Menu MGMT703, Case 1, $23.p_. X + Create 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| @ All tools X Export a PDF Edit a PDF Richard Ivey School of Business The University of Western Ontario IVEY Create a PDF e Combine files TAI 9808C011 0 Organize pages Add comments INFLUENZA PANDEMIC PLANNING AT LHSC Request e-signatures A Scan & OCR David House wrote this case under the supervision of Elizabeth M. A. Grasby solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. Protect a PDF Ivey Management Services prohibits any form of reproduction, storage or transmittal without its written permission. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to Redact a PDF reproduce materials, contact Ivey Publishing, Ivey Management Services, clo Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada, N6A 3K7; phone (519) 661-3208; fax (519) 661-3882; e-mail cases@ivey.uwo.ca. Compress a PDF Copyright @ 2008, Ivey Management Services Version: (A) 2008-08-12 Prepare a form Fill & Sign It was late in the day during August 2007, and Cathy Stark, manager of occupational health and safety services at the London Health Sciences Centre (LHSC) in London, Ontario, Canada, was reviewing or use only in the course MGMT703- Section 001- 004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023. LHSC's proposed Pandemic Influenza Plan. She had been at a meeting with the planning team and was View more somewhat overwhelmed by the many issues that had to be considered in the event of an influenza Use outside these parameters is a copyright violation pandemic. She needed to grapple with many ethical concerns before the plan could be finalized. She also needed to decide how best to communicate the plan and wondered how the staff would react to some of the drastic measures that might have to be implemented if there was an influenza pandemic. 1 9 LONDON HEALTH SCIENCES CENTRE History The London Health Sciences Centre had its origins in 1875 as the London General Hospital, the first public hospital in the London region. By 2007, LHSC comprised three of London's largest hospitals - the South Q Street Hospital, University Hospital and Victoria Hospital - and employed more than 11,000 people. See Exhibit 1 for a breakdown of employees by occupation. Convert, edit, and e-sign PDF forms. Q Free 7-day tria Role and Jurisdiction LHSC was one of Canada's largest acute-care teaching hospitals. dedicated to excellence in patient care. 18'C Mostly sunny Q Search C ENG 9:52 AM US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| @ All tools X Role and Jurisdiction Export a PDF LHSC was one of Canada's largest acute-care teaching hospitals, dedicated to excellence in patient care, Authorized for use only in the teaching and research." Its facilities included 846 beds, and there had been 139,612 emergency visits and Edit a PDF 795,697 outpatient visits the previous year. LHSC was associated with The University of Western Ontario's Schulich School of Medicine & Dentistry (Schulich), wherein 645 medical residents and 683 Create a PDF e Combine files TAI An epidemic is a widespread outbreak of a disease in a geographic region; a pandemic is an epidemic that spreads to many regions or worldwide. The term "plague" is also used by the general public somewhat incorrectly. Plague is a disease caused by the yersinia pestis bacteria. 0 Organize pages LHSC website, www.lhsc.on.ca/about_us/LHSC/Who_We_Are/index.htm, accessed February 12, 2008. Add comments Request e-signatures A Scan & OCR Protect a PDF Redact a PDF Page 2 9B08C011 Compress a PDF Prepare a form nursing students were trained in the 2006-2007 academic year. LHSC's research activities were the third largest in Canada with a research budget in fiscal 2007 of more than $49 million, wherein 543 clinical Fill & Sign rials were initiated. LHSC also housed the Children's Hospital, the London Regional Cancer Program, the Lawson Health View more Research Institute, Canadian Surgical Technologies & Advanced Robotics, and the London Health Sciences Foundation. N Occupational Health and Safety Services The Occupational Health and Safety Services (OHSS) department was responsible for ensuring the health and safety of all the LHSC employees. Duties included ensuring compliance to the Ontario Occupational Health and Safety Act," providing health and safety training, waste management, ergonomic assessments itennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023 of workstations, counselling services and corporate wellness. OHSS was also responsible for infection control, which included pandemic planning. Refer to Exhibit 2 for a more detailed list of the OHSS's responsibilities. Q Convert, edit, and e-sign PDF forms. CATHY STARK Is is a copyright violation Free 7-day tria Cathy Stark, raised in Nova Scotia, Canada, moved to Ontario to attend The University of Waterloo where she earned her honours Bachelor of Science degree in health studies in 1988. Over the years, she worked in several positions throughout Southwestern Ontario as a health and safety expert in both the 18'C Mostly sunny Q Search O W O O A x P C ENG 9:52 AM US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| Q All tools X CATHY STARK Export a PDF Cathy Stark, raised in Nova Scotia, Canada, moved to Ontario to attend The University of Waterloo where Edit a PDF she earned her honours Bachelor of Science degree in health studies in 1988. Over the years, she worked in several positions throughout Southwestern Ontario as a health and safety expert in both the Create a PDF e manufacturing and health-care sectors, working in both non-union and unionized environments. In 2006, Use outside these parameters is a copyright violation she accepted the position of Occupational Health and Safety Services Manager at the London Health Combine files TAI Sciences Centre. 