Significance of contingency planning in Health care delivery.

1. Shoeb Ahmed Ilyas, Health Care Consultant Ruby Med Plus
1
Contingency Planning in Health Care
Delivery
Author: ShoebAhmedIlyas/ShoebAhmed
Healthcare Consultant
Email:shoebilyas@gmail.com
Introduction
Let us look carefully and try to understand and to do so let us probe beneath the surface and
try to decipher the particular form of mind which is coming to birth in the womb of the earth
today. Beneath a change of age lies a change of thought.
—Pierre Teilhard de Chardin
Defining Contingency Management
Contingency management is defined as the "dominant management paradigm" in management
literature and practice and is used to analyze the impact of potential crises and ensure that
adequate and appropriate arrangements are made in advance to respond in a timely, effective
and appropriate way.
Contingency planning in above situation refers to a coordinated strategy involving plans,
procedures, and technical measures that enable the recovery of digital RVG system, operations,
and data after a disruption.
Effective contingency planning, execution, and testing are essential to mitigate the risk of digital
RVG system and service unavailability. In order for contingency planning to be successful Dental
staff will be ensured of the following key points:
1. Understand the Dental Radiology Contingency Planning Process and its place within the
overall Continuity of Operations Plan and Business Continuity Plan process.
2. Develop the contingency policy and planning process and apply the elements of the planning
cycle, including preliminary planning, business impact analysis, alternate site selection, and
recovery strategies.
3. Develop Dental Radiology contingency planning policies and plans with emphasis on
maintenance, training, and exercising the contingency plan.

2. Shoeb Ahmed Ilyas, Health Care Consultant Ruby Med Plus
2
Basic Pre-requisites for Contingency Planning Process
Best practices as illustrated in management literature show that the following issues are of
critical importance in the success of contingency planning-
Commitment
The success of contingency planning depends on a strong commitment and appropriate
leadership of Dental Hospital management and senior dental staff, who ensure that radiology
department is committed to the contingency planning process and that the necessary
resources, both human and financial, are provided and follow-up actions are taken.
Establishing a Steering Groupof Senior Dental Staff
Establishing a steering group of senior dental staff, helps to ensure a balance between
participation and effective management, particularly in situations of breakdown of digital RVG
These employees will be responsible for providing overall strategic direction and guidance to
the contingency planning process and ensure that adequate resources are available to keep the
process active and also approve the contingency plan, monitor implementation of the
preparedness actions identified.
Establishing a Technical-level Contingency Planning Working Group
The above steering group will manage the practical planning process. It will ensure that
plans are in line with the overall planning framework. It will consolidate the results of different
elements of the planning process and ensure that contingency issues are addressed.
Structuring the Contingency Planning Process
Mapping out the contingency planning process, will articulate key timelines meetings and
outputs so that progress can be monitored by all participants.

3. Shoeb Ahmed Ilyas, Health Care Consultant Ruby Med Plus
3
Steps in contingency planning
Feasibility of starting contingency planning process that a Dental
Hospital Radiology department may apply to develop and maintain a
viable contingency planning program
Undertaking a Hazard and Risk Analysis
It is virtually impossible to completely eliminate all risks, hence Identifying hazards
and determining their likelihood and impact is the first step in the analytical process of
contingency plan. In planning, for a specific emergency, it is important to begin with a broad
analysis of all the hazards potentially affecting the operation of radiology department to ensure
that the full range of risks is considered.
Hence in above situation, Contingency planning will be designed to mitigate the
risk of Digital RVG systemand service unavailability by focusing effective and efficient recovery
solutions.
A thorough risk assessment be supposed to identify the systemvulnerabilities, threat, and
current controls and attempt to determine the risk based on the likelihood and threat impact,
hence Dental Radiology department should focus on risk management which identifies threats
and vulnerabilities so that appropriate controls can be put into place to either prevent incidents

