2019

STANDARDS OUTLOOK

What Organizations Can Learn From Hurricane Katrina

by R. Dan Reid

In the days immediately following Hurricane Katrina, many outsiders became aware the City of New Orleans had a comprehensive emergency management plan (CEMP) with an annex specific to hurricane preparedness. This plan detailed responsibilities for some tasks.

It was reported that all the city’s major hospitals had detailed evacuation and emergency plans yet, “None was prepared for a catastrophic flood. …Each responded differently when disaster struck.”1

This calls into further question the efficacy of the current U.S. hospital healthcare accreditation criteria and process, but that is another discussion.2

It was also revealed early in the aftermath of Katrina that in 2002, the New Orleans Times-Picayune forecast the consequences if a large hurricane struck New Orleans.3 As in many organizations, knowledge of the risks was not sufficient to cause government leadership to provide measures to adequately prevent or mitigate the risks.

So, what went wrong? Given that New Orleans had a plan (excerpted in Table 1, p. 84), there are two prime possibilities: the plan was not adequate or execution of the plan failed.


Need for Quality Planning

The need for quality planning and an effective plan has been well documented by many. For example, Hitoshe Kume wrote, “Quality control is said to begin with standardization. Control consists of a cycle of planning, doing, checking and acting.”4

ISO 9001 and its international workshop agreement (IWA) 1, an ISO 9004 based applications document for health services, emphasize the importance of developing a good plan in their first general clause, which says the organization must:

  • Identify the processes needed and their application throughout the organization.
  • Determine criteria and methods needed to ensure effective operation and control of the processes.
  • Ensure the availability of resources and information necessary to support the operation and monitoring of these processes (more on this later).
  • Implement actions necessary to achieve planned results.5

Note the emphasis on planned results. The IWA 1 text explicitly says the planned arrangements must be effective. But cost often weighs heavily on decisions about how much provision is enough. It comes down to risk tolerance—how much can you afford to lose? In the hurricane example, the cost to prevent or mitigate the effects of a category three hurricane is less than for a category four or five one.

Risk Tolerance

That’s why individuals can elect different deductible amount for car and house insurance. Some have a higher tolerance for risk, and therefore are more often exposed to a costly problem than others with a low risk tolerance.

Following the collapse of New Orleans levees that caused large scale flooding, it was reported some of the pumps in place to remove water from the city were not working. IWA 1 calls for preventive and predictive maintenance to avoid this type of situation:

The process to define the infrastructure necessary for achieving effective and efficient product realization should include the … development and implementation of maintenance methods to ensure that the infrastructure continues to meet the organization’s needs; these methods should consider the type and frequency of maintenance and verification of operation of each infrastructure element, based on its criticality and usage; … consideration of environmental issues associated with infrastructure, such as conservation, pollution, waste and recycling … Natural phenomena that cannot be controlled can impact the infrastructure. The plan for the infrastructure should consider the identification and mitigation of associated risks and should include strategies to protect the interests of interested parties.6

To be predictive and preventive, the mean time to failure mode and mean time between failures should be known for equipment so maintenance can occur during scheduled periods prior to a downtime incident rather than in corrective action.

In the design and development phase, accelerated life cycle testing should be completed for key equipment to be able to predict the component life and potential failure modes.

This information should then be incorporated into the design and process failure mode effects analysis (FMEA) and quality or control plans or process pathways, which are key deliverables in advanced quality planning. (See my May 2005 “Standards Outlook” column for more FMEA information with examples)7

Another issue raised with the Katrina disaster is the occasional need for significantly more resources to deal with a surge in demand. With Katrina, the storm surge was devastating.

Surge Capacity

For organizations, demand surge can result from a variety of causes, including an unexpected dramatic spike in demand for the organization’s products or services, financially troubled suppliers, catastrophic failure of critical capital equipment or tooling, or another major product quality problem or natural disaster.

IWA 1 indicates, “The organization should consider its social responsibility and role in a community health service system—for example, emergency services and preparedness for external disasters.”8

Organizations should therefore have a risk mitigation plan that includes consideration of risk factors such as having facilities located in known flood plains, on earthquake fault lines and in tornado prone areas. The plan should also consider the risk due to critical supplier locations in such areas. This may require provisions such as the following to mitigate the potential effects of a problem:

  • Having dual sourcing for critical purchased materials.
  • Carrying more inventory.
  • Locating inventory in facilities outside of known risk areas.
  • Cross training existing staff in more jobs or tasks.
  • Making prearrangements for additional temporary qualified staff.
  • Increasing available inventory of spare parts for critical capital equipment.
  • Having reciprocal resource sharing agreements with similar local organizations.
  • Identifying alternate facilities to be used for business in the event of unexpected loss of primary facilities.

The provisions should be sufficient to reasonably expect they would prevent or mitigate the effects of a potential problem. Management is obligated to provide necessary resources, as stated in the IWA 1 clause noted in this article.