0 Organize pages INFLUENZA VIRUS Add comments Description Authorized for use only in the course MGMT703- Section 001-004-007 at Centennial College taught b Request e-signatures A virus is a particle ranging in size from 20 to 300 nanometres.* These particles can cause disease in A Scan & OCR animals and humans by replicating themselves within the body's cells. Serious human diseases caused by viruses include rabies, ebola, AIDS and influenza. A virus does not respond to antibiotics in the same way bacterial infections do, and a virus is generally more difficult to treat. In fact, treatment of viral diseases Protect a PDF focuses on prevention and frequently relies on vaccines that produce immunity to the virus. Redact a PDF Influenza virus, often called "the flu," is a disease of the lungs that can be spread in animals and humans. Every year, millions of Canadians contract influenza causing symptoms such as fever, runny nose, sore Compress a PDF throat, muscle pain, coughing and general fatigue. The virus is spread by droplets from coughing or sneezing and by physical contact with surfaces, such as door handles, that have already been contaminated Prepare a form by an infected person. A person can begin to infect other people one to three days prior to the appearance of virus symptoms. Most infected people recover completely within a week; however, approximately Fill & Sign The Ontario Health and Safety Act is provincial legislation that details the rights and duties of employers and employees in View more the workplace. A nanometre is one-billionth of a metre. Many people often refer to nausea and vomiting or symptoms of the common cold as the flu. The so-called stomach flu and the common cold are both different viruses from influenza. N Q Page 3 9B08C011 Convert, edit, and e-sign PDF forms. Free 7-day tria 20,000 Canadians need to be hospitalized each year, and an average of 4,000 Canadians die annually because of influenza and its complications. " Deaths generally occur only to the very young or the very old. 18'C Mostly sunny Q Search C ENG 9:52 AM US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create @ 4 Sign in 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| Q X Page 3 9B08C011 All tools Export a PDF 20,000 Canadians need to be hospitalized each year, and an average of 4,000 Canadians die annually Q= because of influenza and its complications." Deaths generally occur only to the very young or the very old. 88 Edit a PDF Create a PDF e Preventative Measures Combine files TAI Standard measures to reduce the risk of spreading influenza include: Receiving annual influenza immunization shots. 0 Organize pages Washing hands frequently. Maintaining a one-metre distance from individuals who are coughing or sneezing. Add comments Avoiding activities where large numbers of people gather in enclosed spaces. Cleaning surfaces in the homes where someone is ill with influenza Request e-signatures Staying home from school or work if ill with influenza. A Scan & OCR The Influenza Vaccine Protect a PDF The influenza vaccine is available at no cost to all residents of Ontario, and provincial health officials Redact a PDF strongly recommend that the population be vaccinated each year. The vaccine is developed by growing live virus and subsequently rendering it inactive. This vaccine, when injected into the bloodstream, causes Compress a PDF the human body to develop immunity to the live virus. The vaccine must be given each year since the influenza virus mutates frequently and an older vaccine might provide no immunity to a person infected with a newer mutation. Prepare a form Use outside these parameters is a copyright violation. Authorized for use only in the course MGMT703- Section 001-004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023 Fill & Sign Canada was one of the few countries in the world that had contracted a vaccine manufacturer to develop and supply influenza vaccine in the event of a pandemic. GlaxoSmithKline' had signed a contract with the government of Canada to provide enough vaccine for every person in Canada. The primary problem with View more this plan was that, after the beginning of an outbreak, a vaccine could take as long as six months to develop, and most predictions indicated that the pandemic would reach Canada in as few as three months after the initial outbreak. w Anti-virals Medications were available to treat people who became sick with influenza. The most notable was oseltamivir, which was sold under the name "Tamiflu." This medication