Continuity of Operations (COOP) Planning

1. Continuity of Operations (COOP) Planning An Introduction for Tribal Health Programs June 23-24, 2010 Sacramento, CA Calvin Freeman Brian Tisdale

2. Presentation Objectives • Define COOP • Provide the rationale for COOP planning • Describe how COOP fits into your overall emergency management program • Describe the elements of a COOP and the plan development process • List special considerations for Pandemic Influenza events Continuity of Operations

3. Scenarios What if your health center: • Is severely damaged by a winter storm? • Becomes inaccessible by staff and patients due to wildfire? • Loses its lab capability and half of its exam rooms for 30 days from a fire? • Faces 30% staff absenteeism over a two-week period from influenza? Continuity of Operations

4. Responding to a COOP Event How do you: • Continue to provide services for your patients? • Respond to community disaster needs, if required? • Return to full functionality? • Recover expenditures and losses? Continuity of Operations

5. Continuity of Operations PlanDefined Plans, policies and procedures to ensure essential functions are performed during emergencies. Continuity of Operations

6. Clinic Emergency Plans • Emergency Operations Plan (EOP) • Community Disaster Response and Recovery Plan • Facility emergency plans (fire, building evacuation, hazardous spills, etc.) • Safety and illness and injury prevention • Continuity of Operations and other business continuity plans Continuity of Operations

7. COOP vs. Other Emergency Plans • Emergency operating procedures • Address only immediate aftermath of incident • COOP • Addresses immediate aftermath, short-term, & long-term (up to 30 days), with focus on continuing essential functions October 21, 2009 Continuity of Operations

8. COOP Builds on Existing Capabilities • Safety policies and procedures • Emergency response plans and procedures • Information technology operational recovery plans • Backup resources for personnel, supplies and equipment • Insurance • Fire and other casualty • Business interruption? Continuity of Operations

9. Building Your COOP Capability Focus on prevention and mitigation • Update hazard vulnerability analysis • Update/review/reinforce safety and illness/injury prevention procedures, including vaccinations • Encourage employee and community home and work preparedness Continuity of Operations

10. Goals of a COOP Plan • Ensure timely & orderly continuous performance of essential functions during & after emergency • Protect facilities, equipment, records, & other assets that support essential functions • Reduce or mitigate disruptions to operations Continuity of Operations

11. Goals of a COOP Plan (continued) • Reconstitution (resumption of normal operations) & devolution (continue as many essential functions as possible when reconstitution at primary facility is not possible) after emergency • Minimize loss of life & injury to agency personnel • Family support planning for agency personnel during emergency Continuity of Operations

12. COOP Elements • Plans and procedures • Essential functions • Delegations of authority • Lines of succession • Alternate operating facilities • Interoperable communications • Vital records and databases • Protection of human capital and other resources • Tests, training and exercises • Devolution of direction and control • Reconstitution Continuity of Operations

13. 1. Plans and Procedures Defines how clinic will respond to event: • Response triggers • Alert and notifications • Communications to patients, staff and other stakeholders • Response management organization – commitment to ICS • Initial response actions (e.g., shut down, relocation, steps to ensure safety of people and preservation of equipment, supplies, and records, etc.) Continuity of Operations

14. 2. Define Essential Functions • Identify functions and services critical to your mission • Assign priorities and timeframe for operation (continuous, restore within 72 hours, etc.) • For each essential function, determine: • Staff skills, numbers, experience, security clearances and licenses (and backups) • Other required inputs (facilities, IT, supplies, vendors, equipment, etc.) • Legal, regulatory and reporting requirements • Alternatives, if clinic cannot continue function Continuity of Operations

15. 3. Delegations of Authority Who has the authority to make critical decisions if the usual decision-maker is incapacitated or not available? • Best if delegations are three-deep. Continuity of Operations

16. 4. Lines of Succession Who will take the place of a manager or executive who is unavailable or unable to perform duties? • Best if delegations are three-deep. • Especially critical for CEOs, Executive Directors or other executive staff Continuity of Operations

17. Key Resources • Alternate operating facilities, if relocation is required. • Interoperable communications, to ensure essential functions maintain contact with other response elements, government agencies, vendors, patients, etc. • Maintain access to/protect vital records and databases (or backups), e.g. patient records, legal documents, contact lists. Continuity of Operations

