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The Healthcare Executive Handbook for Organizational ResilienceSession #203, February 22,2017 @ 4:00 PM
Paul E. Seale, Managing Director Hospital Operations, Milton S. Hershey Medical Center
Scott Ream, President, Virtual Corporation
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Speaker Introduction
Paul E. Seale, MHA, FACHEManaging 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.
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Conflict of Interest
Paul E. Seale, MHA
Has no real or apparent conflicts of interest to report.
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Speaker Introduction
Scott Ream, BAS-EEPresident
Virtual Corporation
Scott Ream founded Virtual Corporation in 1994. Mr. Ream is the originator of the Business Continuity Maturity Model®, an open-access framework for independent assessment of organizational resilience programs.
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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
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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
AG
EN
DA
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Learning ObjectivesLearning 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, inter-dependencies, cascading effects and resilience characteristics that could generate adverse impacts
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How Benefits Were Realized…
Satisfaction Patient, Staff: An executive sanctioned business continuity program improves interdepartmental communication; establishes patient & staff confidence in the organization; enhances participation at department level.
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.
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What is Business Continuity?
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What is Business Continuity?
Source: ISO 22301:20120
Capability of the organization to continue delivery of its
products or services at acceptable predefined levels following
disruptive events
Business Continuity Management SystemPart of an overall management system that establishes,
implements, operates, monitors, reviews, maintains &
improves business continuity
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Incide
nt
Occur
s
Return to Normal
Operations
Completed
Normal
Operations
Time
Business Continuity
Team(s) and Plans
May Be Activated
Disrupted Business
Functions Are In “Recovery
mode”
Normal
Operations
Restoration
Plan May Be
Needed
Hour “0” Recovery
Begins
Recovery
“in place”
Minimal Acceptable
Level of Capability
Crisis Management Team(s) and Plan Activated
Restoration
Begins
Back to
Normal
Operations Risk Mgmt may allow the organization to avoid disruption or minimize impacts
IT Disaster Recovery Restoration Plan
Emergency Management Crisis Management
Business Continuity
Ops Risk Management
Emergency
Management Teams
and Plans Activated
What is Organizational Resilience?
IT Disaster
Recovery Plans May
Be Activated
Copyright, Virtual Corporation, 2016
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So, this is easy to implement, right?
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So, this is easy to implement, right?
Dwight D. Eisenhower
“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.
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Our Goal:Implementing sustainable BC planning
Sus-tain-a-ble: Capable of being maintained at a steady level without exhausting resources
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The Budget Analogy
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A Systematic Approach to a Sustainable Program
Define organizational
resilience specific to your
organizationOrganizational
Resilience Management
Emergency Prep
Business Continuity
Crisis Mgmt
Clinical Eng. Risk
Mgmt
Regulatory Complianc
e
Safety
Legal
Security
IT Disaster Recovery
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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?
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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, 2016.
Health care providers and suppliers
affected by this rule must comply and
implement all regulations one year
after the effective date, on November
16, 2017.
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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
2017.
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Engage executives in an Executive Business Impact Analysis
To help prioritize
events, response &
resources
(internal & external)
RTO: Recovery Time Objective
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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
Other Impacts:- Patient Satisfaction / service- Loss of Personnel- Legal Liabilities- Disruption to Tenure Track- Institutional Image- Public Confidence
- Others as determined by mgmt
MSHMC/COM Materiality Grid(applies to impacts directly attributable to the disruption)
Type of ImpactLow Medium Serious Critical
Managementjudgment
Managementjudgment
Managementjudgment
Managementjudgment
ResearchManagement judgment prevails,
considerations include:
No known or foreseeable impact to research in general,
animal care in particular, or study (i.e. animal) lines
<1 day disruption to research
No impact to animal care
· 1 day disruption to research or potential loss of research materials
· Animal care negatively impacted for 24 hours
· >1 day disruption to research or loss of research materials
· >1 day disruption to animal care
· Loss of animal line(s)
Financial Losses < $5 M Losses between$5 M and $15 M
Losses between$15 M and $36 M
Losses > $36 MApprox. 2% of Net Revenue
Regulatory ComplianceReporting & Quality
Understandable, requires notification to appropriate
compliance individual
Requires discussion/reporting to appropriate compliance body
(internal committee)
Short-term compliance exposure, may require external reporting
Long-term compliance exposure, requires external reporting
Clinical No care delivery impact Potential care delivery impact Serious but reversible care delivery impact
Serious irreversible care delivery impact
Degree of Impact
Required Planning and Preparations
Emergency Plan Only BC & Emergency Plan Required
Academic< 3 days disruption to the
learning experience> 3 days disruption to the
learning experience> 1 week disruption to the
learning experience> 2 weeks disruption to the
learning experience
As of June 23, 2016
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Safety
Legal
IT DR BRCP
Crisis
MgmtSecurity
Clin Eng.