was developed by Gilead Sciences and was subsequently marketed by Roche." This treatment reduced symptoms and shortened the length of illness by reducing the ability of the virus to reproduce within the human body. Canada had stockpiled this medication but did not yet have enough for every person who might become infected. Q Health professionals were also concerned that anti-virals were not completely effective at curing influenza Convert, edit, and e-sign PDF forms. and that they could lead to strains of the virus that had a resistance to the anti-viral medication Free 7-day tria ."Highlights from the Canadian Pandemic Influenza Plan for the Health Sector," Copyright Her Majesty the Queen in Right of Canada, 2006 GlaxoSmithKline, headquartered in the United Kingdom, employed over 100,000 people worldwide and had sales of $23 18'C Q Search ENG 9:52 AM Mostly sunny US 2023-06-15 3Menu MGMT703, Case 1, $23.p_. X + Create - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| Q Page 4 9B08C011 All tools X Export a PDF Recently, there has been growing concern about an influenza virus that had spread through birds (popularly referred to as "bird flu")"in Southeast Asia. This virus had caused a high death rate in chickens and had Edit a PDF caused mild illness in migratory waterfowl. The virus was not easily transmitted to humans, but it had a high death rate in cases where people had handled infected birds. In an effort to prevent the spread of this Create a PDF e avian influenza, millions of birds had been slaughtered Combine files TAI Health experts were extremely concerned that this type of influenza virus could mutate, facilitating its ability to spread easily among humans. Because this would be a new strain of influenza, humans would 0 Organize pages have no immunity to the disease, and it could potentially spread easily throughout the population. Add comments INFLUENZA PANDEMIC" Request e-signatures The most notorious influenza pandemic was the Spanish Flu outbreak in 1918, which was estimated to A Scan & OCR have killed between 40 million and 50 million people worldwide. This flu strain had an extremely high infection rate of approximately 50 per cent and produced very severe and unusual symptoms, including hemorrhaging (bleeding) of the nose, stomach, intestines and ears. The strain also killed a high percentage Protect a PDF of young adults. This was quite different than typical influenza strains, which usually killed only infants or the very old. See Exhibit 3 for a list of other historical influenza pandemics Redact a PDF If a new strain of influenza virus, such as a mutation of the avian flu, were introduced into the human Compress a PDF population, it is believed that it would spread quickly because of the lack of immunity to that specific strain and because infected people now travel rapidly from one country to another by air. If such a mutation Prepare a form occurred, Canadian health officials believed that the disease would appear in Canada within three months Authorized for use only in the course MGMT703- Section 001- 004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023. Use outside these parameters is a copyright violation after developing elsewhere in the world (most likely Southeast Asia). It was estimated that the pandemic Fill & Sign would last 12 to 18 months and would probably come in waves, with each wave lasting six to eight weeks. View more It was believed that the impact of this pandemic on the population would be considerable, and it was expected that up to 70 per cent of the population could become infected. At its peak, the pandemic could cause a 25 per cent absenteeism rate for businesses because employees would either be ill themselves or they would be caring for relatives who were sick. This would have a massive economic impact, including A lost employee productivity, the disruption of supply chains, a drop in customer demand and possible facility shutdowns. In addition, schools and universities could close during the pandemic. Exhibit 4 9 provides a detailed breakdown of an influenza pandemic's health impact in Canada. PANDEMIC PLANNING Because of the enormous impact of a potential influenza pandemic, advanced planning for such an event Q had to be done at the international, national, provincial and institutional level. Both the federal government of Canada and the provincial government of Ontario had worked on plans and maintained websites that Convert, edit, and e-sign PDF forms. could provide businesses and the public with information about influenza and pandemic contingencies. LHSC had information about pandemic planning available to its employees on its intranet and planned to Free 7-day tria post information on its website publicly within the next few months. 