The Operating Environment of Papworth Hospital - Assignment Example

1. INTRODUCTION With the increase of high-profile incidents such as flu epidemics, terrorist attacks and natural disasters of all kinds, Business Continuity Management (BCM) is increasingly becoming an integral aspect of strategic planning for all organizations on the forefront of public service delivery. Such hard to predict incidents highlight the need for organizations such as hospitals to incorporate risk management and business continuity into the corporate strategy to reduce disruption to the public and the institution as a whole. According to the Civil Contingencies Act (CCA) Category 1 responders like NHS Trusts are required to ensure that they have effectual BCM arrangements in place such as Business Continuity Plans (BCPs). These enable the organization to continue to supply its crucial services during a disaster or emergency situation or disaster. Papworth NHS Trust Hospital is an example of an organization that has developed a BCM strategy to deal with disasters. Before the passing of the CCA into law, Papworth Hospital only had informal and undocumented contingency arrangements that were developed on an impromptu basis through individual departments within the Hospital. Following the CCA, the management initiated a far-reaching BCM review. Allowing consistency throughout the entire Trust to ensure that things are more straightforward during emergencies. The following discussion shall analyze the operating environment of Papworth Hospital in relation to its capability in dealing with incidents and disruptions in times of crises. 2. THE CRITICAL ANALYSIS OF THE OPERATING ENVIRONMENT AND STAKEHOLDER ANALYSIS Papworth Hospital NHS Foundation Trust is arguably one of the main specialist centres for the diagnosis and treatment of lung and heart problems. It treats more than 20,000 inpatient and day cases and approximately 30,000 outpatients annually. It has developed a reputation for cutting edge research and innovation and in fact performed the first successful heart transplant in the UK in 1979. Papworth also has one of the main Sleep Clinics in the UK that was actually featured in a BBC documentary in 2008. Our services include cardiology, respiratory medicine, and cardiothoracic surgery. In addition, Papworth is the only hospital in the UK that provides Pulmonary Thromboendarterectomy surgery and is one of the only five centres who offer implant ventricular assist devices (VAD) (NCC Group, 2008).  In a recent inpatient survey, patients voted Papworth as one of the top three NHS hospitals for superior healthcare (NCC Group, 2008). This is testament to the values of the hospital which, according to Papworth Hospital NHS Foundation Trust (2010) has a great commitment towards providing the highest levels of clinical quality, delivering the highest possible standards of personalized care to patients and providing a safe and clean hospital environment. This commitment to high standards was recently recognized when the hospital’s services and use of resources was awarded as being “excellent” by the Healthcare Commission. Papworth Hospital NHS Trust, as part of the wider NHS Foundation Hospitals team, is a Public Interest Company. As such, it is a not-for-profit company limited by guarantee. According to Number 10 (2002), it is managed by a stakeholder council representative of NHS staff and local communities as opposed to being answerable to the Department of Health; owns and manages its assets; makes decisions on the HR policy; and keeps all the surpluses. Papworth’s operating license clearly outlines that its main purpose is to serve NHS patients and its performance against the license is administered by an independent regulator. As a Public Interest Company , Papworth has a variety of stakeholders, each with an interest in the performance of the company. These stakeholders are divided into four groups: internal stakeholders; external stakeholders; the public and patients; and the media. Included in the list of internal stakeholders are the Board of Directors; all staff; NHS Foundation Trust members; the Management Executive; Board of Governors; Lead Clinicians; Senior Managers; Unions; and all staff. The external stakeholders include Strategic Health Authorities; GPs; Primary Care Trusts; Local government; Clinical networks; and National charities. Part of the Public and patients are carers; Parish Councils; and patient support groups. And lastly, the professional, national and regional media constitute key stakeholders of Papworth Hospital as the media. An efficient method of analyzing the operating environment of the hospital is via a stakeholder analysis. The first step in such an analysis is identifying the key stakeholders; their stake in the organization; their potential impact on the organization and their various responsibilities. The following is a cross section of a stakeholder analysis of Papworth Hospital: PAPWORTH HOSPITAL STAKEHOLDER ANALYSIS Stakeholder Stake in the organization Potential impact on organization What does the organization expect the Stakeholder to provide? Perceived attitudes and/or risks Stakeholder Management Strategy Responsibility Board of Directors They determine organizational administrative policy and procedures High Leadership and decision making role. Commitment to implementing change. Lack of knowledge concerning key medical procedures and approaches. Taking part in Project Steering Board and updating meeting with management. Directors Senior managers Manages hospital administration and staff who will operate the day to day activities. Medium Technical contribution to change. Being out of touch with junior staff. Technical involvement in management. Managers Patients Will benefit from organizational decisions Medium Contribute through suggestions based on direct/ personal experience with hospital services. Bias against hospital staff and lack of medical knowledge. N/ A. Contributory 3. Critical activities and an assessment of maximum tolerable period of disruption The critical activities carried out by Papworth Hospital are various and include the vast range of medical procedures such as lung and heart surgeries, cancer treatments such as chemotherapy and radiology, administrative processes such as record-keeping, ambulance services, nursing care, supplier management, insurance and billing processing, and the like. Without these crucial activities, Papworth Hospital would grind to a halt and the less critical activities will be disrupted in a major way. 1 Indeed, major disruptions can and do occur in hospital environments and if the disruption continues unabated, severe losses in terms of finances and human life shall be incurred in the process. A major part of ascertaining the effect of a disruption is by determining the Maximum Tolerable Period of Disruption (MTPOD) which refers to the time after which an organization's efficiency will be irreversibly threatened if service and product delivery is not resumed and it ascertains how much unavailability an organization can withstand before all the systems and processes crash causing lasting damage (BCC Management, 2006). To determine the MTPOD, the maximum duration following the start of a disruption within which activity must be resumed has to be identified as does the minimum level at which the activity needs to be performed on its resumption and the length of time within which normal levels of operation need to be resumed (British Standards, 2006). In the hypothetical case that Papworth was to experience a nurses strike for instance, a major disruption to a critical activity will have occurred since the hospital cannot run without nurses. In such an incident, the maximum duration that the hospital can last without nurses is an hour (60 minutes). This is on the maximum time since in the interim. 