failing by design: why winter is a season, not a surprise ed shorter stays forum april 2013 jane...
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Failing by Design: why winter is a season, not a surprise
Failing by Design: why winter is a season, not a surprise
ED Shorter Stays ForumApril 2013
Jane Lawless
ED Shorter Stays ForumApril 2013
Jane Lawless
Definition of a Crisis – A critical event or point of decision which, if not handled in an appropriate and timely manner (or if not handled
at all), may turn into a disaster or catastrophe
Focus of the sessionFocus of the session
Living within the failure boundaries
Organisational resilience and why it matters
The three levels of design – base –buffer – recovery
The Resilience Zones Model
Surviving the ‘Death Zone’
Living within the failure boundaries
Organisational resilience and why it matters
The three levels of design – base –buffer – recovery
The Resilience Zones Model
Surviving the ‘Death Zone’
ORGANISATIONAL RESILIENCEORGANISATIONAL RESILIENCE
“A property of an organisation that enables it to continue to achieve its objectives under varying conditions, and when major variance occurs to
recover without significant loss.”(Eric Hollnagel)
“A property of an organisation that enables it to continue to achieve its objectives under varying conditions, and when major variance occurs to
recover without significant loss.”(Eric Hollnagel)
• Working within maximum productive capacity
• Addressing the organisational blind spot around the gap between work as imagined and work as it actually happens
• Focusing on studying success in preference to studying failure
• Working within maximum productive capacity
• Addressing the organisational blind spot around the gap between work as imagined and work as it actually happens
• Focusing on studying success in preference to studying failure
The three levels of designing for success
The three levels of designing for success
1. Base design – average service utilisation (volumes) x average hours of care
2. Buffer design – Built in level of redundancy and flexibility to account for known variance range
1. Base design – average service utilisation (volumes) x average hours of care
2. Buffer design – Built in level of redundancy and flexibility to account for known variance range
Production planningProduction planning
July August September
2011 budgeted 109 109 109
2011 actual 117 135 187
2012 budgeted 102 102 102
2012 actual 117 155 148
The three levels of designing for success
The three levels of designing for success
1. Base design – average service utilisation (volumes) x average hours of care
2. Buffer design – Built in level of redundancy and flexibility to account for known variance range
3. Recovery design – harm minimisation when working in a degraded context (the ‘death zone’)
1. Base design – average service utilisation (volumes) x average hours of care
2. Buffer design – Built in level of redundancy and flexibility to account for known variance range
3. Recovery design – harm minimisation when working in a degraded context (the ‘death zone’)
Sacrificing decisionsSacrificing decisions• reduce demand (cancel/defer) – affects productivity & volumes
• increase capacity by using unbudgeted resources tagged for future activity (extras, overtime) – impacts financially and on future service provision
• increase capacity by cancelling planned non clinical activity (e.g. education or leave) – impacts on workforce & ultimately service quality
• Require extraordinary work effort
• reduce quality of service
• reduce demand (cancel/defer) – affects productivity & volumes
• increase capacity by using unbudgeted resources tagged for future activity (extras, overtime) – impacts financially and on future service provision
• increase capacity by cancelling planned non clinical activity (e.g. education or leave) – impacts on workforce & ultimately service quality
• Require extraordinary work effort
• reduce quality of service
Impact of sacrificing optionsImpact of sacrificing options• Budget over run• Queuing• Production delays• Service cancellation• Care rationing• Harm/error incidents/adverse events • Poor patient placement• Increased staff discretionary effort (missed breaks/overtime)• Staff fatigue/anxiety or distress• Staff feeling professionally compromised• Avoidable patient deaths
• Budget over run• Queuing• Production delays• Service cancellation• Care rationing• Harm/error incidents/adverse events • Poor patient placement• Increased staff discretionary effort (missed breaks/overtime)• Staff fatigue/anxiety or distress• Staff feeling professionally compromised• Avoidable patient deaths
Lawless 2013
AVOIDABLE HARM
AVOIDABLE DEATH
CANCELLATIONS INCREASED LOS
STAFF OVERTIME
TREATMENT DELAYS
WASTED CAPACITY – UNABLE TO BE REINVESTED
Care Capacity Demand Management: strengthening resilience
Addressing the blind spot
Critical metrics
Smoothing Variance
Care Capacity Demand Manage
ment
CCDM ESSENTIAL METRICS
SAFE SIX IMPACT METRICS
PTS RECEIVING THE FULL PACKAGE OF CARE
FREEDOM FROM HARM
STAFF SATISFACTION WITH THE JOB DONE
WORK EFFORT REASONABLE
PRODUCTIVITY/FLOW/VOLUME TARGETS ACHIEVED ADHERENCE TO BUDGET
Organisational planning, design & resourcing •Forecast demand•Resource matching•Budgeting
Service/Ward Core Data Set
Mix & Match Set base staffing design Set base resource design
Central Operations Management
•Reallocating resources•Adjusting care capacity & demand using Standard Operating Responses
CCDM CouncilMonitors persistent issues with Indicator SetRecommends design changes to organisation
Ward Data Council•Adapts local design and responses•Recommends change to operational design and responses
Service/ Ward Management
•Uses Standard Operating Responses
CARE CAPACITY DEMAND MANAGEMENTCARE CAPACITY DEMAND MANAGEMENT
EVERYDAY VARIAN
CE MAN
AGEM
ENT
REFI
NE
DES
IGN
OVE
R TI
ME
PLANNING AND RESOURCING THE FUTURE
DHB Involvement with CCDM (chronological)DHB Involvement with CCDM (chronological)
Current or past involvement
Bay of PlentyWest CoastNorthlandMidCentralNelson MarlboroughTairawhiti (combined CCDM/RTC)TaranakiSouthern (both sites)WaitemataHutt Valley
Current or past involvement
Bay of PlentyWest CoastNorthlandMidCentralNelson MarlboroughTairawhiti (combined CCDM/RTC)TaranakiSouthern (both sites)WaitemataHutt Valley
Next 12 months confirmedSouth CanterburyWanganuiADHB
Eligible & under discussionWairarapa Hawkes Bay Capital & Coast (planning to be eligible)
Not currently eligibleCounties Manukau (Demonstration site)WaikatoLakesCanterbury
Next 12 months confirmedSouth CanterburyWanganuiADHB
Eligible & under discussionWairarapa Hawkes Bay Capital & Coast (planning to be eligible)
Not currently eligibleCounties Manukau (Demonstration site)WaikatoLakesCanterbury
What does the organisation need to deliver?
SET PRELIMINARY DEMAND FORECAST
What capacity will it take to deliver that?
(CAPACITY MATCH)
Do we have the finances & resource capacity to support
that?
NO
Address the gap
YES
What are we able to do?
RE SET DEMAND FORECAST
-BASE STAFFING MODELLING-(PLANT)-(SUPPLIES)-(SUPPORT INFRASTRUCTURE)
ESTABLISH RESOURCES
DEVELOP & IMPLEMENT PRODUCTION PLAN BASED ON CAPACITY/DEMAND
PROJECTIONS
MONITOR FOR MID RANGE VARIANCE & ACTIVELY REDESIGN
(up to 6 weeks out)
DEAL WITH EMERGENT VARIANCE-Variance smoothing -↑↓ Demand-↑↓Capacity-Redistribute demand or capacity-Make sacrificing decisions
DELIVER SERVICESCOLLECT IMPACT
METRICS
-CAPACITY/DEMAND FORECASTING
-WORKPLACE DESIGN
-DEMAND FLOW
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