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

The purpose of this preparedness phase is to ensure that Woodlands Hospital is operationally, clinically, and organisationally ready to respond rapidly to the closure of multiple inpatient wards while maintaining patient safety, continuity of care, and essential hospital services.

Effective preparedness minimises disruption, shortens recovery time, and enables hospital leadership to make informed decisions under pressure.

This phase should be reviewed annually and after every major exercise or incident.

1. Governance and Crisis Preparedness

Objective

Establish governance structures, accountability, and decision-making processes before a crisis occurs.

Activities

1.1 Establish the Crisis Management Team (CMT)

The Hospital Chief Executive shall appoint members of the Crisis Management Team.

Typical members include:

• Hospital Chief Executive (Crisis Director)
• Chief Operating Officer
• Chairman, Medical Board
• Director of Nursing
• Director of Clinical Services
• Facilities Management Director
• Infection Prevention and Control Lead
• Emergency Department Director
• Pharmacy Director
• Human Resource Director
• Information Technology Director
• Corporate Communications Manager
• Security Manager
• Business Continuity Manager
• Finance Representative

Deliverables

• Updated CMT organisation chart
• Appointment letters
• Contact directory
• Duty roster

1.2 Define Crisis Roles

Each member shall have documented responsibilities.

Examples include:

• Strategic decision making
• Clinical oversight
• Resource allocation
• Media management
• Regulatory reporting
• Staff welfare
• Recovery coordination

Deliverables

• Role cards
• Responsibility matrix (RACI)
• Delegation authority

1.3 Maintain Crisis Contact Directory

Maintain updated contacts for:

Internal

• Executive Management
• Department Heads
• Ward Managers
• Engineering
• Security
• Pharmacy
• Laboratory
• Radiology
• ICT Support

External

• Ministry of Health
• Singapore Civil Defence Force
• Police
• National Centre for Infectious Diseases
• National Healthcare Group
• Partner hospitals
• Ambulance providers
• Medical suppliers
• Utility providers
• Cleaning contractors

Review frequency

• Monthly

2. Risk Assessment

Objective

Identify scenarios that could result in multiple ward closures.

Activities

Conduct annual risk assessments covering:

Infrastructure Risks

• Fire
• Flooding
• Ceiling collapse
• Structural defects
• Lift failure
• Water leakage

Utility Failures

• Electrical outage
• Oxygen supply interruption
• Medical gas failure
• HVAC malfunction
• Water supply interruption

Clinical Risks

• Infectious disease outbreaks
• Drug-resistant organism outbreaks
• Hazardous material exposure
• Radiation contamination

Technology Risks

• Electronic Medical Record outage
• Network failure
• Cyberattack
• Medical equipment system failure

Security Risks

• Bomb threats
• Active assailant
• Civil disturbance
• Suspicious package

Environmental Risks

• Haze
• Pandemic
• Extreme weather
• Vector-borne disease outbreaks

Deliverables

• Risk Register
• Risk Heat Map
• Risk Treatment Plan

Review frequency

• Annually

3. Ward Dependency Assessment

Objective

Understand dependencies that may affect patient care.

Assess

Critical Infrastructure

• Oxygen supply
• Vacuum systems
• Medical gas
• Air-conditioning
• Water
• Electricity
• Nurse call systems

Clinical Dependencies

• Pharmacy
• Laboratory
• Radiology
• ICU
• Operating Theatre
• CSSD
• Blood Bank

Technology Dependencies

• Electronic Medical Records
• PACS
• Medication systems
• Bed Management System

Deliverables

• Ward Dependency Map
• Critical Service Inventory

4. Bed Capacity Planning

Objective

Prepare contingency plans for sudden loss of inpatient capacity.

Activities

Determine:

• Normal bed capacity
• Surge bed capacity
• Temporary treatment areas
• Step-down wards
• Isolation wards
• Community Hospital capacity

Identify locations that can be converted into:

• Observation wards
• Holding areas
• Temporary inpatient areas

Develop

Bed Escalation Levels

Level 1

<10% bed loss

Level 2

10–20% bed loss

Level 3

20–40% bed loss

Level 4

40% bed loss

Deliverables

• Surge Capacity Plan
• Overflow Ward Plan
• Bed Allocation Matrix

5. Patient Transfer Planning

Objective

Ensure rapid relocation of patients.

Develop prioritisation categories

Priority 1

Critical Care Patients

Priority 2

High Dependency Patients

Priority 3

Isolation Patients

Priority 4

General Medical Patients

Priority 5

Discharge-ready Patients

Prepare agreements with

• Partner hospitals
• Community hospitals
• Nursing homes
• Ambulance providers

Prepare

• Transfer documentation
• Patient tracking forms
• Medical handover templates

6. Workforce Preparedness

Objective

Ensure sufficient staffing during ward closures.

