Business Continuity Planning

The pharmaceutical regulations call, repeatedly for business continuity plans. For example, the FDA calls for fairly significant requirements for Medically Necessary Products:

Medically necessary drug products and their components are manufactured all over the world. An emergency situation anywhere in the world thus might affect the availability of drug products in the United States and result in drug shortages. Emergency preparedness for situations that could result in high employee absenteeism is an important goal for manufacturers of drug products and their components. For example, in an influenza pandemic, widespread human outbreaks of illness would be expected in the United States and around the world, resulting in widespread high absenteeism that could hinder normal production activities and cause shortages in the supply of drug products, packaging materials, and drug components. It is therefore vital for industry to prepare before an emergency situation occurs and to develop plans to ensure continuity of operations during emergencies (including, for example, an influenza pandemic, natural disaster, or personnel issue) that would prevent a significant portion of the work force from reporting. It is especially important for manufacturers of finished drug products to be aware of their suppliers’ and contractors’ responses to personnel shortages and, when appropriate, work with them to ensure the availability of high quality materials and services that contribute to the manufacture of MNPs.
FDA, Guidance for Industry Planning for the Effects of High Absenteeism to Ensure Availability of Medically Necessary Drug Products

You can find less definitive requirements throughout the various health authorities’ regulations and guidances.

So what do we mean by business continuity?

Business continuity is the holistic management process that ensures operations continue and that products and services are delivered at predefined levels (e.g. no shortages, no halt to an ongoing clinical trial). This approach is aligned with ISO 22301 Business Continuity Management Systems.

Business continuity management is an ongoing process based on the plan-do-check-act methodology that is made up of 4 key elements:

Emergency Action and Response Plans
Disaster Recovery Plans
Crisis Management Plans
Business Continuity Plans

Emergency Action Plans

An emergency action plan is designed to respond to an emergency with mitigating procedures to protect, secure and evacuate people to safety. This is more an OSHA thing; chances are your average Quality unit doesn’t end up owning it. Unless you have no HS&E unit, and then you write one.

This plan includes procedures for detecting, warning, and responding to specific potential emergencies such as fire, severe weather, earthquake, medical emergencies, workplace violence, and other potential threats.

Disaster Recovery Plan

Disaster recovery plans are designed to recover from a disaster, usually related to equipment, infrastructure, and information technology. Something big goes boom, how do you restore this vital support system or equipment as soon as possible and minimize downtime and loss of data. Very important for computer system lifecycle, disaster recovery plans should include specific plans for recovery functions, resumption strategies, critical personnel, equipment, services, and external and internal communications.

Crisis Management Plans

Crisis management is all about planning and mitigating situations that have risk, and are usually a lot of management of communications internally and externally. This includes with regulators, health care providers, etc. When we implement SOPs for health authority notifications we are engaging in crisis management planning.

Business Continuity Plans

Business continuity planning identifies and plans for disasters to events that could negatively an organization’s business functions, objectives, income, reputation, and ultimate survival. This planning takes place in advance of the potential disasters or events that could harm an organization. It takes potential disasters and events into consideration with their effects on suppliers, vendors customers, and the organization’s other stakeholders.

In a GxP environment, we are looking at the potential impact of disasters on drug supply and clinical study outcomes (amongst other key activities).

The BCP is all about minimizing the effects of the disaster or event on the organization and returning to normal operations as soon as possible.

These Plans are Interrelated

All four plans are interrelated and should be coordinated. The plans can be combined, but as there are usually very different owners they are often separated.

Documented Plans

The business continuity planning process should result in formal, documented plans that serve as a reference guide in the event of a disaster or event. The existence of the business continuity plans should be well communicated, with individuals with responsibilities having ready access and additional training.

Applying the Risk Management Process

The Business Continuity process should leverage existing risk assessments and sit around it.

Select Team

The team should be multifunctional and very knowledgeable about the organization’s business and the risks it faces. This should be a permanent team, not ad hoc, as this is a living process. You can always bring in ad hoc members for specific questions.

Define Context, Purpose, Scope

At a minimum you are tackling the disruption to product supply and cessation of critical GxP data but there may be other business requirements to tackle. Make sure everyone agrees on these.

