Thursday, June 28, 2012

Effective Risk Management Prepares Businesses and Organizations for Difference-Making Rescue Management

This post reflects my comments to a article, Risk Management vs Rescue Management by Steve Denning, a columnist whose posts I very much enjoy reading.  Steve's columns are thought-provoking and usually challenge conventional thinking and ways of doing things.
Steve's post is influenced by a post, Failure and Rescue, by Atul Gawande.  Mr. Gawande states:  "The difference between triumph and defeat ... isn’t about willingness to take risks. It’s about mastery of rescue."
While "mastery of the rescue" can be "the difference between triumph and defeat," this issue is not about the "willingness to take risks."  People in all walks of life take risks everyday; it's called living.  Instead, private, public, and non-government organizations should focus on their preparedness for dealing with risks when they happen.  "Mastery of the rescue" is a direct reflection of risk preparedness.
A risk management plan is only the beginning.  As a former Army officer who exercised contingency plans on a regular basis and a consultant who has helped organizations develop risk management and associated contingency plans, I recognize that the the real value of such plans is in exercising the actions called for in these plans, including contingency plan operational rehearsals.  There are other factors such as organizational leadership, processes, knowledge, and training that also impact risk and the effectiveness of any risk mitigation strategy.
Rescue management and risk management are very much linked.  They should not be viewed from a perspective of one "versus" the other.  Risk management is the act of preparing for rescue management
The University of Michigan study, Variation in Hospital Mortality Associated with Inpatient Surgery, cited by Mr. Gawande, includes a number of factors contributing to "low surgical mortality."  These include "multiple complex processes, including the timely administration of antibiotics in patients with sepsis, the rapid transfer of a patient to an intensive care unit (ICU), and the availability of interventional cardiologists during an acute myocardial infarction. ... A system of daily rounds with a certified intensivist [a physician who specializes in the care of critically ill patients] was associated with a reduction in in-hospital mortality by a factor of three and an increased nurse-to-patient ratio was associated with a halving of in-hospital mortality. ... Intra-operative checklists have become an increasingly promising and popular approach for reducing risks of complications." 

The hospitals that have adopted and institutionalized these actions recognize that effective rescue management is only possible if there's effective risk management reflected in risk mitigation actions that are exercised on a daily basis.  Therein, is the key to effective risk management - the institutionalization of processes and activities designed to create a culture that mitigates risks that are part of its business processes and enables effective and efficient rescue actions when things go wrong. 

The failures in the BP oil disaster cited in Mr. Denning's post, "failure to recognize a problem, "adopting the wrong plan," and "failure to implement even the rescue properly," have their roots in a lack of knowledge, poor decision-making, inadequate training, and ineffective contingency operation plans per testimony before the U.S. House of Representatives in February 2011.  In effect, the personnel on the BP oil drilling platform, Deepwater Horizon, were not prepared for events that took place on April 20, 2010. 

Strong leadership could have prevented these failures.  Leadership is the most important risk mitigator as pointed out by Colonel Eric Kail in his HBR post, "Lessons From the Military: Your Risk is My Risk, Too."  COL Kail makes the excellent point that as a leader, "you can't become someone in 30 seconds that you haven't practiced being for the last 30 days. ... You also can't be everywhere all the time, so you need to know that other leaders in your organization are making decisions that support your intent regarding acceptable risk."  The U.S. Navy's Blue Angels pilots in the picture for this post know by virtue of their training, knowledge, and procedures what acceptable risk is.  Knowing that acceptable risk mitigates the need for rescue management. 

One of the best examples of the value of leadership, training, and established processes (all risk mitigators) in enabling effective rescue actions when things go wrong were the actions that Captain Chesley "Sully" Sullenberger and his flight crew took to safely land US Airways Flight 1549 and its passengers in the Hudson River on March 15, 2009.

It wasn’t heroism that brought Flight 1549 down safely. It was rigorous training that’s inbred in the U.S. aviation system. Pilots have to fly for years before they can command an airliner, and even experienced pilots must routinely train in simulators and pass ‘check rides’  at least once a year under the supervision of Federal Aviation Administration inspectors. … ‘In simulator training, we’re doing nothing but flying in all sorts of emergencies.’”

Actual rescue management operations provide an excellent opportunity for the organization to learn, enhance its risk management knowledge base, and have people better prepared to deal with the next challenge.  Rescue management participants should be debriefed and lessons learned identified, validated, disseminated, and made available for others to access.  Knowledge gained from this activity may necessitate changes to training, processes, and operations and potentially influence innovations to existing portfolios of products and/or services.  Do not limit the applicability of lessons learned to the same function or industry; look for non-linear applicability as well.  This post began with a focus on hospital care and moved to aviation safety.  It's fitting then to provide a link to an excellent lessons learned report, "What Went Right - Lessons for the Intensivist From the Crew of US Airways Flight 1549."  This report shows the applicability of effective aviation risk management that can "can help intensivists ... remain as focused and prepared for any emergency as the crew of Flight 1549."

In an interview, Captain Sullenberger stated:  "One way of looking at this might be that for 42 years, I've been making small, regular deposits in this bank of experience: education and training. And on January 15 the balance was sufficient so that I could make a very large withdrawal."

Organizations should view their risk management actions in the same way - deposits "to **prepare** for the possibility" of things going wrong."  That's only way difference-making rescue management will happen.