Develop

Reserve Staffing Pool

Include

• Nurses
• Doctors
• Allied Health
• Administrative staff
• Porters
• Patient service associates

Prepare

Cross-training programmes

Ensure staff can support:

• Alternative wards
• Isolation wards
• Emergency Department
• Temporary wards

Develop

Fatigue Management Policy

Including

• Maximum shift duration
• Rest periods
• Staff accommodation
• Transportation support

7. Clinical Continuity Planning

Objective

Maintain essential clinical services.

Identify Critical Services

• Emergency Department
• ICU
• Operating Theatre
• Pharmacy
• Dialysis
• Imaging
• Laboratory
• Blood Bank

Develop prioritisation criteria for

Continue

• Emergency surgery
• Trauma
• Stroke
• Acute cardiac care
• Intensive care

Postpone

• Elective surgery
• Routine admissions
• Non-essential clinics

8. Medical Equipment Preparedness

Objective

Ensure equipment availability.

Prepare an inventory of

• Ventilators
• Monitors
• Infusion pumps
• Portable X-ray
• ECG machines
• Defibrillators
• Portable oxygen

Maintain

• Preventive maintenance
• Backup equipment
• Equipment loan agreements

9. Pharmaceutical Preparedness

Maintain a contingency stock of

• Emergency medications
• IV fluids
• Antibiotics
• Isolation medications
• PPE
• Oxygen cylinders

Review

• Minimum stock levels
• Supplier arrangements
• Emergency procurement process

10. Facilities and Engineering Preparedness

Prepare contingency procedures for

• HVAC shutdown
• Water contamination
• Medical gas failure
• Electrical failure
• Lift failure
• Fire suppression activation

Maintain

• Preventive maintenance schedule
• Emergency repair contracts
• Backup generators
• Portable cooling systems

11. Infection Prevention and Control (IPC) Preparedness

Develop outbreak response plans for

• COVID-19
• Influenza
• Tuberculosis
• MRSA
• VRE
• Norovirus
• Emerging infectious diseases

Prepare

• Isolation protocols
• PPE deployment plans
• Cohorting strategies
• Environmental cleaning procedures

Conduct

• Routine IPC audits
• Staff competency assessments

12. Information Technology Preparedness

Ensure the resilience of

• Electronic Medical Records
• Bed Management System
• Staff communication platforms
• Telephony
• Internet connectivity
• Clinical systems

Prepare

• System recovery procedures
• Manual documentation forms
• Downtime workflows

13. Communications Preparedness

Prepare communication templates for

Internal

• Staff advisory
• Executive briefing
• Department update
• Clinical alert

External

• Patient notification
• Family notification
• Media holding statement
• Public advisory
• Ministry of Health notification
• NHG Health update

Develop

• Communication approval workflow
• Media spokesperson list
• Frequently Asked Questions (FAQs)

14. Business Continuity Preparedness

Ensure every department maintains updated Business Continuity Plans covering

• Minimum staffing levels
• Recovery priorities
• Alternate work locations
• Manual workarounds
• Critical suppliers
• Resource requirements

Validate recovery priorities through annual reviews.

15. Logistics Preparedness

Pre-position critical resources

• Beds
• Mattresses
• Wheelchairs
• Stretchers
• Linen
• Meals
• Medical supplies
• Cleaning equipment
• PPE

Develop

• Emergency replenishment procedures
• Supplier escalation contacts
• Inventory monitoring dashboard

16. Training and Competency

Conduct mandatory training on

• Hospital Crisis Management Plan
• Hospital Incident Command System (HICS)
• Ward evacuation
• Patient relocation
• Infection control
• Communication protocols
• Business continuity procedures

Training frequency

• Orientation for new staff
• Annual refresher training
• Competency assessments every two years

17. Exercises and Validation

Conduct progressive exercises throughout the year.

Discussion Exercise (Quarterly)

Review activation criteria, roles, communication procedures, and decision-making processes using realistic ward-closure scenarios.

Tabletop Exercise (Biannually)

Test crisis management processes with executive leadership, department heads, and clinical leaders, focusing on coordination, resource allocation, and patient flow.

Functional Exercise (Annually)

Validate the operational capability of critical functions such as bed management, patient transfers, emergency communications, logistics, and incident command without relocating actual patients.

Full-Scale Simulation (Every 2–3 Years)

Conduct a hospital-wide exercise involving simulated closure of multiple wards, requiring activation of the Crisis Management Team, patient relocation, coordination with external agencies, and recovery planning.

After-Action Review

Following every exercise or actual incident:

• Document strengths and improvement areas.
• Update the Crisis Management Plan, Business Continuity Plans, and Standard Operating Procedures.
• Assign corrective actions with owners and implementation timelines.
• Monitor completion of improvements through the hospital's governance process.