Risk Mgt
ORM
Emerg.
Prep
Reg.
Comp.
Where do we want to be …
Legal
Clinical
Eng.
HR
Risk
Mgmt
Reg.
Comp.
• 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
Desired End State:
Aligned and InclusiveTransformation
Safety
Current State
BRCP
IT DR
Security
Crisis
Mgmt
Emerg.
Prep.
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Form an Executive Steering Committee
BRCP Relationship MSHMC/COM Position
Executive SponsorManaging Director Hospital
Operations
SMT Liaison and
Administrative
Advisor
Administrator
Interim BRCP
Program Director
Information Protection and
Compliance Officer
Committee Member Administrator
Committee Member Chief Information Officer
Committee Member Managing Director Medical Group
Committee Member Chief Financial Officer
Committee Member Emergency Preparedness Manager
Committee Member Associate General Counsel
Committee MemberSenior Director Ambulatory Practice
Quality & Compliance
Committee MemberPenn State University Risk
Management
Committee Member Director of Facilities
Committee MemberAssociate VP and Controller of
COM
Committee Member Director of Safety
Committee Member
Associate Dean for Research and
Associate Professor of
Pharmacology
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To lead program design,
launch, & ongoing
program
(Unfunded mandate)
Establish a central BC Program Office
$
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Challenges & Barriers
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Management is unaware of challenges to resilience
In terms of changing
regulatory demands,
workplace, or workflow
adaptions based on
care models or
healthcare IT resourcesBUSINESS
CONTINUITY
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Management may be over confident
Current
organizational
resilience plans may
not suffice for
changing continuity
demand profile
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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
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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. 2000 Mar
18;320(7237):791–794
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At 1st blush, implementing a BC program may appear “simple”
As such it may not
receive the level of
executive support &
participation required
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What Outcomes Have We Achieved to Date?
1. BCMM Baseline
Self-Assessment
2. Executive BIA
3. BC Program
Design
4. Software tool
configuration
Phase 2 - Conduct BC Program Pilot Pilot Implementation
Launch Preparation
Phase 1 - Prepare for BC Program Launch BCMM Self-Assessment Workshop
Enterprise Business Impact Analysis
BC Program Design
Tools Customization
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)
Execute
BCM Program
Roll Out
Initiate
Governance
and Support
Provide
Ongoing Program
Maintenance
Initiate Maturity Program
Review State of
Preparedness
Consult
with Business
Design and Build
BCM Program
Model
Gain Sr. Mgmt.
Commitment
Activate
BCM Program
Management
Refine BCM
Program Model
Conduct
Pilots (s)
© Copyright: “Virtual Corporation, 2016
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2
3
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Prioritize
Launch
Sequence
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What Outcomes Have We Achieved to Date
Now engaged in pilot
with 16 departments
from across the
institution (clinical,
research, academic,
administration)
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Lessons Learned
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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
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Establish an interdisciplinary BC management team
• Engage senior leadership
• Standardized methods, tools, and
centralized BC expert support
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Effective Resilience Programs …
Emergency Preparedness
Including Internal and External
Disaster Planning
Safety Fire, Security
Personnel, Tangible Assets Protection
Business Resilience and Continuity Planning
IT ServicesData Back up, Disaster
Recovery
LeadershipHMC-COM
Medical Group
Property
Management
Facilities
Materials
Management
Risk
Management
Accreditation
Compliance
Regulatory
Guest
Services
Collaborative – Synergetic Programs
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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
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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
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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
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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
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HIMSS IT Value Suite
Satisfaction Patient, Staff: An executive sanctioned business continuity program improves interdepartmental communication; establishes patient & staff confidence in the organization; enhances participation at department level.
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.
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Questions
Paul E. Seale, MHA, FACHE
Managing Director, Hospital Operations
Milton S. Hershey Medical Center
717-531-8801 (w)https://www.linkedin.com/in/paul-seale-00511a12
Scott W. Ream
President
Virtual Corporation
973-804-0676 (w)https://www.linkedin.com/in/sream
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