Managing pandemic influenza in general practice


A guide for preparation, response and recovery

6.4 Business continuity

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Every business needs a business continuity plan. A pandemic business continuity plan sets out how to prepare for a pandemic and continue to operate during and after the disaster. General practices require the capacity to respond to the health needs of patients while ensuring both the protection of staff and business continuity – which may include periods without any external assistance or supplies. In the event of a pandemic, it may be days before any information, advice, assistance or awareness of an issue occurs and is acted upon by authorities.

As part of pandemic planning, the pandemic coordinator should schedule a meeting to develop the business contingency plan. The plan needs to consider:1

  • identifying the critical functions that need to be sustained (including periods without supplies)
  • identifying the personnel, supplies and equipment vital to maintain critical functions
  • how to deal with staff absenteeism to minimise its impact on critical functions
  • clear command structures, delegations of authority and orders of succession
  • assessing the need to stockpile strategic reserves of supplies, material and equipment
  • identifying services that could be downsized or closed
  • assigning and training alternative staff for critical posts
  • establishing guidelines for priority of access to essential services
  • the training of staff in workplace infection prevention and control, and communication of essential safety messages
  • ways of reducing social contact (eg. working from home and reducing the number of physical meetings and travel)
  • the need for family and childcare support for essential workers
  • the need for psychosocial support services to help workers to remain effective
  • a plan for the recovery phase
  • strategic planning of financial obligations
  • communication of how the practice will run during a pandemic to staff, patients, clients and the community.

General practices need to identify their ‘break point’ – the point where an organisation can no longer maintain available services in a safe manner due to identified risk in workplace health and safety. This could be due to insufficient staffing levels through absenteeism or the disruption of services or resources on which the practice depends.

 

6.4.1 Human resources management


Practices need to develop practice-specific policies to support human resource management and the provision of safe healthcare to patients. When planning a pandemic roster, practices should factor in changes in situation for employees, and heightened distress during a pandemic, which might not be apparent during planning as circumstances and risk may change (eg. a staff member might become pregnant, the virus may have a high mortality rate), as well as restrictions on travel that may apply.

Additionally, as a significant number of women work in the healthcare sector (and may have dependent school-aged children), their ability to work during a pandemic may be affected if schools are forced to close.37

Other factors, such as availability of PPE, vaccinations and antivirals, also affect the willingness of staff to continue to work through a pandemic.38–40 A high proportion of general practice respondents to an Australian study into attitudes to pandemic influenza indicated that they would need access to vaccines and antiviral medication for themselves and for their families in order to consider treating patients.39

Workplace absenteeism due to staff illness and other factors during a pandemic is inevitable. Estimates suggest that businesses should plan for 30–50% staff absence at the peak of a pandemic.41 Establish contingency plans for continuation of critical business processes at less than full capacity. Identify the functions that are critical for practice survival and which staff members provide these functions.

A key to successfully navigating a business through a disaster is having some flexibility in the sharing of roles and tasks. Practices should consider:

  • identifying staff members who can multitask to replace staff lost through absenteeism
  • training staff in alternative roles
  • making arrangements for staff to work from home (eg. GPs offsite can still write reports or perform telephone triage or patient telephone follow-up).

Rosters will need to be adjusted to cope with absenteeism due to fear, sickness, family needs or choosing to work in other capacities outside the practice.

Establish policies for employee compensation and sick leave absences unique to a pandemic (eg. non-punitive), including policies on when a previously ill practice staff member is no longer infectious and can return to work. Practices also need to discuss paying staff who elect not to work during a pandemic and how to avoid stigmatising those staff.12 In contrast, staff who elect to work during a pandemic can also be stigmatised as people may view them as being potentially infectious.

Practices also need to consider how to manage practice staff who have been exposed to pandemic influenza, are suspected to be ill or become ill in the practice (eg. infection control response, immediate mandatory sick leave). Practices should consider how they would manage employee evacuation.


6.4.2 Strategies to maintain workflow and manage surges


Practices should plan for possible practice modification (physical and procedural) during a pandemic. Strategies include:

  • flexible worksite (eg. working from home) and flexible hours (eg. staggered shifts)
  • e-health technologies (eg. e-consultation, e-prescribing, e-referrals)
  • postponement of non-essential/routine procedures/consultations
  • identifying potential additional staff sources such as local hospital casual staff, recently retired GPs and nurses, and volunteers through local/state public health and emergency services.

 

6.4.3 Relationships and sharing resources


Providing healthcare and managing a business during a pandemic requires coordination and collaboration. Where available, practices could consider identifying and developing arrangements with other local practices and businesses. For example:

  • local pharmacists, to ensure continuity of prescriptions for patients during a pandemic, particularly for patients living in residential aged care facilities
  • local hospitals
  • pathology services
  • allied healthcare professionals
  • local veterinary hospitals, which could provide additional PPE during shortages.

These arrangements may be formal or informal, depending on local need.


6.4.4 Financial resourcing


The principle of ‘as low as reasonably practicable’ (ALARP) is a risk management concept that may be useful when assessing the optimum level of financial resourcing to allocate to preparedness activities (see Figure 5). This requires that a vigorous risk assessment be performed.

Figure 5. Risk versus expenditure based on the ALARP (as low as reasonably practicable) principle

Risk versus expenditure

Reproduced with permission from State Emergency Management Committee, Western Australia, from: Emergency Preparedness Report 2012

  1. World Health Organization. Pandemic influenza risk management: WHO interim guidance. Geneva: WHO, 2013.
  2. Collins N, Litt J, Winzenberg T, Shaw K, Moore M. Plan your pandemic – guide for GPs. Aust Fam Physician 2008;37:794–99, 802–4.
  3. Sadique M, Adams EJ, Edmunds WJ. Estimating the costs of school closure for mitigating an influenza pandemic. BMC Public Health 2008;8:135.
  4. Devnani M. Factors associated with the willingness of health care personnel to work during an influenza public health emergency: an integrative review. Prehosp Disaster Med 2012;27:551–66.
  5. Seale H, Ward KF, Zwar N, Van D, Leask J, Macintyre CR. Examining the knowledge of and attitudes to pandemic influenza among general practice staff. Med J Aust 2010;192:378–80.
  6. Martin SD, Brown LM, Reid WM. Predictors of nurses’ intentions to work during the 2009 influenza A (H1N1) pandemic. Am J Nurs 2013;113:24–31.
  7. Department of Industry, Tourism and Resources. Being prepared for a human influenza pandemic: a business continuity plan for Australian businesses. Canberra: Department of Industry, Tourism and Resources, 2006.