[CM] [WH] [E3] [PB] [CS] [2] During-Crisis Steps for Closure of Multiple Wards

Closure of Multiple Wards Crisis Scenario for Woodlands Hospital (WH)

Detailed Steps During the Crisis

Response, Recovery, and Resume

Purpose

The response phase begins when a decision is made to close two or more inpatient wards, or when an incident significantly affects the hospital's ability to provide safe inpatient care.

The objective is to protect patients, staff, and visitors; maintain critical clinical services; coordinate hospital-wide decision-making; minimise operational disruption; and restore safe healthcare operations as quickly as possible.

This playbook adopts a structured crisis management approach comprising Assessment, Activation, Stabilisation, Response, Communication, Monitoring, and Transition to Recovery.

Response Objectives

During the crisis, the Crisis Management Team (CMT) shall:

• Protect life and patient safety.
• Ensure continuity of critical healthcare services.
• Prevent escalation of the incident.
• Maintain regulatory compliance.
• Preserve public confidence.
• Coordinate internal and external stakeholders.
• Prepare for orderly recovery.

Stage 1 – Incident Detection and Initial Notification

Objective

Detect the incident early and notify the appropriate hospital leadership promptly.

Step 1.1 Identify the Incident

The incident may be identified by:

• Ward Manager
• Nurse-in-Charge
• Facilities Management
• Infection Prevention and Control (IPC)
• Security
• Clinical Department
• Engineering Services
• Hospital Operations Centre
• Emergency Department
• Information Technology
• External agencies

Typical triggering events include:

• Infectious disease outbreak
• Fire or smoke contamination
• Water leakage
• Structural damage
• HVAC failure
• Medical gas failure
• Electrical outage
• Chemical spill
• Radiation incident
• Security threat

Step 1.2 Immediate Actions by the Discovering Staff

The discovering staff shall:

• Protect patients from immediate danger.
• Stop admissions into the affected ward(s).
• Notify the Ward Manager immediately.
• Inform the Hospital Operations Centre.
• Contact Security where appropriate.
• Activate emergency response if required.
• Preserve evidence if the incident involves a criminal or regulatory investigation.

Step 1.3 Initial Situation Report

Collect preliminary information, including:

• Time of incident
• Exact location
• Cause (known or suspected)
• Number of wards affected
• Number of patients
• Number of staff
• Immediate hazards
• Casualties
• Current containment actions

Stage 2 – Crisis Assessment

Objective

Determine whether the incident requires activation of the Crisis Management Team.

Step 2.1 Conduct Rapid Assessment

Assess:

Patient Safety

• Immediate danger
• Clinical deterioration risks
• Infection exposure
• Evacuation requirements

Clinical Services

• Bed availability
• ICU impact
• Emergency Department capacity
• Operating theatre impact
• Diagnostic services

Infrastructure

• Building integrity
• Utilities
• Air-conditioning
• Medical gases
• IT systems

Workforce

• Staff availability
• Staff exposure
• Specialist shortages

Reputation

• Public concern
• Media interest
• Social media activity

Step 2.2 Determine Crisis Level

Level 1

• Single ward closure
• Localised disruption

Level 2

• Multiple ward closures
• Significant patient relocation
• Hospital-wide coordination required

Level 3

• Major hospital crisis
• Large-scale evacuation
• Regional healthcare support required

Stage 3 – Crisis Activation

Objective

Mobilise hospital leadership.

Step 3.1 Activate the Crisis Management Team

The Hospital Chief Executive (or delegate) authorises activation.

Actions include:

• Notify CMT members.
• Activate Crisis Command Centre.
• Activate Business Continuity Plans.
• Assign Incident Commander.
• Schedule the first Crisis Management Team briefing.

Step 3.2 Activate Hospital Incident Command Structure

Assign functional leads:

• Operations
• Planning
• Logistics
• Finance
• Communications
• Clinical Operations
• Engineering
• Human Resources
• Infection Prevention and Control
• Information Technology

Step 3.3 Establish Operational Priorities

Typical priorities include:

Priority 1

Life safety

Priority 2

Patient care continuity

Priority 3

Containment

Priority 4

Resource allocation

Priority 5

Recovery planning

Stage 4 – Clinical Response

Objective

Maintain safe patient care.

Step 4.1 Stop Further Admissions

Suspend admissions into affected wards.

Notify:

• Emergency Department
• Bed Management Unit
• Admission Office
• Ambulance services

Step 4.2 Patient Clinical Review

Every patient shall be clinically assessed.

Categorise patients into:

Category A

Critical

Immediate transfer

Category B

High dependency

Transfer within hours

Category C

Stable inpatient

Relocate internally

Category D

Suitable for discharge

Expedited discharge

Step 4.3 Patient Relocation

Coordinate with:

• Bed Management
• Nursing
• Medical Departments
• Ambulance providers
• Partner hospitals

Consider:

• Infection status
• Clinical specialty
• Isolation requirements
• Medical equipment needs

Step 4.4 Clinical Service Prioritisation

Continue:

• Emergency surgery
• Intensive care
• Dialysis
• Stroke services
• Cardiac emergencies
• Oncology emergencies

Defer:

• Elective admissions
• Non-urgent surgery
• Routine procedures
• Non-essential clinics

Stage 5 – Infrastructure Response

Objective

Stabilise hospital facilities.

Engineering shall:

• Assess structural safety.
• Isolate affected utilities.
• Restore essential services.
• Secure affected wards.
• Coordinate specialist contractors.
• Monitor environmental conditions.

Stage 6 – Workforce Management

Objective

Maintain safe staffing.

