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Aligning Leaders to Make Great Choices Wednesday, March 3, 2016
David Frank Consultant
Lisa Olenski Executive Director
Conflict of Interest
BJC HealthCare Lisa K. Olenski, BS, MBA, MCP Kepner-Tregoe David Frank, BA, LSSMBB, PMP
Has no real or apparent conflicts of interest to report
Agenda
• Kepner-Tregoe (KT) Overview • BJC Overview • How Our Brains Get in the Way • BJC HealthCare adoption of Kepner-Tregoe methodology • The Story – loss of power and redundancy (a raccoon, a transformer and
a fire) – The Impact – Realizing the Value of Health IT STEPS – The Key Stakeholders – What would you do?
• Rational Thinking – Visible Thinking Process • Applying Rational Thinking to The Story • Insights • Summary of How Benefits Were Realized for the Value of Health IT • Questions and Answers
Learning Objectives
• Demonstrate the rational decision making tool process
• Analyze alternative solutions against weighted objectives
• Decide on a balanced decision using data and risk
assessment
• Demonstrate how facilitated decision making tool use leads
to reduction in unconscious bias and emotional response
Benefits Realized for the Value of Health IT The value STEPS impacted were: • Satisfaction Patient Satisfaction Staff Satisfaction • Treatment/Clinical Efficiencies Safety • Electronic Secure Data Enhanced Communication Data Sharing
http://www.himss.org/ValueSuite
T
Preserve Satisfaction, Treatment/Clinical Effectiveness and Electronic Secure Data
Maximize Patient Satisfaction
Maximize Staff Satisfaction
Maximize Patient Safety
Maximize IS Specialty Resource Efficiency
Minimize Time on Generator
Minimize Downtime for End User
Minimize Disruption/Maintain Data Integrity
S
T
E
How Our Brains Get in the Way
Daniel Kahneman’s Nobel Prize winning research identified 5 common errors in Human Thinking that drive behavior and lead to poor decisions.
Source: http://www.someecards.com/users/profile/Alicia1367203
Thought errors that lead to poor decisions…
• Halo Effect - If I like some of the parts, I will like the whole
• What You See Is All There Is (WYSIATI) Effect - What you see is all there is
• Framing Effect - The same information can be viewed favorably or unfavorably depending on how it is stated
• Anchoring Effect - We can be strongly influenced by numbers and facts not really relevant to the issue
• Availability Bias Effect - We don’t access all of our memories, we recall the impactful, unusual occurrences
BJC HealthCare
BJC Hospitals 1. Alton Memorial Hospital 2. Barnes-Jewish Hospital 3. Barnes-Jewish St. Peters
Hospital 4. Barnes-Jewish West County
Hospital 5. Boone Hospital Center 6. Christian Hospital and
Northwest HealthCare 7. Missouri Baptist Medical
Center 8. Missouri Baptist Sullivan
Hospital 9. Parkland Health Center 10. Progress West Hospital 11. St. Louis Children's
Hospital 12. The Rehabilitation Institute
of St. Louis
BJC Health Services • BJC Accountable Care
Organization • BJC Behavioral Health • BJC Corporate Health
Services • BJC Home Care Services • BJC Medical Group BJC Shared Services
BJC HealthCare
Hospitals 12
Employees 26,514
Physicians 3,869
Staffed Beds 3,380
Hospital Admissions 138,909
Home Health Visits 201,240
Emergency Department Visits 463,033
Net Revenue $4.1 billion
Charity and Unreimbursed Care $301 million*
Community Health Programs (providing more than 592,000 individual services)
$19.6 million*
2014 data; * = based on 2013 data Statistics are from year-end 2014, except where noted. Totals are aggregate figures for the hospitals and health care services that are members of BJC HealthCare.
