Innovations in EH & S Technology : Innovence - How did we get there? Ed Hall, Chief Executive, The Risk Authority Stanford 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 1
History of SHC and SCH Initiative to move this Direction Enhancing Employee Safety (Cal/OSHA Title 8) Corrective Action Plan Goals Actions Phases Build Safety Foundation (12-18 months) Correct identified gaps in existing programs Align and update existing procedures and processes Establish improved incident reporting investigation and reporting with feedback loop Reduce incident rates, severity and frequency Monitor progress using SREOs The foundation (tools, training, and processes) is established Develop the Leadership (18-36 months) The Cal/OSHA CAP activities Champion the use of established tools training, & processes Engage managers & supervisors to use foundation tools Improve supervisory efforts in preventing incidents by effective use of JHAs Continue to reduce incidents severity and frequency Integrate Safety into Active Daily Management Worker safety is integrated into ADM Behavior Based Safety (BBS) (>36 months) Continue to use established protocols, reporting tools and processes Observe workers and their actions Use behavioral changes to reduce incident severity and frequency Improve/understand Behavior modifiers Continually reinforce the safety culture Employee Safety becomes priority Align all daily efforts and thoughts to embrace employee safety as a core value 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 2
ISO 31000 ERM Process 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 3
Decision Analysis Textbook 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 4
Tools and Methods Applied in VDERM Value Protection Value Creation Value & Risk Maps Value at Risk Quantified Risks and Uncertainties Value-based Risk Tolerance Quantified Value Model Components of Value Key Value Drivers Simple, Decision Analysis-based Process The decision analysis tools and methods applied in VDERM achieve the twin aims of value protection and value creation. 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 5
Value Driven Enterprise Risk Management 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 6
ISO 31000 ERM Process 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 7
Hospital Aggregate Claims- Patient Handling Patient Handling Injuries 2001-2008 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 8
ISO 31000 ERM Process 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 9
General Safety Key elements, target dates, and current status of implementation: General Safety Program PHASE OF IMPLEMENTATION PROGRAM IMPROVEMENT AREA SYSTEM STATUS SELF SCORE 1. Appoint Organizational Champion Don is the current Sponsor 2. Establish Measurable Performance Objectives at each location and tie to Performance for All Staff 3. Conduct Job Hazard Analysis for All Job Categories 4. Identify and Develop Program for Three Primary Causes of Injuries and Data is Easily Obtained and Communicated to all Management 5. Implement a Safety Awareness Program with Performance Objectives Identified "Stay Safe" 6. Train Employees on Loss Control Program Objectives, RCA Completion & Accident Investigation 7. Annual Evaluation and Safety Certification Process of the General Safety Policy by Peer or Third Party. Some Executives do tie performance to department goals but not all are treated the same. Need to conduct hopefully as a system based on job classifications. Not all management get consistent reports with standard data. No loss data is provided Still new and needs to be expanded past safe patient handling No training exist at this time for this for managers and Employees. Current not being filled out correctly or completed properly Review is completed as part of established process but focus is on injury number reduction not ROI and no formal review of programs or safety Certification. 81-100% - Good compliance noted. Further improvement possible. ( 2-points) 41-80% - Some Compliance noted. Possible plan in place, no/inconsistent implementation. (1-Point) 0-40% - Little compliance, significant inconsistency, no firm plan. (0-Point) 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 10
Direct Observation Assessment Special HAZARD Radar Diagram As an additional component of the report, we have provided a graphic illustration in the form of a radar diagram. This tool provides a visual summary of the healthcare organizations current readiness along the six distinct domains of our assessment and the focused domain of the System Safety Process. These graphs plot a summary of TRA s observations of an organizations current level of performance relative to the optimal performance per TRA s synthesis of best practices for each domain along with a comparison of the system as a whole. Corporate 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 11
ISO 31000 ERM Process 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 12
Case Example: SPH At Stanford Internal Rate of Return 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 13
