Increasing organisational resilience in the NHS

The Department of Health's NHS Resilience Project is promoting the adoption of the British Standard for Business Continuity Management (BCM) BS25999 to build collective resilience across the organisation. The recent launch of the NHS Standard BS NHS25999 further strengthens this initiative.
But what are the realities of implementing business continuity management within the NHS and more generally, a care services environment? How different is a care services setting to a ‘traditional' office environment? What are the likely challenges and how can the standard business continuity management approach be applied?

Over the past two years, Steelhenge has supported Primary Care Trusts and a number of other organisations involved with the care of vulnerable people in the delivery of their continuity objectives. This article explores our experience of adapting business continuity programmes for care services.

Intelligent BCM Programme Management
Whilst the benefits of BCM in ensuring continued delivery of critical services are clear in principle, gaining buy-in amongst staff and particularly front-line staff, where multiple initiatives, targets and drives for change frequently take an already overstretched workforce away from the ‘day job', can be an obstacle. An autocratic directive from the top and allocated resource may be all that's required in a commercial environment, however, the care sector may require more compelling powers of persuasion.
This buy-in will be greatly helped by not only senior management commitment to the implementation of a business continuity management system (BCMS) but also gaining the same commitment and understanding at the tiers below this to ensure the resources and people with the right knowledge are involved in the project.
Steelhenge has found that having the ability to articulate the drivers and lasting benefits of the project (beyond the legal requirement) in a language that staff will understand is essential. Patient welfare is at the sharp end of the care services world and business continuity needs to be explained in this context.
Meaningful Business Impact Analysis (BIA)
Conducting the Business Impact Analysis (BIA) can be hugely resource intensive. However, the Steelhenge team found a practical, phased approach to the BIA process worked well whilst still gathering the quality of data needed. This avoids the process becoming an overly onerous and time-intensive task for the staff involved.
Taking the time to tailor the BIA so that it uses relevant language is also important. Where traditional BIA's focus on incremental work area recovery requirements, such as desk spaces, IT and data, this means little to, for example, a care home manager whose primary focus is on feeding, clothing and care of the patients. Whilst the care sector has become increasingly reliant on systems, staff, their knowledge and day to day essentials such as personal protective equipment remain core.
A care services Business Impact Analysis should also consider multiple and community based working environments, specialist medical equipment and priority items for salvage that may be difficult or expensive to replace. It should also make use of relevant impact criteria e.g. possibly a greater emphasis on threat to human life rather than lost revenue.
Pragmatic Site Risk Assessment
Conducting a site risk assessment (or finding out whether one has ever been done) as part of the business continuity programme can be particularly useful in a care services setting. It is not unusual for services to run out of ageing or problematic buildings. A site risk assessment can sometimes reveal a whole host of issues, such as inappropriate storage of a hazardous substance or a lapse in fire and evacuation rehearsals that could lead to a BC incident.
Action Orientated Plan Development
Care services often encompass a wide geographical area and multiple sites - for example, district nurses. Therefore the approach to planning has to be applicable and useful for those people whom the plans support. The plans need to be pragmatic and action orientated covering both services and the physical locations.
A useful way of ensuring key areas are covered is to focus on key scenarios. Business continuity plan development workshops that explore the response to these scenarios can be an economical and effective mechanism to achieve this alongside gaining ownership of the plans.
Build on Existing Strengths
Lastly, it is important to remember that the NHS has a good record of responding well to ‘big-bang' events. The last couple of years have seen many care organisations focused on pandemic flu planning. This coupled with experience gained during periods of snow and flooding has forced many organisations to examine their continuity priorities. Many NHS organisations will also already have well developed Major Incident Plans and care service staff are often used to dealing with incidents.
With a bit of thought and tailoring, all these strengths can be built on and applied to a standard business continuity programme without completely reinventing the wheel to achieve lasting results.

About the author
Dominic Cockram is the founder and Managing Director of Steelhenge Consulting Ltd, specialists in business continuity and crisis management. Special thanks to Rebecca Norton, Project Manager with Steelhenge Consulting, for her extensive contribution to this article.

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