Define Terminology

Make sure everyone is on the same page with just what disaster, event, crisis, stakeholder, and business continuity plan (and other important concepts) are.

Agree on the scales for likelihood and severity.

Critical Function Assessment

Identify the business functions that are sensitive to downtime, fulfill regulatory obligations and are vital for maintaining product supply.

Threat Assessment

Identify the threats to the performance of the critical functions.

Identify Hazards and Risks

There are three major categories of hazards:

Natural Hazards
- Meteorological
- Geological
- Biological
Human-Caused Hazards
- Accidents
- Intentional acts
Technological Hazards
- Information technology
- Utility
- Fire/explosion
- Hazardous material
- Supply Chain interruption

Utilize a risk matrix to assess the likelihood and severity of the identified hazards and risks.

Develop Business Continuity Plan(s)

After the hazards and risks have been identified, the impact understood and the risks assessed it is time to develop the business continuity plan (BCP). The BCP allows the organziation to survive the event or disaster with minimal disruption. The BCP focuses on mitigating the consequences of the event or disaster that could not be prevented. Recovery strategies for these cosnequences are determined, developed and become part of the BCP.

When many potential risks have been identified, use the risk score to prioritize.

BCPs cover management commitment, team ientification, team responsibilities, mitigation plans, recovery strategies, training, testing and evaluation and continious improvement. Basically the same thing any good plan does.

Mitigation plans are intended to lessen the negative effectis of an event or disaster.

Provide appropriate awareness training to everyone impacted, with more substantial trining to the BCP team.

Verify it periodically and ensure it is continues to be relevant.

Whenever relevant, procceduralize these BCP instructions.

Detectability in Risk Management is a “Sort of” “Sometimes” thing

I’ve recently seen a few audits that point out something along the line of “Recommendation to revise Quality Risk Management Process/Procedure to include detectability as a variable in determining Risk Priority Numbers (RPNs). The current process only includes the frequency and severity of impact in the calculation. However, ICH Q9 also recognizes the use of risk management tools which include the ability to detect harm (detectability) in the estimation of risk (refer to the section titled “Risk analysis”).”

So, first of all, that’s not what Q9 says. Q9 (R1) is actually pretty clear here, stating “Risk analysis is the estimation of the risk associated with the identified hazards. It is the qualitative or quantitative process of linking the likelihood of occurrence and severity of harms. In some risk management tools, the ability to detect the harm (detectability) also factors in the estimation of risk.”

Q9 later goes on to state “Quality risk management supports a scientific and practical approach to decision-making. It provides documented, transparent and reproducible methods to accomplish steps of the quality risk management process based on current knowledge about assessing the probability, severity and sometimes detectability of the risk.”

Q9 clearly recognizes that detectability is useful sometimes, with specific tools in specific cases. This is in alignment with risk management thinking in general, for example ISO 31000:2018 states that Risk analysis should consider factors such as:

— the likelihood of events and consequences;
— the nature and magnitude of consequences;
— complexity and connectivity;
— time-related factors and volatility;
— the effectiveness of existing controls;
— sensitivity and confidence levels.

Detectability is then one of several methods to consider in risk analysis. The selection criteria for tools should take into account situations when detectability is desired and drive to use of those tools, for example, the FMEA which is built to determine how and when a failure can be detected. In other tools, detectability is usually built into the evaluation of current controls and is often captured in likelihood or somewhere else

When it comes to risk, avoid a one-size fits all. Think of what the intent is and use the right tool for the job.

The Risks of Nonspecificity in Work-As-Prescribed

There are a lot of ways to discuss uncertainty, and narrow down on vaguess and unspecificity, following Smithson’s model of Ignorance.

Different Kinds of Unknowns, Source: Smithson (1989, p. 9); also in Bammer et al. (2008, p. 294).

An alternative way to look at uncertainty is offered by Klir, which adds discord to the mix.

Work-As-Prescribed can be a real avenue for all three of these uncertainties. But by using risk management to examine the possibilities of these uncertainties we can truly interrogate. This is one of the things we mean by risk management and knowledge management being bound at the hip as enablers.

