Heartbeat: Retaining resilience – learning from incidents
August 22, 2018
Photo caption: L-R: Head of Operations and Resilience, Caroline Rennalls; Emergency Planning Officer, Phil Stirling and Director of Communications, Ruth Wilkin at the major incident practice in February
Organisational resilience is key to ensuring we are prepared for any eventuality – from terrorist to cyber-attacks and floods to fires. Being on the frontline of the NHS, it is imperative that our organisation is able to provide the best possible care to our patients, even under the most pressurised situations.
Heartbeat spoke to Head of Operations and Resilience, Caroline Rennalls and Emergency Planning Officer, Phil Stirling to find out more about the measures in place to ensure we remain resilient.
“Each department has a business continuity plan (BCP),” said Caroline.
“This is specific to their area and is relevant for both clinical and non-clinical departments. It is a live document which can be updated at any time, but we are required to review it every year.”
Phil added: “The BCP outlines a range of scenarios and indicates the steps the department should take in order to continue their business as normal in the event of an incident occurring.”
The Civil Contingencies Act (2004) states that all NHS Trusts are required to have an emergency planning officer (EPO) and an accountable emergency officer (AEO).
“Our emergency preparedness, resilience and response (EPRR) group meets monthly and is chaired by Chief Operating Officer, Rachel Barlow, who is also our AEO,” said Caroline.
“The group is made up of both clinical and non-clinical colleagues.”
“We have also relaunched our Clinical Management of Mass Casualties group (CMMC),” said Phil.
“This is chaired by Critical Care Clinical Lead, Dr Nick Sherwood, who is our Trust clinical lead for emergency planning, preparedness and response. Each clinical group identifies consultant leads to sit on the CMMC group. Any issues which are identified at this group are then taken forward and discussed at the EPRR group.”
As well as having a robust governance structure in place, Caroline and Phil oversee a comprehensive training programme, which test our assumptions and processes, but also allows for colleagues to practice and learn in a safe environment.
“Every three years we host a multi-agent live major incident practice,” said Phil.
“Our last one took place in February this year at Sandwell Hospital and involved colleagues handling an influx of pretend causalities following the scenario of a shooting at New Square Shopping Centre.”
Caroline continued: “In addition to the live exercise, we host regular table top exercises, where we talk through a scenario and the steps that people would take. NHS England core standards state that we should do this twice a year, but we exceed that.
“We also hold tests of our communications twice a year and carry out monthly radio tests.”
Although there have been no major incidents declared in our organisation for the past few years, there have been a number of critical incidents and occasions when teams have had to revert to their business continuity plans.
Caroline and Phil told Heartbeat what some of these incidents have been and also explained the process in which the incidents are managed.
Phil said: “In the last couple of years we haven’t had to declare a major incident, but we have had a range of critical incidents. These have included flooding, loss of water, severe weather, generator loss, IT outages, a bomb threat and strikes.”
Caroline added: “The way we manage an incident is the same whether it is classed as critical or major.
“We are able to open an incident command centre 24 hours a day, seven days a week at any of our hospital sites.
“We use a command/control structure and we open two incident rooms – strategic and tactical. We have a strategic commander, a tactical commander and then operational commanders. It is through these commanders that we co-ordinate our response to the incident and then plan our recovery.
“Once the incident is stood down, it is important that we are able to learn from it. A hot debrief takes place as soon as possible and is then followed up with a cold debrief, which takes place within six weeks.
“Waiting six weeks allows colleagues to reflect on the incident and see if anything has changed, whether it’s back to normal or if it is now a new normal. The cold debriefs are open and transparent and we assess if any harm occurred as a result of the incident and identify any lessons learned. The findings of these debriefs are then reported back to the EPPR group.”
Phil added: “We have recently introduced a new method of scheduling cold debriefs to ensure that they can happen within the six week timeframe. A session is now pencilled in the diary each month and should an incident occur it can be discussed at the time already allocated.”
Caroline concluded: “Learning from our incidents and ensuring we make the most of our regular training sessions is key to ensuring that we remain resilient as an organisation. We have made some real positive steps during the last year, but we will continue to look at ways we can improve and be prepared for whatever incident may come our way.”
Top 3 achievements
- The way in which we declare and notify people of an incident is much improved
- Execs and senior managers receive specialised training before going on the on-call rota and also now receive annual training
- Business continuity folders are in place in every department throughout the organisation
Top 3 things to work on
- We need to increase the amount of trained loggists that we can call on during an incident
- We need to further embed the business continuity plans to ensure that all colleagues have knowledge and understanding
- We need to ensure that action cards are ready for the roll out of the 7-2-4 element of Unity