ISO 9004 and IWA 1 go on to say, “Top management should ensure that the resources essential to the implementation of strategy and the achievement of the organization’s objectives are identified and made available.”9

If the organization does all that, the plan should be effective. So, what about providing for the proper execution of the plan when needed?

Who Is Responsible for What?

People need to know their roles and responsibilities in an organization. A 1997 supplier survey on the benefit of implementing QS-9000, a requirements document in the auto industry based on the 1994 version of ISO 9001, revealed key intangible benefits of implementation, included better understanding of jobs and tasks, and better morale.

In my Quality Progress “Standards Outlook” column in November 2004, I described the changes in the 2005 revision to IWA 1.11 I also included an example of a responsible, approve, support, inform, consult (RASIC or RASCI) chart for a typical healthcare clinical process.

A RASIC chart, similar in function to a Six Sigma accountability matrix, is included in the IWA 1 revision as a tool to easily define roles and responsibilities for each step in a process. These charts can be used to effectively “implement actions necessary to achieve planned results” from the earlier noted IWA 1 wording.

Looking at the New Orleans CEMP (see excerpts in Table 1, p. 84), use of a RASIC chart could have provided a fast and easy reference in time of crisis to guide people on their roles and responsibilities as well as remind those responsible for each task of others who needed to be informed.

The larger the organization, the harder it is to ensure everyone who needs to know does, in fact, know—and knows when he or she needs to know. Figure 1 is a rough illustrative example of the start of a RASIC chart I prepared based on the New Orleans CEMP.


Ideally, the tasks and responsibilities for coordination and interface with state, regional and federal resources should be included in the RASIC chart to ensure effective implementation of the plan. Additional agencies involved should also be added in an actual application of the RASIC chart for this process.

A RASIC chart can also be used to effectively define other critical processes for your organization. A powerful feature of the tool is it allows a complex process to easily be documented on one page to highlight roles and responsibilities through each step of a process.

Clinical healthcare and manufacturing processes can also benefit from the application of a RASIC chart. It is best to further document critical processes with process flowcharts or process maps to show how work gets accomplished across functions in the organization.

Flowcharts are better for this purpose than are traditional organization charts, which show only the reporting relationships and structure.

Looming on the Horizon

Officials at the World Health Organization have repeated warnings about the potential for a deadly bird flu pandemic. “Faced with the un-precedented damage caused by Hurricane Katrina, calls for better disaster planning against disease have taken on new urgency … We have learned in the past weeks bad things can happen very fast.”12

Quality tools and methodologies I have discussed, such as RASIC, flowcharts, accelerated life cycle testing, FMEA, control plans and process maps, should be used in disaster planning and other key organizational processes.

In some cases, as we have seen, it might be a matter of life or death.


ACKNOWLEDGMENT

Thanks to my IWA 1 colleague Mickey Christensen of TQM Systems in Baton Rouge, LA, for his contributions, including the IWA 1 updates that appear in the news area of this issue.


REFERENCES

  1. Sewell Chan and Gardiner Harris, “Death Stalked the Hospitals: None Was Prepared for New Orleans Flood,” International Herald Tribune, Sept. 15, 2005, p. 1.
  2. David Beerber, “Knowing When To Quit: O’Leary’s Hedging Opens Doors for Others on Patient Safety,” Modern Healthcare, May 2, 2005, p. 26, and Mark Taylor, “Quality As Gospel,” same issue, p. 32.
  3. John McQuaid and Mark Schleifstein, “Washing Away,” Times-Picayune, June 23-27, 2002, www.nola.com/hurricane/?/washingaway.
  4. Hitoshe Kume, “Management by Quality,” 3A Corporation, 1995, p. 10.
  5. International Organization for Standardi-zation, International Workshop Agreement (IWA) 1, Quality Management Systems—Guidelines for Process Improvements in Health Service Organi-zations, Automotive Industry Action Group (AIAG), 2001, clause 4.1.
  6. Ibid, clauses 0.2 and 6.3.
  7. R. Dan Reid, “FMEA—Something Old, Something New,” Quality Progress, May 2005, p. 90.
  8. IWA 1, see reference 5, clause 5.2.2.5.
  9. Ibid, clause 6.1.1.
  10. ASQ-AIAG survey, 1997.
  11. R. Dan Reid, “Healthcare Agreement Revision Nears Release,” Quality Progress, November 2004, p. 90.
  12. Elizabeth Rosenthal, “Nation Redoubling Steps Against Bird Flu: Fears of Pandemic Move Many To Plan,” International Herald Tribune, Sept. 17-18, 2005, Europe section, p. 3.

R. DAN REID, an ASQ Fellow and certified quality engineer, is a purchasing manager at General Motors Powertrain. He is co-author of the three editions of QS-9000 and ISO/TS 16949; the Chrysler, Ford, GM Advanced Product Quality Planning With Control Plan; Production Part Approval Process and Potential Failure Modes and Effects Analysis manuals; ISO 9001:2000; and ISO IWA 1. Reid also was the first delegation leader of the International Automotive Task Force.

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