Case Example: SPH At Stanford Direct Cost Savings for Worker s Comp & Replacement Staff Only Year 1 Year 2 Year 3 Year 4 Year 5 Total 5 Year Average Worker's Comp Expense $ 832,168 $ 832,168 $ 832,168 $ 832,168 $ 832,168 $ 4,160,840 Staff Replacement Cost Salary $ 210,824 $ 210,824 $ 210,824 $ 210,824 $ 210,824 $ 1,054,120 Benefits $ 71,680 $ 71,680 $ 71,680 $ 71,680 $ 71,680 $ 358,401 Savings WC Expense Reduction 30% $ (249,650) $ (249,650) WC Expense Reduction 60% $ (499,301) $ (499,301) $ (499,301) $ (499,301) $ (1,997,203) Replacement Cost Reduction 30% $ (84,751) $ (84,751) 60% $ (169,502) $ (169,502) $ (169,502) $ (169,502) $ (678,010) Total Savings $ (334,402) $ (668,803) $ (668,803) $ (668,803) $ (668,803) $ (3,009,615) Operating Costs Staff Training $ 700,000 $ 700,000 Education Consultants $ 62,500 $ 62,500 $ 125,000 Total Costs $ 762,500 $ 62,500 $ 825,000 Net Savings $ 428,098 $ (606,303) $ (668,803) $ (668,803) $ (668,803) $ (2,184,615) In Current Operational Budget 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 14
Case Example: SPH At Stanford Speed Bump However, Stanford encountered the following issues: Need to quantify the uncertainty in total potential program cost and value to get the most value out of the program. The initial justification was not sufficient for the new hospital being built at a cost of $3 billion. SPH equipment was identified as a potential cost savings and was slated to be cut. Accordingly, Decision Analysis was applied, starting with a value map. 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 15
Case Example: SPH At Stanford Safe Patient Handling Value Map 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 16
Case Example: SPH At Stanford The Tornado Chart shows the key drivers of value 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 17
Hospital Aggregated Claims- Patient Handling Patient Handling Injuries 2001-2008 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 18
Hospital Lost & Restricted Work Days From Patient Handling Injuries Days Restricted Duty and Days Absent 2002-2007 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 19
Case Example: SPH At Stanford The CDP shows the total uncertainty in value Cumulative Probability Distribution Cumulative Probability 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 Net Present Value ($ '000) (EV = $5,184) 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 20
Case Example: SPH At Stanford The Waterfall Chart shows the breakdown among costs and value components -$1,536 Initial Investment Workers Comp Savings Lost & Restricted Days Savings $1,789 $500 Patient Falls Savings $245 Ulcer Treatment Savings $1,761 Retention Costs Savings $782 Gallup Score Improvement $374 Press Ganey Score Improvement $1,307 Patient Referral $106 -$144 On-going Costs Mean NPV $5,184 -$3,000 -$2,000 -$1,000 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 NPV ($ '000) 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 21
Case Example: SPH At Stanford We looked at the uncertainty in rate of return 100% 90% Cumulative Probability 80% 70% 60% 50% 40% 30% 20% 10% 0% 40% 60% 80% 100% 120% 140% 160% 180% 200% IRR (EV = 111%) 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 22
This Approach Has Been Widely Heralded Incorporated in the 2010 Guidelines for the Design and Construction of Health Care Facilities published by the American Society of Healthcare Engineers (ASHE) http://www.fgiguidelines.org/interim_pubs.html Safe Patient Handling Best Practices Award - 2010 Published in American Society for Healthcare Risk Management Monograph - October 2010 Risk & Insurance Innovator of the Year - 2010 Melinda S. Mitchell, Service and Quality Award - November 2010 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 23
Data Collection and Assessment Methodology Description Applications Statistical Data Analysis Analyze historical data and construct statistical model for making projections Produces probabilities and significance as outputs of analysis Only appropriate with a stable system and statistically significant data set Subjective Probability Assessment Careful use of appropriate methods to assess subjective estimates for uncertainties Uses probabilities to describe the likelihood for either discrete events (a fire) or continuous ones (the number of patients next year) Most risks (competitor actions, capital project cost and schedule, economic variables, etc.) Direct Observation Assessment Rounding with best practice audit forms to draw conclusions to program readiness compared to industry best practice. Can be used on all types of risk but usually do require expert to conduct assessment 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 24
Key Indicator Types Leading Indicators These are forward facing indicators and are gathered in Safety Culture Survey assessments typically given to staff on an annual basis Lagging Indicators are rear view facing and provide in-site in to historical incidents which in turn can predict future performance. Example. Claims Incidents, and Complaint Data. Real Time Indicators Provide the best source and immediate identification and correction of hazards in the fields. Direct Observation or Rounding Programs with best practice audit forms or software track can be used to identify current hazards or work practice deviations and are the key to the future of improving health performance. 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 25
Do These Programs Work? 2012 Workers' Compensation Losses (Incurred developed) AVERAGE REDUCTION (%) AVERAGE COST REDUCTION ($) APPROACH 1 Culture of Safety (Behavior Based) $8,805,098 59.6 $5,247,838 2 Ergonomics $7,027,453 51.6 $3,626,166 3 Engineering Change $1,521,233 29.0 $441,158 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 26