BJC HealthCare adoption of rational decision making methodology
• BJC leadership identified the need for a rational decision
making and problem solving process
• Initiated as a leader driven approach
• Application and adoption of a rational decision making process
within the BJC culture
• Formally added rational decision making as a core
competency within transformation tool set
BJC HealthCare Transformation Core Competencies
The Story
Ameren experienced a power outage 4:35am 12/2/08
BJC’s UPS was damaged and the data center suffered a partial down
Ameren power was restored and BJC received power directly from Ameren while UPS was being repaired
UPS repairs were completed and BJC attempted a standard “Hot Switch” to restore redundant power systems 11:25am 12/2/08
BJC decided to bring system back up using generator power until UPS repaired/replaced and a decision could be made on the best way to restore redundant power systems
How have these events affected our ability to make the next decision??? 11:00am 12/3/08
8-11 hour impact to BJC and patients
System control panel failed during “Hot Switch” and caused a HARD DOWN to data center, network, storage – across BJC
X
Encountering the Perfect Storm
•BJC impacted by an external event
•Standard procedure
•Standard procedure built by IT subject matter experts
•Continued trust in Ameren
Initial power surge event
Power directly from Ameren
Decision to use HOT switchback to UPS
•Standard procedure -performed monthly
•Decision made by IT vendor subject matter experts
•Trust in UPS vendor repairs
Second failure - UPS
•Catastrophic impact organization wide
•Patients at risk
•Different UPS failure
•Lost trust in Ameren
•Lost trust in UPS vendor
•8-11 hours downtime
•Lost trust in BJC IT from IT customers
•Higher and broader level of visibility including external media
•Need for additional decision makers (not all subject matter experts)
•Tendency to make decision based on avoiding previous events versus best alternative
Impact result Decision to run on generator power
•Within BJC control (not relying on Ameren or UPS vendor)
•Decision made by IT management
•Environment of high risk, no redundant power source, extended use of generator, single source of failure
X
The Impact
• Series of sequential failures
• Higher and broader level of involvement
• Highly visible
• Expectations and anxiety was rising
• Greater sense of urgency was mounting
• Current environment extremely risky (single point of failure)
The Key Leadership Stakeholders
• John Barenkamp, Vice President, Information Services
• Ginny Clark, Director, Information Services
• Chero Goswami, VP, Information Services, Core Clinical Solutions
• Mike Kelly, Vice President, Information Services, Community Hospitals
• Gary LaBlance, Vice President, Quality and Safety
• Steve Mapes, Manager, Health Information Management
• Pam Overman, Director, Information Services
• Dave Streibig, Director, Information Services
• Jerry Vuchack, Vice President, Information Services, Academic Hospitals
• Chris Ward, Director, Technology and Infomatics
• Lisa Olenski, Certified Kepner-Tregoe Program Leader/Facilitator
The Key Stakeholders Responses
What would you do to restore UPS (Uninterrupted Redundant Power Source)? (remove dependency on generator power)
Hot Switch Warm Switch Cold Switch
• All applications continue running
• Flip the switch to UPS
• Turn off generator
• Mission critical applications are shut down in controlled order
• Flip the switch to UPS
• Turn off generator • Bring mission critical
systems up in controlled order
• All applications are shut down
• Flip the switch to UPS
• Turn off generator • Bring all
applications back up
AUDIENCE POLLING:
Which option would you choose?
Thinking Process
Visible Thinking
Making thinking processes visible will help to:
• Capture progress and outputs
• Avoid jumping to conclusions
• Improve communications
• Establish a consistent approach
• Promote use of common language and terminology
• Provide foundation for effective questioning
Decision Statement – Choose best method to
restore UPS/redundant power systems with minimal impact on patient safety
Key Decision #1 - Choose the best data center UPS Redundancy switchback method with minimal customer impact Key Decision #2 - Choose the best timing to conduct switchback
MUST and WANT Objectives
MUST Objective
Maximize patient safety
WANT Objectives Weight
Minimize downtime for users in hours 10
Minimize time on generator in hours 7
Minimize disruption & maintain data integrity in number of users and applications
5
Maximize resource efficiency in number of subject matter experts needed
5
Maximize communication to the customers 3
The Alternatives and the Risks
Hot Switch Warm Switch Cold Switch
All applications continue running
Flip the switch to UPS
Turn off generator
Mission critical applications are shut down in controlled order
Flip the switch to UPS Turn off generator Bring mission critical
systems up in controlled order
All applications are shut down
Flip the switch to UPS
Turn off generator Bring all
applications back up
294 Points 108 Points 144 Points
Assessed Risk: IF we lose power to the data center, THEN we could
suffer a HARD DOWN and must execute the recovery plan as
established in the COLD switch alternative.
The Best Balanced Choice
Execute a HOT switch
to restore protected power
AND
Plan for COLD switch for up to a 12 hour recovery period in case of failure
IT and UPS vendor have >90% confidence level in this
decision based on testing data
Our Next Step - Communicate honestly with employees and customers
Rational Decision Making Process
The Results! Summary of How Benefits Were Realized for the Value of Health IT
Maintained Patient Satisfaction
Maintained Staff Satisfaction
Protected Patient Safety Effective use of IS Specialty Resources Removed Dependency on Generator
Restored All Power for End User
Maintained Data Integrity
S
T
E Loss of one pesky raccoon
Insights
Benefits of using rational thinking process:
• Use of a Rational Decision Making Process allowed for a reduction of unconscious bias and emotional responses
• Engaged a diverse team with right skills to make critical decisions
• Achieved alignment through transparent and visible thinking
• All were confident in the decision due to a disciplined, factual thoughtful process
• Leaders were equipped to communicate clearly and answer questions after the best balanced decision was determined
• Effective execution of the decision
• The initial proposed solution was not the final decision
"Plan to be better tomorrow than today, but don't plan to be finished."
Carol Ann Tomlinson, US Educator
Questions
Lisa K. Olenski Executive Director
Email: [email protected]
LinkedIn: Lisa Olenski
David Frank Consultant
Email: [email protected]
LinkedIn: David Frank