The Healthcare Executive Handbook for Organizational Resilience

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1 The Healthcare Executive Handbook for Organizational Resilience Session #203, February 4:00 PM Paul E. Seale, Managing Director Hospital Operations, Milton S. Hershey Medical Center Scott Ream, President, Virtual Corporation 1

2 Speaker Introduction Paul E. Seale, MHA, FACHE Managing Director - Hospital Operations Milton S. Hershey Medical Center As managing director of hospital operations, Paul Seale oversees day-to-day hospital operations at the Penn State Health 548 bed academic medical center. 2

3 Conflict of Interest Paul E. Seale, MHA Has no real or apparent conflicts of interest to report. 3

4 Speaker Introduction Scott Ream, BAS-EE President Virtual Corporation Scott Ream founded Virtual Corporation in Mr. Ream is the originator of the Business Continuity Maturity Model, an openaccess framework for independent assessment of organizational resilience programs. 4

5 Conflict of Interest Scott Ream, BAS Salary: Both myself and my spouse are employees of Virtual Corporation Receipt of Intellectual Property Rights/Patent Holder: Virtual Corporation holds certain Property Rights including copyrighted materials Ownership Interest (stocks, stock options or other ownership interest excluding diversified mutual funds): Both myself and my spouse are stockholders in Virtual Corporation Other: Milton S. Hershey Medical Center is a client of Virtual Corporation 5

6 AGENDA 1. What is Business Continuity (BC)? 2. So this is easy to implement, right? 3. How do we achieve steady state 4. Challenges & Barriers 5. What outcomes have we achieved to date? 6. Six lessons learned to get you started 7. Q&A 6

7 Learning Objectives Learning Objective 1: Describe the critical role of an executive in preparedness and response for all disruptive events to mitigate the medical, financial, regulatory and other impacts associated with incidents Learning Objective 2: Measure the effectiveness of organizational resilience with business impact analysis, risk assessment, program assessment and hazard vulnerability assessment (HVA) Learning Objective 3: Create a sustainable resilience program able to respond effectively to disruptive, unexpected events that impact clinical and business operations Learning Objective 4: Recognize executive risk appetite for inclusion of dependencies, interdependencies, cascading effects and resilience characteristics that could generate adverse impacts 7

8 How Benefits Were Realized S S T Satisfaction Patient, Staff: An executive sanctioned business continuity program improves interdepartmental communication; establishes patient & staff confidence in the organization; enhances participation at department level. E P Treatment/Clinical Safety; Quality of Care; Efficiency: An effective Business Continuity Plan improves patient safety; reduces medical errors; maintains continuity of care; minimizes adverse outcomes due to disruption of critical services. Electronic Information/Data Evidence Based Medicine; Data Sharing and Reporting: Data continuity & resilience planning provides access to critical patient information in support of care plan & treatment. Effective planning allows for data access & availability during operational disruption. Patient Engagement/Population Management Prevention: Effective communication of the business continuity plan improves patient compliance, prevents gaps in patient care. Savings Financial / Business; Efficiency Savings; Operational Savings: Organizational resilience planning reduces negative financial outcomes, contributes to the ongoing stability of the organization despite adverse disruptions or disasters. 8

9 What is Business Continuity? 9

10 What is Business Continuity? Capability of the organization to continue delivery of its products or services at acceptable predefined levels following disruptive events Business Continuity Management System Part of an overall management system that establishes, implements, operates, monitors, reviews, maintains & improves business continuity Source: ISO 22301:

11 What is Organizational Resilience? Emergency Management Time Normal Operations Minimal Acceptable Level of Capability Incide nt Occur s Operations Risk Mgmt may allow the organization to avoid disruption or minimize impacts Crisis Management Team(s) and Plan Activated Hour 0 Emergency Management Teams and Plans Activated Recovery Begins Crisis Management Business Continuity Team(s) and Plans May Be Activated Recovery in place Disrupted Business Functions Are In Recovery mode IT Disaster Recovery Plans May Be Activated Ops Risk Management Restoration Begins Restoration Plan May Be Needed Back to Normal Normal Operations Return to Normal Operations Completed Business Continuity IT Disaster Recovery Restoration Plan Copyright, Virtual Corporation,

12 So, this is easy to implement, right? 12

13 So, this is easy to implement, right? Plans are nothing planning is everything. Engage the organization in understanding their dependencies & vulnerabilities. Teach them how to develop practical, prudent strategies & plans that remain relevant over time. Dwight D. Eisenhower 13