4. Shoeb Ahmed Ilyas, Health Care Consultant Ruby Med Plus
4
from happening or to limit the effects of an incident. These security controls protect a Digital
RVG system against three classifications of threats-
 Natural—e.g., hurricane and fire
 Human—e.g., operator error, sabotage, implant of malicious code……etc.,
 Environmental—e.g., equipment failure, software error, and electric power failure.
Second, Dental radiology department must also identify residual risks for which contingency
plans must be put into place, as it will be very closely related to the results of the risk
assessment and its mitigation process.
Contingency planning as an Element of Risk Management
Implementation have to consider system development life cycle
Initiation Phase- Digital RVG systemrequirements are identified and matched to their
related operational processes, and initial contingency requirements may become apparent.
Usually very high system availability requirements may indicate that redundant, real-time
mirroring at an alternate site and fail-over capabilities should be built into the system design.
Development/Acquisition Phase- Contingency plan may include Preventive steps such
as redundant communications paths, lack of single points of failure, enhanced fault tolerance of
network components and interfaces, power management systems with appropriately sized
backup power sources, load balancing, and data mirroring and replication to ensure a uniformly
robust system, same requirements are considered for alternate site in case of breakdown.
Implementation Phase- Here contingency strategies will be tested to ensure that technical
features and recovery procedures are accurate and effective. When these contingency
measures have been verified, they are clearly documented in the contingency plan.
Operational / Maintenance Phase. When the system is operational, dental employees of
radiology department must maintain a training and awareness program which covers the
contingency plan procedures. Exercises and tests are conducted to ensure that the procedures
continue to be effective. Coordination and documenting changes in the plan may be performed
in a timely manner to maintain an effective plan.
Disposal Phase- Contingency considerations are not neglected because a Digital RVG
system may be retired and another systemreplaces it. Until the new system is operational and
fully tested, the original systems contingency plan may be ready for implementation.
Business Continuity Plan (BCP)
It will focus on sustaining a Dental Hospital business functions during and after a
disruption by addressing short term recovery of processes and return to normal operations. It

5. Shoeb Ahmed Ilyas, Health Care Consultant Ruby Med Plus
5
may focus on adding, disaster recovery plan and business resumption plan. It will coordinate
Responsibilities and priorities set in the BCP with those in the Continuity of Operations Plan
(COOP) to eliminate possible conflicts.
Continuity of Operations Plan (COOP)
It will focus on restoring radiology department essential functions at an alternate site
or room before returning to normal operations.
Continuity of Support Plan
It will develop and maintain continuity of support plans for general support systems
and contingency plans for major applications.
IDENTIFYING PREVENTIVE CONTROLS IN CONTINGENCY PLAN
Preventive controls are documented in the contingency plan, and employees
associated with the RVG system must be trained on how and when to use the controls. These
controls will be maintained in good condition to ensure their effectiveness in an emergency.
 RVG equipment, including components supporting are connected to an appropriately
sized uninterruptible power supply (UPS) that provides 45 minutes to 1 hour of
electricity during a power failure. (Including environmental and safety controls).
 Gasoline- or diesel-powered generators must be fully operational at the time of
breakdown to provide long-term backup power.
 Current backups of the application software and Diagnostic data must be intact and
available at the offsite storage facility.
 Fire suppression systems.
 Emergency master systemshutdown switch to switch off RVG.
 Technical security controls, such as cryptographic key management and least-privilege
access controls
Developing Recovery Strategy-
Service agreements are maintained with provider of hardware, software, and quick
communication protocol with provider to support the emergency system recovery. RVG digital
System diagnostic data may be backed up daily. It must also consider location of stored data,
file-naming conventions, media rotation frequency and method for transporting data offsite.
Diagnostic Data may be backed up on magnetic disk, tape, or optical disks (such as compact
disks [CDs}.

6. Shoeb Ahmed Ilyas, Health Care Consultant Ruby Med Plus
6
Developing contingency Plan
Establishing a task force of a few employees from radiology department or naming a key
employee with authority to get the plan done. Key alternatives may also include:
 Keeping duplicate records at a different site.
 Keeping backup equipment necessary to continue basic operations at a location other
than the worksite and by updating the plan at least annually.
 A valid option of contract can be made with the alternate Dental Practice in City, as the
dental hospital alternate operating facility during an emergency/Beak-down situation
which will be used to take Diagnostic X-rays processing throughout the period of
disruption, until the return to normal operations.
 Crisis Communications Plan for Dental Radiology Department may prepare internal and
external communications procedures with Hospital Management and contractor
responsible for maintenance.
Plan testing, training and exercise
The developed contingency plan should be tested appropriately. Training of dental
employees engaged in contingency plan must be given with appropriate mock drills.
Plan Maintenance
Hospital management should support contingency plan by proper resource allocation and plan
maintenance.

7. Shoeb Ahmed Ilyas, Health Care Consultant Ruby Med Plus
7