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: Lisa.Olenski@bjc.org

LinkedIn: Lisa Olenski

David Frank Consultant

Email: dfrank@kepner-tregoe.com

LinkedIn: David Frank