14 Our Goal: Implementing sustainable BC planning Sus-tain-a-ble: Capable of being maintained at a steady level without exhausting resources 14

15 The Budget Analogy 15

16 A Systematic Approach to a Sustainable Program Emergency Prep Define organizational resilience specific to your organization Security IT Disaster Recovery Organizational Resilience Management Business Continuity Crisis Mgmt Safety Legal Regulatory Complianc e Clinical Eng. Risk Mgmt 16

17 Baseline your current state of business continuity How mature is your current business continuity program? Have you integrated business continuity with the other organizational resilience disciplines? 17

18 Did You Know? On September 8, 2016 the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation goes into effect on November 16, Health care providers and suppliers affected by this rule must comply and implement all regulations one year after the effective date, on November 16,

19 Know your regulations in order to stay compliant These new regulations are a condition or requirement to participate in Medicare. We anticipate releasing the Interpretive Guidelines & Survey Procedures in Spring of

20 Engage executives in an Executive Business Impact Analysis RTO: Recovery Time Objective To help prioritize events, response & resources (internal & external) 20

21 Materiality Grid Conducted 15 minute conversations with the following executives to set the Materiality Grid for MSHMC/COM: Clinical Financial Regulatory Research Academic Medical Group Type of Impact MSHMC/COM Materiality Grid (applies to impacts directly attributable to the disruption) Low Medium Serious Critical Clinical No care delivery impact Potential care delivery impact Financial Regulatory Compliance Reporting & Quality Research Management judgment prevails, considerations include: Academic Losses < $5 M Understandable, requires notification to appropriate compliance individual No known or foreseeable impact to research in general, animal care in particular, or study (i.e. animal) lines < 3 days disruption to the learning experience Losses between $5 M and $15 M Requires discussion/reporting to appropriate compliance body (internal committee) <1 day disruption to research No impact to animal care > 3 days disruption to the learning experience Degree of Impact Serious but reversible care delivery impact Losses between $15 M and $36 M Short-term compliance exposure, may require external reporting 1 day disruption to research or potential loss of research materials Animal care negatively impacted for 24 hours > 1 week disruption to the learning experience As of June 23, 2016 Serious irreversible care delivery impact Losses > $36 M Approx. 2% of Net Revenue Long-term compliance exposure, requires external reporting >1 day disruption to research or loss of research materials >1 day disruption to animal care Loss of animal line(s) > 2 weeks disruption to the learning experience Other Impacts: - Patient Satisfaction / service - Loss of Personnel - Legal Liabilities - Disruption to Tenure Track - Institutional Image - Public Confidence - Others as determined by mgmt Required Planning and Preparations Management judgment Emergency Plan Only Management judgment Management judgment Management judgment BC & Emergency Plan Required 21

22 Where do we want to be Emerg. Prep. Safety Current State Legal Crisis Mgmt Security IT DR Reg. Comp. HR BRCP Clinical Eng. Risk Mgmt Transformation Aligning existing Steering Committees Develop consistent methodology, terminology and processes Enhance communications between stakeholders Focus on the critical operations / material risks Balance cost vs. risk Fully integrate with business practices 22 Security Desired End State: Aligned and Inclusive IT DR Safety Legal Emerg. Prep ORM Reg. Comp. BRCP Clin Eng. Risk Mgt Crisis Mgmt

23 Form an Executive Steering Committee BRCP Relationship MSHMC/COM Position Executive Sponsor SMT Liaison and Administrative Advisor Interim BRCP Program Director Committee Member Committee Member Managing Director Hospital Operations Administrator Information Protection and Compliance Officer Administrator Chief Information Officer Committee Member Committee Member Committee Member Committee Member Committee Member Associate General Counsel Senior Director Ambulatory Practice Quality & Compliance Penn State University Risk Management Director of Facilities Associate VP and Controller of COM Committee Member Committee Member Committee Member Managing Director Medical Group Chief Financial Officer Emergency Preparedness Manager Committee Member Committee Member Director of Safety Associate Dean for Research and Associate Professor of Pharmacology 23

24 Establish a central BC Program Office To lead program design, launch, & ongoing program (Unfunded mandate) $ 24

25 Challenges & Barriers 25

26 Management is unaware of challenges to resilience In terms of changing regulatory demands, workplace, or workflow adaptions based on care models or healthcare IT resources BUSINESS CONTINUITY 26

27 Management may be over confident Current organizational resilience plans may not suffice for changing continuity demand profile 27