18'C Q Search C ENG Mostly sunny WOOA P 9:52 AM US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create On s - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| @ All tools X As the manager of occupational health and safety services, Stark was part of the pandemic planning team Export a PDF at LHSC. Detailed planning was particularly important at hospitals because of the extreme situation they were expected to manage. Hospitals normally worked close to full capacity in dealing with the daily health Edit a PDF care of the population. In the event of an influenza pandemic, many more people would seek medical care, overtaxing the hospital's ability to service everyone. Additionally, the hospital's staff (including doctors Create a PDF e and nurses) would also get sick at the same rate (or at a greater rate due to exposure) as the general population, further hampering the hospital's ability to deliver health care. Combine files TAI The city of Toronto had suffered an unfortunate experience with the outbreak of "severe acute respiratory 0 Organize pages syndrome" (SARS) in 2003. During this epidemic, 800 people died worldwide and 44 died in Toronto. Thousands of people, including several hundred health-care workers, were quarantined due to their Add comments exposure to SARS. Two Toronto area nurses and one doctor died from their exposure to the disease. Request e-signatures The SARS epidemic provided government and health-care officials several insights into situations that could occur in the event of an influenza pandemic. These included: A Scan & OCR Hospital staff may falsely call in sick and say that they had to tend to sick family members. Front line health-care workers would likely be given priority to receive anti-viral medications due to Protect a PDF the high probability of exposure while treating infected patients. Some may not actually use the anti- viral medications given to them but may take the medication home to treat family members rather than Redact a PDF themselves. Staff may refuse to come to work because of danger to themselves. . Compress a PDF Scarce resources would necessitate difficult decisions concerning who should or should not receive reatment. Prepare a form Staff may undergo adverse long-term psychological disorders after the pandemic is over, including Use outside these parameters is a copyright violation. Authorized for use only in the course MGMT703- Section 001-004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023 burnout and post-traumatic stress Fill & Sign Staffing the hospital would be a problem, and workers would need clear protocols concerning which jobs received coverage first. View more Visitation restrictions would likely be imposed, preventing families and friends from seeing their sick relatives Cancellation of elective surgeries would be likely. There may be a requirement for armed security to protect both anti-viral supplies and medical staff in the event of public panic. THE DILEMMA Stark considered the issues carefully. One of the primary dilemmas in planning for an influenza pandemic was the inherent conflict between her role as manager of OHSS and the likely requirement that LHSC's staff would need to do work that posed a personal danger to themselves. The Ontario Health and Safety Act required that an employer must take every precaution to ensure the safety of its workers. Yet, the Q SARS outbreak had clearly illustrated that health-care workers could be exposed to life-threatening Convert, edit, and e-sign PDF forms. conditions in the event of an influenza pandemic. Free 7-day tria The Act gave an employee the right to refuse to do work that the employee believed to be unsafe but limited these rights for workers who, as a normal part of their job, had a responsibility to protect public 8.50 x 11.00 in 18'C Q Search P ENG 9:53 AM Mostly sunny US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6 | @ All tools X Export a PDF Edit a PDF Page 6 9B08C011 Create a PDF e safety." Workers with limited rights included police officers, firefighters and health-care workers, along Combine files TAI with the support staff for these groups, such as food, laundry and technical services. 0 Organize pages The Canadian Medical Association's (CMA) most recent code of ethics" provides a guide for the conduct of physicians, residents and medical students. The first item in the CMA code stated that a physician had a Add comments fundamental responsibility to "consider first the well-being of the patient." The nursing profession's ethical code* had a similar focus on the patient's health. Both professions also included statements Request e-signatures concerning the practitioners' ethical requirements to provide for their own health. Neither document was clear about how much personal risk health-care workers should be required to take in order to fulfil their A Scan & OCR obligations to the patient's health." The CMA had issued a notice that it would soon develop a policy statement outlining an ethical framework for practitioners in the event of a pandemic. Protect a PDF Although physicians and nurses had a code of ethics that suggested they should be prepared to put Redact a PDF themselves in danger in the event of a pandemic, this did not apply to most other employees working at LHSC. What was their duty to the employer under pandemic circumstances, and what was the employer's duty to protect the employees? Compress a PDF The planning team had also reviewed other actions that seemed at odds with privacy and personal liberty Prepare a form norms. Should the hospital have