learned Strengths ● All outpatient areas submitted department status reports - Form Simplified ● BCP triggers were integrated for interruptions of operations of department and impacts to essential operations ● Actions listed in BCP were performed when the dependency was unavailable ● Continuous communication to staff Weaknesses / Mitigation ● Engineering to investigate strategies to avoid bringing outside air in when HVAC is non-operational ● Have supplemental lighting available in kits ● Lanterns available upon request from DRC ● Monthly radio checks ● Evaluate battery back up system for cameras

44. ROAD TO RECOVERY Questions & Answers • Erik Pinnell pinnelles@henrymayo.com • Thank you.

45. ROAD TO RECOVERY Cedars - Sinai Emergency Operations & Business Continuity Plan Activation Ryan Tuchmayer, MPH, EMT Disaster Resource Center Coordinator Cedars-Sinai Medical Center

46. ROAD TO RECOVERY Water Main Break

47. ROAD TO RECOVERY Emergency Operations & Business Continuity Plan Activation

48. ROAD TO RECOVERY Event Recognition • Thursday ~ 7:30am notified of water main break • 11 story high rise medical office building Broken Main

49. Alert & Notification HICS activated ROAD TO RECOVERY Alert and Notification Hospital Command Center opens* • Building manager emails buildings occupants • Building closed • Estimated 6-8 hour repair timeline • Building manager emails and calls emergency management • HICS activation • Everbridge notification • Hospital Command Center activation

50. ROAD TO RECOVERY Incident Response Operations • Incident Commander: Coordinate and direct response and recovery • Liaison Officer: contacts L.A. Department of Water and Power to validate restoration estimate • Safety Officer: Determines building is unsafe to occupy due to lack of fire sprinkler protection. Orders building closed. • Public Information Officer: Drafts message for patients, staff and physicians • Template messages previously created • Operations • Send a RN to triage/coordinate issues at the building • Planning • Searching for alternate work spaces (clinical administrative) • Logistics • Shuttles to escort staff/patients to alternate locations • Fire hose to connect to standpipe (ends up not working in this situation)