There is a 95% chance a Culture of Safety initiative will positively impact SHC cash flow, with a mean contribution of $17m NPV over 5 years with 171 IRR. 1.0 1.0.9.9.8.8.7.7 Cumulative Probability.6.5.4 Cumulative Probability.6.5.4.3.3.2.2.1.1 0 10 5 0 5 10 15 20 25 30 35 40 45 50 0 Incremental NPV ($mm) 1.00 0.00 1.00 2.00 3.00 4.00 5.00 6.00 Yes;EV=17 No;EV=0 ROI Yes;EV=1.71 No;EV=0.00 Culture of Safety program decision: 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 27
Present Strong Business Case Sample Culture of Safety Program 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 28
Return on Investment For Housekeeping Shoes For Crews Campaign Cumulative Probability 1.0 Compliance for Alternative 2 Relevant WC costs this year.9 Base number of Lost & Restricted Days Reduction in targeted WC at 100%compliance.8 Reduction in L&R Days at 100%compliance Annual Growth rate in WC costs With 80% compliance, net.7 Percent L&R days replaced at regular rate present value will be $487,000 Average regular hourly wage rate this year.6 over the next 5 years Annual growth in Lost & Restricted days Annual growth in violations *Program will cost $16,100 per Average cost per violations.5 year for two pairs of shoes Compliance for Status Quo Percent of Lost & Restricted days replaced.4 Current number of violations Annual growth in labor cost.3 in Number of Violations at 100%compliance tion in Cost per Violation at 100%compliance.2 Strategy Number Compliance for Alternative 1 Current number of hazard incidents.1 Annual growth in number hazard incidents Average cost per hazard incident 0 on in Number of Hazards at 100%compliance 0 200 400 600 800 1000 1200 1400 1600 1800 2000 uction in Cost per Hazard at 100%compliance NPV ($000's) 1;EV=44 2;EV=238 3;EV=530 Scenario 1: current program (none) net present value (NPV) is $44,000 Scenario 2: Voluntary program where housekeepers buy own shoes NPV is $180,000 Scenario 3: Hospital purchases shoes and monitors thru OBSERVATIONS program NPV is $487,000 Current Impact on staff injuries in 1.5 years has been over $120,000 in savings $ NPV ($000's) 300 350 400 450 500 550 600 650 700 750 800 0.6 0.99 70 150 250 600 0.5 0.8 0.5 0.8 0.015 0.1 0.9 0.2 20 26 0.02 0.02 0.1 0.1 3 10 0.1 0.02 0.9 1 0 1 0.01 0.035 0.5 0.8 0.5 0.8 3 3 0.5 0.2 0 0 0.2 0.1 15 5 0.8 0.3 0.5 0.1 Base Value: 487 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 29 Base Value 0.8 90 350 0.7 0.7 0.05 0.5 22.61 00 5 0.03 0.95 1 0.025 0.7 0.7 3 0.3 0 0.1 10 0.5 0.3 %Swing Explained 30.5 28.7 21.4 6.9 4.1 3.3 1.7 1.5 0.4 0.4 0.3 0.3 0.2 0.2 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
SHC Workers Compensation Benchmark Analysis Data Source: Milliman 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 30
SHC Workers Compensation Benchmark Analysis Data Source: Milliman 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 31
Web and Mobile-Based Inspections for the Health Care Environment
Capture Positive and Negative Findings
Communicate Inspection Findings Inspection Reports Negative Finding Details
Incorporate Recognition and Accountability Programs 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 35
Monitor Trends - Identify Risk - Take Action based on Real-Time Indicators 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 36
Monitor Trends - Identify Risk - Take Action based on Real-Time Indicators 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 37
Web and Mobile-Based Inspections for the Health Care Environment 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 38
Web and Mobile-Based Inspections OR Observations 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 39
Web and Mobile-Based Inspections OR Observations 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 40
Trend Alerts Category Based- Department Based- Building Based 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 41
Example EOC Findings Building 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 42
Inspector Based Reports Inspector 1 Inspector 2 Inspector 3 Inspector 4 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 43
Trend Alerts Category Based- Department Based- Building Based Observation and High Loss Common Cause Factors (Workers Compensation) Projected a 171% ROI on initial Studies Software allows Tracking and Ensure Compliance with the following: Patient Safety Rounding Environment of Care Rounding Tracking for Joint Commission (Infection Control Risk Assessment) ICRA and PCRA Compliance OSHA Compliance Increased Program Compliance on High Cost Causal Factors Customize Observation (i.e. Department Rounding) New Building Opening Pre Acceptance from Contractor ISO Rounding Client Satisfaction Rounding Tool Create Operational Efficiencies for EHS Staff (Current Estimates are 400K for SHC EH&S) Safety Observation Study to Begin on HAPU and the OR (Patient Safety Impact Analysis) 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 44
OSHA Reporting Tool Introduction OSHA Reporting Tool 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 45
OSHA Reporting Tool Introduction OSHA Reporting Tool 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 46
OSHA Reporting Tool Introduction OSHA Reporting Tool 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 47
OSHA Reporting Tool Introduction OSHA Reporting Tool 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 48
OSHA Reporting Tool Introduction OSHA Reporting Tool 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 49
OSHA Reporting Tool Introduction QUESTIONS? 2017 BOARD OF TRUSTEES OF THE LELAND STANFORD JR. UNIVERSITY 50