What Happens When??? Contingency Planning

By Larry Ozeran MD, President, Clinical Informatics Inc.

HIMSS core objective as an organization is to improve healthcare quality and patient safety information technology. As hospitals and providers work to implement electronic health records and other IT and management systems, HIMSS is launching a blog series on health IT and patient safety to help providers and hospitals identify potential risks to patient safety that have resulted from problems with EHR implementations and mitigate those risks through proactive measures.

“If hospitals are basing patient safety efforts on the assumption that they can get people not to make mistakes, they’re misdirecting their resources. They should study where errors occur, identify which ones put patients at higher risk, [and] then, redesign systems.” Terry Fairbanks, MD, Director National Center for Human Factors Engineering in Healthcare, Health Data Management, Feb 2012.

What happens when a small piece of worn plastic breaks and shuts down your data center forcing all of your facilities to revert to paper charts for several hours?

This happened to one facility. The piece of plastic was part of a fire alarm that then self-triggered, setting off a cascade of fire protection systems.

Could this have been avoided?

Probably not in any practical manner. Risk avoidance is not a real option.

This brings us to finding balance between trying to avoid a problem and creating contingencies for when they occur. Many problems are actually cheaper to solve than they are to prevent.

The case above is one such problem. Imagine developing a process to periodically check all of your fire alarms for the integrity of the plastic. How would you do it? How frequently would you check? How long would it take to check each one? How much would it cost? What opportunity costs would be lost?

Your staff would not be doing something else. What if you spent all of those resources and none of the plastic pieces were ever defective, but PVC plumbing broke in the walls and flooded your data center?

None of us has unlimited resources. It is simply not feasible to prevent every possible disaster. So, how do we make reasonable contingency plans?

-Consider starting with broad categories: power failure, water leakage / damage, major security breach, natural disaster, major software error, minor software error.

-Begin, in each, to tease out specific instances and prioritize those instances based on your sense of their likelihood.

-Prioritize them, as well, based on how serious the harm to patients would be and the cost to recover from the event.

You will find risks that are costly to prevent, but not very costly to manage if they occur, particularly if your culture supports being a failure-ready organization.

This entry was posted in Health IT, Patient safety and tagged , , , , . Bookmark the permalink.

1 Response to What Happens When??? Contingency Planning

  1. Agreed, a zero defects policy is unsupportable. Continuous quality improvement processes, and accepting failure to occur at some point makes sense. I believe error and failures are measurable elements therefore, we must accept them. Many of these have a probability of failure, MTTF and a MTTR (mean time to repair). However, chaos exists, i.e., when it comes to people in the equation, as a transient event, thus reacting to each error or failure in the most cost effective way is critical. A feedback loop, forensics along with practicing for contingency must be part of any rapid response equation.

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