witnesses to ensure that health-care workers actually took the anti-viral medications given to them (to prevent the use of the medication to help sick family members)? This might Fill & Sign require an inspection of the employee's mouth (to ensure that medication was not hidden under the tongue). If a health-care worker called in sick, should a person be sent to the worker's residence to ensure se only in the course MGMT703- Section 001-004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023. View more that the employee was, in fact, sick? What disciplinary actions, if any, should be applied to those employees who refused to come to work because of family obligations or for their own personal safety Use outside these parameters is a copyright violation reasons? During the SARS outbreak, a small number of health-care workers, in an effort to protect themselves and their families from infection, failed to report to work and were subsequently terminated 6 from their employment. In addition to these questions, Stark wondered how the plan should be communicated to the staff. Staff needed to be clear on the protocols to follow in the event of a pandemic, but Stark also wondered whether there should be some discussion to resolve the many moral and ethical dilemmas. Stark cleaned up her desk and prepared to go home for the day, still pondering the plan's many issues and wondering what her recommendations should be. Q Convert, edit, and e-sign PDF forms. Free 7-day tria 18'C Mostly sunny Q Search O HOWOO A EX P ENG 9:53 AM US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| Q All tools X Export a PDF Page 7 9B08C011 Edit a PDF Create a PDF Exhibit 1 e EMPLOYEE NUMBERS BY OCCUPATION AT LHSC Combine files TAI Medical Dental Midwifery 718 0 Organize pages Add comments Nursing 3.100 Residents/Fellows 645 Request e-signatures A Scan & OCR Research 1.016 Protect a PDF Technicians/labs 816 Redact a PDF Clerical 1,153 Compress a PDF Service 1,143 Prepare a form Management 273 Fill & Sign Allied Health 490 for use only in the course MGMT703- Section 001-004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023 View more Volunteers 930 Use outside these parameters is a copyright violation. Other 459 7 Source: London Health Science Centre, Facts & Stats 2007-2008, www.Ihsc.on.ca, accessed Aug 29, 2007. 9 Q Convert, edit, and e-sign PDF forms. Q Free 7-day tria 18'C Q Search ENG 9:53 AM Mostly sunny US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| @ All tools X Page 8 9B08C011 Export a PDF Exhibit 2 Edit a PDF OCCUPATIONAL HEALTH AND SAFETY SERVICE RESPONSIBILITIES AT LHSC Create a PDF e Combine files TAI Occupational hygiene (noise, chemicals, air quality, gloves) Ergonomics assessments (workstation set-up, workflow) 0 Organize pages . . . Health and safety training (WHMIS, N95 Fit testing, regulations) Add comments Personal protective equipment Accident investigation Request e-signatures Environmental safety . . Health and safety consultation A Scan & OCR Hospital health and safety policies . . Safety bulletins Protect a PDF Radiation safety Redact a PDF New chemical approval process Pre-placement health assessments Compress a PDF Health and wellness promotion . . . . Primary care first aid Prepare a form Communicable disease management Pandemic planning horized for use only in the course MGMT703- Section 001-004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023 Fill & Sign Case management (return to work for short/long term disabilities) Use outside these parameters is a copyright violation. . . Physiotherapy services View more . Medical surveillance . Employee assistance program . Corporate health and fitness program 8 Source: Occupational Health and Safety Services, London Health Science Centre. C Convert, edit, and e-sign PDF forms. Free 7-day tria ENG 9:53 AM 18'C Mostly sunny Q Search US 2023-06-15Menu MGMT703, Case 1, $23.p_. X + Create - 0 X All tools Edit Convert Sign Find text or tools Q | A $ 6| @ All tools X Page 9 9B08C011 Export a PDF Exhibit 3 Edit a PDF RECENT FLU PANDEMICS Create a PDF e Name Years Minimum Estimated Deaths Combine files TAI Russian Flu 1889-1890 1 million 0 Organize pages Spanish Flu 1918-1920 40 million Add comments Asian Flu 1957-1958 1 million Request e-signatures Hong Kong Flu 1968-1969 0.75 million A Scan & OCR Source: "Highlights from the Canadian Pandemic Influenza Plan for the Health Sector," 2006. Protect a PDF Redact a PDF Exhibit 4 Compress a PDF ESTIMATED HEALTH IMPACT OF INFLUENZA PANDEMIC IN CANADA Prepare a form Use outside these parameters is a copyright violation. Authorized for use only in the course MGMT703- Section 001-004-007 at Centennial College taught by Dr. Amir Ghazinoori from 5/8/2023 to 8/19/2023 Fill & Sign Clinically ill 4.5 million to 10.6 million people View more Outpatients (emergency room or physician) 2 million to 5 million people Hospitalized (and recover) 34 thousand to 138 thousand people 9 Deaths 1 1 thousand to 58 thousand people 9 Source: "Highlights from the Canadian Pandemic Influenza Plan for the Health Sector," 2006. Convert, edit, and e-sign PDF forms. Q Free 7-day tria 18'C Q Search ENG 9:53 AM Mostly sunny US 2023-06-15