Human Resources shall:

Implement:

• Staff redeployment
• Emergency rostering
• Shift extensions
• Standby activation
• Relief staffing

Provide:

• Meals
• Rest facilities
• Transport
• Psychological support

Stage 7 – Logistics Management

Objective

Support clinical operations.

Logistics shall monitor:

• Bed availability
• Wheelchairs
• Stretchers
• Oxygen
• Pharmacy supplies
• Linen
• PPE
• Meals
• Medical equipment

Activate emergency procurement if required.

Stage 8 – Infection Prevention and Control

Objective

Prevent secondary outbreaks.

IPC Team shall:

• Conduct an outbreak investigation.
• Isolate affected patients.
• Cohort patients where necessary.
• Increase environmental cleaning.
• Conduct staff surveillance.
• Monitor infection trends.
• Review PPE compliance.

Stage 9 – Information Technology Response

Objective

Maintain clinical information systems.

IT shall:

• Protect clinical systems.
• Activate downtime procedures if necessary.
• Restore affected applications.
• Support temporary workstations.
• Maintain cybersecurity monitoring.

Stage 10 – Communications Management

Objective

Deliver accurate, timely, and coordinated communications to all stakeholders.

Internal Communications

Issue regular updates to:

• Crisis Management Team
• Executive Leadership
• Department Heads
• Clinical staff
• Support services

Communications should cover:

• Situation updates
• Operational decisions
• Ward closures
• Patient relocation plans
• Staffing arrangements
• Safety instructions
• Recovery status

External Communications

Coordinate communications with:

• Ministry of Health
• National Healthcare Group
• Singapore Civil Defence Force (where applicable)
• Partner healthcare institutions
• Ambulance providers
• Suppliers and contractors

Patients and Families

Provide timely information on:

• Reason for ward closure
• Patient condition and location
• Transfer arrangements
• Visiting restrictions
• Alternative contact channels
• Expected timelines

Public and Media

All external statements shall be approved by the Crisis Director or authorised spokesperson.

Key messages should include:

• Nature of the incident
• Impact on hospital services
• Measures taken to ensure patient safety
• Service continuity arrangements
• Commitment to restoring normal operations

Monitor traditional and social media continuously to identify misinformation and respond where appropriate.

Stage 11 – Regulatory Reporting

Notify relevant authorities where required.

Typical notifications include:

• Ministry of Health
• National Healthcare Group
• Workplace Safety and Health authorities (if applicable)
• Public utilities (where applicable)
• Police or Singapore Civil Defence Force (where applicable)

Maintain records of:

• Notification time
• Contact person
• Information provided
• Required follow-up actions

Stage 12 – Situation Monitoring and Decision-Making

Objective

Maintain situational awareness and support evidence-based decisions.

Crisis Management Team Briefings

Conduct structured briefings at regular intervals:

• Every 2 hours during the initial response (or more frequently if conditions change rapidly)
• Every 4–6 hours once the situation stabilises
• Daily during prolonged incidents

Each briefing should review:

• Patient safety status
• Bed occupancy and surge capacity
• Staffing levels
• Infrastructure repairs
• Infection control status
• Logistics and supply levels
• Communications
• Emerging risks
• Outstanding decisions

Situation Reports (SITREPs)

Issue SITREPs to senior leadership and key stakeholders covering:

• Current incident status
• Number of wards closed
• Number of patients relocated
• Clinical service impacts
• Resource utilisation
• Key risks
• Planned actions for the next operational period

Stage 13 – Documentation

Maintain comprehensive records throughout the incident.

Documentation shall include:

• Crisis activation records
• Incident logs
• Decisions and approvals
• Resource requests
• Patient transfer records
• Communications issued
• Regulatory notifications
• Financial expenditures
• Contractor activities
• Clinical incidents
• Staff deployment records

All documentation should be retained for audit, legal, insurance, and post-incident review purposes.

Stage 14 – Transition to Recovery

Objective

Prepare for the controlled restoration of hospital operations.

Transition planning should begin once:

• Immediate risks have been contained.
• Patient safety is assured.
• Infrastructure stabilisation is underway.
• Clinical services are functioning safely.
• No further ward closures are anticipated.
• Engineering and IPC teams confirm that restoration activities can commence.

Before transitioning to the recovery phase, the Crisis Management Team should confirm:

• Temporary patient placements are stable.
• Staffing arrangements remain sustainable.
• Essential services continue without unacceptable risk.
• Communication plans for recovery have been prepared.
• Recovery objectives, responsibilities, and priorities have been agreed.

Response Phase Exit Criteria

The response phase concludes when the Crisis Management Team determines that:

• The incident has been stabilised, and no immediate threats remain.

• All affected patients have been safely relocated, discharged, or are receiving appropriate care.

• Clinical services are operating safely under temporary or restored arrangements.

• Infrastructure risks have been contained.

• Staff, patients, and visitors are no longer exposed to immediate danger.

• Regulatory reporting requirements have been met.

• The Crisis Management Team has formally authorised the transition to the Recovery Phase.

At this point, responsibility shifts from emergency response to Phase 3 – Recovery and Restoration, focusing on reopening wards, restoring normal healthcare services, supporting staff and patients, and implementing lessons learned to strengthen Woodlands Hospital's future resilience.

Click the icon for the crisis management playbook for the three stages: Pre-, During-, and Post-crisis

Introduction	Pre-Crisis	During Crisis	Post-Crisis
Closure of Campus	Preparedness and Prevention/ Reduction	Response, Recovery and Resume	Recovery, Restore and Return Home

More Information About Crisis Management Blended/ Hybrid Learning Courses

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

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