To do this we need to make sure that:

There is the management of information quality. Management of information quality is crucial in risk management because uncertainty is prevalent. Uncertainty, as a state for which we lack information, means that uncertainty analysis should play an integral part in risk management to ensure that the uncertainty in the risk management process is kept at a feasible level.
There is explicit management of either existing knowledge that can be applied to improve the quality of the analyses or to improve the knowledge acquired in the process that can be used in the follow-up process. Knowledge management is pivotal to ensuring an effective risk management process by providing context and learning possibilities. In essence, risk management is not just about managing risks – the entire context surrounding the risks must be understood and managed effectively.

Resilience

In the current world scenario, which is marked by high volatility, uncertainty, complexity, and ambiguity (VUCA), threats are increasingly unforeseen. As organizations, we are striving for this concept of Resilience.

Resilience is one of those hot words, and like many hot business terms it can mean a few different things depending on who is using it, and that can lead to confusion. I tend to see the following uses, which are similar in theme.

Where used	Meaning
Physics	The property of a material to absorb energy when deformed and not fracture nor break; in other words, the material’s elasticity.
Ecology	The capacity of an ecosystem to absorb and respond to disturbances without permanent damage to the relationships between species.
Psychology	An individual’s coping mechanisms and strategies.
Organizational and Management studies	The ability to maintain an acceptable level of service in the face of periodic or catastrophic systemic and singular faults and disruptions (e.g. natural disasters, cyber or terrorist attacks, supply chain disturbances).

For our purposes, resilience can be viewed as the ability of an organization to maintain quality over time, in the face of faults and disruptions. Given we live in a time of disruption, resilience is obviously of great interest to us.

In my post “Principles behind a good system” I lay out eight principles for good system development. Resilience is not a principle, it is an outcome. It is through applying our principles we gain resilience. However, like any outcome we need to design for it deliberately.

Principles behind a good system

We gain resilience in the organization through levers that can be lumped together as operational and organizational.

The attributes that give resilience are the same that we build as part of our quality culture:

The ability to anticipate problems before they build-up (includes risk management)
Diversified structural flexibility to respond to both adverse and beneficial changes
Broken down silos and glass ceilings to allow risk information to flow freely and prevent ‘risk blindness’
Rapid response capabilities to avoid incidents escalating into crises
Learn from previous mistakes from themselves and others making the necessary changes

On the operational side, we have processes to drive risk management, business continuity, and issue management. A set of activities that we engage in.

Like many activities they key is to think of these as holistic endeavors proactively building resiliency into the organizaiton.

Risk Assessments Do Not Replace Technical Knowledge

The US Food and Drug Administration (FDA) last month warned Indian generic drugmaker Lupin Limited over three good manufacturing practice (GMP) violations at its facility in Maharashtra, India that identified issues with the company’s written procedures for equipment cleaning, its written procedures for monitoring and controlling the performance of processing steps and the “failure to investigate all critical deviations.”

The FDA said the company “performed multiple risk assessments with the purpose to verify whether existing cleaning procedures and practices eliminate or reduce genotoxic impurities … generated through the manufacture of [redacted] drugs after you detected [redacted] impurities in your [active pharmaceutical ingredient] API.” The company also performed risk assessments to determine whether its cleaning procedures reduced the risk of cross-contamination of intermediates and API. However, FDA said the risk assessments “lacked data to support that existing equipment cleaning procedures are effective in removing [redacted] along with residual API from each respective piece of equipment to acceptable levels. “The identification of genotoxic impurities in quantities near their established limits suggests excursions are possible. All intermediates and API manufactured on non-dedicated equipment used to manufacture [redacted] drugs should be subject to validated sampling and analytical testing to ensure they are not contaminated with unacceptable levels of genotoxic impurities,” FDA said.

At heart this warning letter shows a major weakness in many company’s risk management approach, they use the risk assessment to replace technical inquiry, instead of as a tool to determine the appropriateness of technical understanding and as a way to manage the uncertainty around technical knowledge.

A significant point in the current Q9 draft is to deal with this issue, which we see happen again and again. Risk management cannot tell you whether your cleaning procedures are effective or not. Only a validated testing scheme can. Risk management looks at the aggregate and evaluates possibilities.