[BCM] [NUHS] [E2] [C3] Common Pitfalls in Hospital BCM Implementation

Chapter 3

Common Pitfalls in Hospital BCM Implementation

Introduction

Singapore’s healthcare system is among the most advanced in the world, with hospitals operating at the cutting edge of technology and patient care.

Yet, even top-tier hospitals face pitfalls in Business Continuity Management (BCM) that can undermine resilience.

These pitfalls are not unique to Singapore, but the local healthcare environment—characterised by high digitalisation, regulatory oversight, and supply chain dependencies—makes them especially critical.

This chapter examines the common pitfalls in BCM implementation, supported by examples and lessons from the Singapore healthcare context.

Lack of Leadership Buy-In Beyond Compliance

Many hospitals initially treat BCM as a compliance requirement for Joint Commission International (JCI) or Ministry of Health (MOH) audits.

As a result, BCM becomes siloed under facilities or risk departments, rather than being integrated into hospital-wide strategy.

• Pitfall: Plans are created to “pass audits,” not to ensure real resilience.
• Case Study: A large, restructured hospital in Singapore prepared detailed pandemic response plans during the SARS outbreak in 2003. However, by the time COVID-19 emerged in 2020, parts of the plan were outdated. Leadership had not refreshed BCM as a living program, and quick adjustments were needed at the height of the crisis.

Incomplete Risk Analysis and Review (RAR) and Business Impact Analysis (BIA)

Hospitals sometimes underestimate indirect risks.

For instance, clinical teams may focus on patient-facing services, overlooking support functions such as sterile processing, labs, or blood bank services.

• Pitfall: Critical dependencies fall through the cracks, delaying recovery.
• Case Study: During COVID-19, Singapore hospitals realised their dependency on international PPE supply chains. Despite stockpiles, certain specialised items (e.g., N95 masks of specific grades) became scarce, affecting frontline safety. This highlighted the gap between paper-based BIAs and real-world interdependencies.

Siloed and Fragmented Planning

Hospitals are vast, with departments ranging from oncology to IT to facilities.

Without integration, each unit tends to develop isolated continuity plans.

• Pitfall: Fragmented responses during a crisis.
• Case Study: In the 2018 SingHealth cyberattack, the incident was initially treated as a technical issue within IT. However, it quickly became a hospital-wide crisis, affecting clinicians, administrators, and communications staff. The event demonstrated that cyber resilience must be a hospital-wide BCM priority, not just an IT responsibility.

Overemphasis on IT Disaster Recovery Alone

Singapore’s hospitals invest heavily in IT Disaster Recovery (IT DR) and cyber resilience, but BCM must extend beyond servers and databases.

• Pitfall: Plans assume that restoring IT systems equals restoring hospital functions.
• Case Study: After the SingHealth breach, hospitals rehearsed IT failover and data backup procedures, but clinicians also had to revert to manual patient records and treatment notes. This highlighted the importance of fallback procedures to ensure the continuity of patient care even when IT systems are offline.

Inadequate Testing and Exercising

BCM plans are only as firm as their testing. In Singapore, many hospitals run fire drills or table-top simulations for outbreaks.

However, broader BCM drills that cut across IT, facilities, clinical care, and communications are rare.

• Pitfall: Staff are unfamiliar with the real-life execution of continuity plans.
• Case Study: During the COVID-19 surge, drills at Tan Tock Seng Hospital (TTSH) helped rehearse outbreak response, but hospitals still had to adapt on the fly to issues such as staff fatigue, rapid expansion of isolation wards, and inter-hospital transfers. Limited scenario testing had not captured all these operational challenges.

Resource Constraints and Competing Priorities

Hospitals operate under immense pressure—high patient loads, manpower shortages, and financial constraints.

BCM is often deprioritised in favour of urgent clinical needs.

• Pitfall: Insufficient resources for BCM training, staffing, or drills.
• Case Study: During the Delta wave of COVID-19 in 2021, hospitals had to divert nearly all available manpower to frontline operations. Planned BCM exercises and updates were postponed, exposing the tension between long-term resilience and short-term crisis response.

Weak Crisis Communication Frameworks

Clear communication with staff, patients, and the public is vital. Yet many hospitals lack tested crisis communication frameworks.

• Pitfall: Confusing or delayed messages lead to misinformation and loss of trust.
• Case Study: In the aftermath of the SingHealth cyberattack, MOH and SingHealth had to issue coordinated public statements to reassure patients that medical care was not compromised, even though personal data was stolen. This event reinforced the need for pre-planned communication strategies and trained spokespersons.

Supply Chain Blind Spots

Singapore imports most of its pharmaceuticals, equipment, and consumables. While MOH maintains national stockpiles, hospitals often rely on just-in-time supply models.

• Pitfall: Lack of alternative sourcing strategies during global disruptions.
• Case Study: During COVID-19, Singapore hospitals faced challenges securing PPE, ventilators, and test kits when global supply chains froze. MOH stepped in with national-level coordination, but the experience revealed the importance of local BCM-driven supply chain resilience.

Failure to Maintain and Update Plans

BCM is not static—hospitals must update plans regularly to keep pace with new services, technologies, and risks.

• Pitfall: Plans sit on shelves, becoming outdated and irrelevant.
• Case Study: Telehealth adoption in Singapore surged during COVID-19, yet many BCM plans had not accounted for disruptions to telemedicine platforms or home-based care services. This gap left continuity procedures for remote patient management underdeveloped.

The Singapore healthcare environment offers excellent infrastructure and strong regulatory support, yet hospitals still face recurring challenges in BCM implementation.

The SingHealth cyberattack and the COVID-19 pandemic both highlighted how gaps in leadership commitment, testing, and supply chain planning can quickly escalate into systemic vulnerabilities.

Overcoming these pitfalls requires hospitals to move from BCM-as-compliance to BCM-as-strategy.

By embedding resilience into leadership priorities, supply chains, clinical operations, and communication frameworks, Singapore hospitals can strengthen their ability to protect patients, staff, and public trust during crises.

Avoiding the Pitfalls: Overcoming Key Challenges in Hospital BCM
C1	C2	C3	C4

More Information About Business Continuity Management Courses

To learn more about the course and schedule, click the buttons below for the BCM-300 Business Continuity Management Implementer [B-3] course and the BCM-5000 Business Continuity Management Expert Implementer [B-5].

	If you have any questions, click to contact us.