Day: February 24, 2017

Implications of NIMS Integration Plan For Hospitals and Healthcare

The Homeland Security Act of 2002 provided the authority for the creation of the Department of Homeland Security (DHS). It also directed the Director of DHS to create a National Incident Management System (NIMS). Published in 2004, NIMS formed the framework for detection, mitigation, response and recovery from manmade and natural occurring disasters, events and incidents of national significance within the United States, its territories, protectorates and Indian Tribal nations. NIMS provided the framework for the creation of the National Response Plan (NRP), also published in 2004.

The National Response Plan is an all-hazards, all-agencies approach to the detection, mitigation, response and recovery from disasters, whether natural or manmade events and incidents of national significance. A little known provision of NIMS created a classification system for all disaster-related resources. This classification system, the National Resource Typing System (NRTS) provides a unified cross-agency, cross-jurisdictional means of classifying all resources that are or could be used in response to a NRP/NIMS event, whether these resources are equipment or personnel.

Responsibilities of a Signatory:

All federal agencies, all 50 states, all U.S. protectorates and territories and all Tribal Nations within the scope and authority of the federal government have now become signatories to NRP/NIMS. Among these signatories are the Health Resource and Services Administration (HRSA) and the Department of Health and Human Services (DHHS), the parent agency for Medicare, Medicaid and Veteran Healthcare funding. This signatory status places certain responsibilities upon these agencies and governments, as well as providing them certain rights and privileges. These rights and responsibilities are incumbent upon all agencies that derive their funding or authority from a signatory to NRP/NIMS.

In addition to an irrevocable agreement to participate fully in any disaster, whether manmade or natural, event or incident of national significance within the region of that signatory or the authority of that signatory’s office, department or agency, all signatories to the NIMS/NRP have pre-agreed to all changes, classifications, modifications and regulations that may be promulgated by the director of DHS or the NIMS Integration Center or the NRP Implementation Center. Such changes, classifications, modifications and regulations must be implemented without modification.

NIMS Requirements Upon DHS of Significance:

Within NIMS, there are several clauses that are of significance to establishing a new industry in the area of Disaster Preparedness, Planning, Training and Evaluation within the United States. Recurrent through the document is the phrase “establish qualifications, credentials and certification for hospitals and healthcare facilities in cooperation with … and national professional organizations”. This phrase appears in every reference to hospitals and healthcare facilities in all levels of the response – administrative, financial, logistical and most notably operational. When hospitals are specifically noted, this phrase occurs with increased regularity. To date, there has been no classification, credentialing or certification system implemented by the DHS, NIMS, or NRP.

The NRTS provides no guidance, as of the writing of this report, for the qualification, certification, credentialing, or typing of medical providers and, more specifically, physicians. However, the NIMS Integration Center, on September …

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Inventory is a list of goods and materials, or those goods and materials themselves, held available in stock by a business. Inventory are held in order to manage and hide from the customer the fact that manufacture/supply delay is longer than delivery delay, and also to ease the effect of imperfections in the manufacturing process that lower production efficiencies if production capacity stands idle for lack of materials.

The reasons for keeping stock

All these stock reasons can apply to any owner or product stage.

Buffer stock is held in individual workstations against the possibility that the upstream workstation may be a little delayed in providing the next item for processing. Whilst some processes carry very large buffer stocks, Toyota moved to one (or a few items) and has now moved to eliminate this stock type.

Safety stock is held against process or machine failure in the hope/belief that the failure can be repaired before the stock runs out. This type of stock can be eliminated by programmes like Total Productive Maintenance

Overproduction is held because the forecast and the actual sales did not match. Making to order and JIT eliminates this stock type.

Lot delay stock is held because a part of the process is designed to work on a batch basis whilst only processing items individually. Therefore each item of the lot must wait for the whole lot to be processed before moving to the next workstation. This can be eliminated by single piece working or a lot size of one.

Demand fluctuation stock is held where production capacity is unable to flex with demand. Therefore a stock is built in times of lower utilisation to be supplied to customers when demand exceeds production capacity. This can be eliminated by increasing the flexibility and capacity of a production line or reduced by moving to item level load balancing.
Line balance stock is held because different sub-processes in a line work at different rates. Therefore stock will accumulate after a fast sub-process or before a large lot size sub-process. Line balancing will eliminate this stock type.

Changeover stock
is held after a sub-process that has a long setup or change-over time. This stock is then used while that change-over is happening. This stock can be eliminated by tools like SMED.

Where these stocks contain the same or similar items it is often the work practice to hold all these stocks mixed together before or after the sub-process to which they relate. This ‘reduces’ costs. Because they are mixed-up together there is no visual reminder to operators of the adjacent sub-processes or line management of the stock which is due to a particular cause and should be a particular individual’s responsibility with inevitable consequences. Some plants have centralized stock holding across sub-processes which makes the situation even more acute.

The basis of Inventory accounting

Inventory needs to be accounted where it is held across accounting period boundaries since generally expenses should be …

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