18. 8. Protect Human Capital and other Resources Ensure: • Safe facilities and operations • Critical equipment, pharmaceuticals, and data are protected • Security for facilities, whether occupied or unoccupied Continuity of Operations

19. 9. Tests, Training and Exercises • As with all emergency response activities training is essential and exercises serve to build proficiency. • Suggestion: Build a Continuity of Operations component into your next fire drill. What steps would you take to restore services if the fire had created significant damage? Continuity of Operations

20. 10. Devolution Devolution is “passing the baton” to another site or organizational unit, e.g., if leadership is lost, direction and control may be passed to a satellite unit or to a non-health unit of tribal government. Continuity of Operations

21. 11. Reconstitution • Return to previous clinic facilities or move operations to new site • Replace employees lost during emergency Continuity of Operations

22. Pandemic Influenza Considerations • Threat is to workforce rather than facilities • Response based on social distancing rather than relocating operations • Consider HR policies that discourage infected employees from coming to work • Threat is widespread, not localized • Limits availability of mutual aid • Affects suppliers, government agencies, transporters Continuity of Operations

23. Pandemic Influenza General Considerations General • Threat is to workforce rather than facilities • Response based on social distancing rather than relocating operations • Consider HR policies that discourage infected employees from coming to work • Threat is widespread, not localized • Limits availability of mutual aid • Affects suppliers, government agencies, transporters Continuity of Operations

24. Pandemic Influenza Considerations Plans and Procedures • Include monitoring of pandemic activation phases and public health guidance from CDC, California Department of Public Health and Local Health Department • Create an Influenza Team to monitor and address pandemic issues Continuity of Operations

25. Pandemic Influenza Considerations Essential Functions • Review effect of pandemic on contract and support services • Develop mitigation strategies if external suppliers are unable to provide needed resources Continuity of Operations

26. Pandemic Influenza Considerations Delegations of Authority • For multi-site clinics, consider tele-management Alternate Operating Facilities • Modify patient flow to increase social distancing • Consider combining facilities to improve logistics and support services • Focus on sanitation Continuity of Operations

27. Pandemic Influenza Considerations Interoperable Communications • Maximize use of wireless communications, PDAs, tele-conferencing rather than meetings Vital Records • Ensure maintenance of IT systems Continuity of Operations

28. Pandemic Influenza Considerations Protection of Human Resources • Review/Modify HR Policies • Sick leave • Fitness for duty • Family medical leave • Family assistance program • Enforce infection control & hygiene measures • Keep staff and their families informed • Promote cross training Continuity of Operations

29. Pandemic Influenza Considerations Tests, Trainings and Exercises • Include social distancing and alternative patient flow strategies Devolution of Direction and Control • Develop detailed guidance that addresses essential functions, points of contact, and resources and phone numbers Reconstitution • Include provisions to maintain pandemic surveillance Continuity of Operations

30. References and Resources • California OES COOP/COG and Pandemic Influenza Planning - http://www.oes.ca.gov/Operational/OESHome.nsf/PDF/COOPCOG%20Document%20Downloads/$file/DP%20Pan%20Influenza%20.pdf • Pandemic Preparedness Planning Matrix - www.Naaep.org • Pandemic Flu and Continuity of Operations (Colorado) - www.cdhs.state.co.us/Pandemic/Documents/SafetyMeeting.ppt • Pandemic Planning Kit for Ambulatory Care Facilities (Georgia) - http://www.pandemicpractices.org/files/16/16_planning_kit.pdf Continuity of Operations

31. IHP Technical Assistance Program • FREE! • On-site technical assistance • Promote community and family preparedness • Work with Executives, Boards and safety staff • Plan and policy and procedure development • Pandemic influenza preparedness • Workshops and other training Continuity of Operations

32. Resources and Contact • Video: Preparing for Coming Seasons • Plan templates • Trainings and workshops Contact Us • Barbara Aragon, MSW BAragon428@gmail.com (916) 201-6866 • Calvin Freeman Calvin_Freeman@comcast.net T: (916) 714-1793 F: (916) 714-1794 Continuity of Operations