28 Limited access to resources And critical patient data during a disruptive event can have catastrophic impact on the well-being of patients EHR connectivity issues Interruptions to ADT data Power failures 28

29 There is a need to create new visualizations* That provide improved feedback and high observability to help people recognize when events challenge current plans in progress *Cook R, Render M, Woods D. Gaps in the continuity of care and progress on patient safety. Br Med J Mar 18;320(7237):

30 At 1 st blush, implementing a BC program may appear simple As such it may not receive the level of executive support & participation required 30

31 What Outcomes Have We Achieved to Date? 1. BCMM Baseline Self-Assessment 2. Executive BIA 3. BC Program Design 4. Software tool configuration Phase 1 - Prepare for BC Program Launch BCMM Self-Assessment Workshop Enterprise Business Impact Analysis BC Program Design Tools Customization Phase 2 - Conduct BC Program Pilot Pilot Implementation Launch Preparation Phase 3 - BC Program Launch Launch Program for Tier 1 sites Launch Tier 2 sites Phase 4 - Sustaining Organization Conduct initial exercises Institutionalize BC Program Focus: Governance, Consulting, Education, Plan Testing and Update Support (Ongoing) Design and Build BCM Program Model Gain Sr. Mgmt. Commitment Prioritize Launch Sequence Activate BCM Program Management Conduct Pilots (s) Refine BCM Program Model Execute BCM Program Roll Out Initiate Governance and Support Provide Ongoing Program Maintenance Initiate Maturity Program Review State of Preparedness Consult with Business 31 Copyright: Virtual Corporation, 2016

32 What Outcomes Have We Achieved to Date Now engaged in pilot with 16 departments from across the institution (clinical, research, academic, administration) 32

33 Lessons Learned 33

34 Create best fit framework for a sustainable resilience program Program Strategy: sponsorship, steering committee, policy Program Scope: how big, how wide, how deep Program Support: rollout, training, work effort, support model 34

35 Establish an interdisciplinary BC management team Engage senior leadership Standardized methods, tools, and centralized BC expert support 35

36 Effective Resilience Programs Property Management Facilities Materials Management Collaborative Synergetic Programs Emergency Preparedness Including Internal and External Disaster Planning Business Resilience and Continuity Planning Leadership HMC-COM Medical Group Safety Fire, Security Personnel, Tangible Assets Protection IT Services Data Back up, Disaster Recovery Risk Management Accreditation Compliance Regulatory Guest Services 36

37 Define and understand your corporate competencies for sustaining BC program 1. Leadership 2. Employee awareness 3. BC program structure 4. Program pervasiveness 5. Metrics 6. Resource commitment 7. External coordination 37

38 Consider the use of BC planning software Build enterprise engagement Communicate with data, systems, and teams Gain commitment from senior management Standardized structures & reporting within departments Appropriate SP screenshot (can t show product name) graphic supplied by VMD 38

39 Choose a dynamic vs. static resilience program posture Design & implement for today Flexible to adapt to changing needs tomorrow Program maturity affected by Executive support Organizational change Regulatory change Systems change 39

40 Prepare an executable BC Program Implementation Plan Program Staffing Plan BC Policy BC Program Launch Plan Phase 1 Prepare for BC Program Launch Phase 2 Conduct BC Program Pilot Phase 3 Launch BC Program Phase 4 Test, maintain & continuous improvement 40

41 HIMSS IT Value Suite S S T Satisfaction Patient, Staff: An executive sanctioned business continuity program improves interdepartmental communication; establishes patient & staff confidence in the organization; enhances participation at department level. E P Treatment/Clinical Safety; Quality of Care; Efficiency: An effective Business Continuity Plan improves patient safety; reduces medical errors; maintains continuity of care; minimizes adverse outcomes due to disruption of critical services. Electronic Information/Data Evidence Based Medicine; Data Sharing and Reporting: Data continuity & resilience planning provides access to critical patient information in support of care plan & treatment. Effective planning allows for data access & availability during operational disruption. Patient Engagement/Population Management Prevention: Effective communication of the business continuity plan improves patient compliance, prevents gaps in patient care. Savings Financial / Business; Efficiency Savings; Operational Savings: Organizational resilience planning reduces negative financial outcomes, contributes to the ongoing stability of the organization despite adverse disruptions or disasters. 41

42 Questions Paul E. Seale, MHA, FACHE Managing Director, Hospital Operations Milton S. Hershey Medical Center (w) Scott W. Ream President Virtual Corporation (w) Reminder: please complete the online session evaluation 42

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