4. RECOVERY TIME OBJECTIVES 5. Critical dependencies According to the standard BS 25999, critical dependencies are those activities that are reliant upon the critical activities and include suppliers, assets, and resources, outsource partners as well as other activities (BCC Management, 2006). As a major hospital in the UK, Papworth has several critical dependencies all of whom will be drastically affected in the case of a disruption in a critical activity. These dependencies include chemists, opticians, dentists, shop attendants, administrative staff, delivery vehicles, delivery drivers, stores, warehouses, drug suppliers, fuel suppliers, lab coat suppliers, medical equipment suppliers, patients, food suppliers, and the like. 6. STRATEGIES FOR MAINTAINING CRITICAL ACTIVITIES/DEPENDENCIES To deal with aforementioned critical dependencies, various strategies shall need to be employed. For the critical activities/ dependencies related to people, people strategies need to be implemented. Therefore, if there is a nurses strike, drastic people strategies have to employed such as keeping a record of the few nurses who have not gone on strike and assigning them to the most critical patients; temporarily outsourcing for other nurses from other hospitals/ regions; dividing/ assigning their duties to other medical staff temporarily such as midwives or interns; and so on. In the case that the disruption is a fire or earthquake, damage to the premises will have occurred and thus premises strategies shall be required. In these instances, patients, particularly the critical ones, must be transferred to other hospitals or clinics and/ or makeshift/ impromptu medical tents in liaison with staff from other hospitals. This was witnessed recently during the recent Haiti earthquake. These are just a few examples of the strategies that can be used in the case of disruptions at Papworth Hospital. 7. Critical dependency monitoring arrangements The monitoring arrangements of the critical dependencies are crucial in determining when a situation has reached a critical level. Therefore, there has to be leadership at the helm of each dependency to ensure things do not get out of control. For instance, with regards to the number of nurses on duty, the head of the nursing department has to ensure that the levels are stable and that at least 80 per cent of the nurses are working. This monitoring shall be done through record keeping and marking a roll call at regular intervals. If during the course of this monitoring the head of nursing realizes that the percentage of nurses is less than about 40 per cent, he/ she will have to mitigate against the coming disruption and activate a Business Continuity Plan which may consist of a variety of measures such as outsourcing for external nurses. 8. Plan invocation arrangements When an event has occurred, the way forward must be planned and this is where the plan invocation comes in. Papworth has a Forward Planning Commission and together with top management, these commissioners are the ones to be consulted in the case of emergency. First and foremost, they are the ones responsible for determining whether or not an incident is an emergency. In addition, they specify the procedures to be followed by the rest of the staff are specified by….who outline the people to be consulted (Pershing, 2010). When the Business Recovery Plan is to be invoked, a Manager, most likely a departmental manager, notifies the rest of the staff and it is this departmental manager that all should keep in contact with during this period for direction and the status of events. These same Department managers will ascertain whether shift work is possible from the recovery site. In short, the Department managers manage and coordinate the recovery process (Plan BDR, 2010). 9. GENERIC RESPONSE ARRANGEMENTS FOR MANAGING DISRUPTION 10. A media strategy for internal and external stakeholders During a disaster, the flow of communication is crucial and without it, harmful disinformation and rumours will spread negating any recovery and continuity efforts. As such, an effective media strategy for the response must be developed. For internal stakeholders, the management should employ the use of text messaging. That is, departmental heads should be in constant touch with their juniors via text messaging to ensure timely and accurate information reaches them first hand. To mitigate against the risk of network errors, fliers along the hallways of the hospital is a viable option. For external stakeholders, radio and television broadcasts are the best mediums as it ensures quick and direct information to the affected. An effective broadcast shall ensure that the public will be satisfied that business will be run as normal in case of disruption and this will reduce the panic among people. 11. Plan development, review and training arrangements 12. Arrangements for embedding the plan into the day to day management systems and organization culture REFERENCES BCC MANAGEMENT. 2006. Maximum Tolerable Period of Disruption MTPOD. Retrieved 31st March, 2010 from http://www.bccmanagement.com/mtpod.html British Standards. 2006. Business Continuity. Impact Aware. How do I assign a Recovery Time Objective? http://www.impactaware.com/support/guide/how-do-i-assign-a-recovery-time-objective/ NCC Group. 2008. Papworth Hospital. Retrieved on the 30th of March, 2010 from http://www.nccgroup.co.uk/clients/consultancy-case-studies/papworth-hospital.aspx Number 10. 2002. NHS Foundation Hospitals. Retrieved on the 30th of March, 2010 from http://www.number10.gov.uk/Page2617 Papworth Hospital NHS Foundation Trust. 2010. About the Hospital. Retrieved on the 30th of March, 2010 from http://www.papworthhospital.nhs.uk/content.php?/about/ Pershing. 2010. Business Continuity for Pershing Employees (UK) http://www.pershing.com/3529.htm Plan BDR. 2010. Recovery Service Invocation. Retrieved 31st March 2010 from http://www.planbdr.co.uk/disaster-recovery/disaster-recovery-invocation/ Read More