Cause Mapping is a Root Cause Analysis method that captures basic 1 Problem HOSPITAL HURRICANE cause-and-effect relationships supported with evidence. What Problem(s) Damage, flooding from hurricane/ tropical storm Cause Mapping When Date October 29, 2012 PREPAREDNESS Cause Map Time 7:10 PM (landfall at Atlantic City, New Jersey) Problem Solving • Incident Investigation • Root Cause Analysis Different, unusual, unique Massive storm system with high winds After Hurricane Sandy, medical What's the Geographic location 1 Where City, New York Step 1. Problem Problem? Facility, site Major medical institutions centers work to prevent future issues Task being performed Treating patients Why did it "What we see regarding hospital readiness for large-scale Step 2.2 Analysis happen? Impact to the Goals disasters are random acts of preparedness. Hardy Patient Safety Risk to patient safety, health sufficient." Employee Safety Risk to employee safety, health What will be - Irwin Redlener, director of the National Step 3. 3 Solutions done? Patient Services Evacuation of patients Center for Disaster Preparedness, Schedule/ Operations Closures/ partial closures of hospitals Billions Property/ Equipment Repairs, response, long-term protection As a result of Hurricane Sandy, multiple hospitals in were evacuated, many of which Labor/ Time >$800 million earned accreditation by the Joint Commission - which includes criteria for emergency preparedness and This incident Billions backup power capacity. NYU Langone Medical Center has upgraded its infrastructure and purchased flood barriers which can be deployed in the case of flooding. The hospital was reimbursed $150 million Frequency Similar issues from Hurricane Irene in 2011 for rebuilding costs by the federal government shortly after the storm. Bellevue Hospital Center, where Annualized Cost Billions the basement flooded in 45 minutes and took 5 days to pump out, also installed flood barriers and will be raising its backup generator's fuel pumps from the basement. Coney Island Hospital has elevated its 2 Analysis outside electrical equipment and installed temporary barriers, but is looking at the elevation of its emergency department, which is on the first floor. Basic Level Cause Map - Start with simple Why questions. Basic Cause-and-Effect As a result of both infrastructure damage and power What about the hospitals that managed to weather the storm? The Shorefront Center for Rehabilitation failures due to Hurricane Sandy, many hospitals in the Hospitals and Nursing Care in , just a few yards from the Atlantic Ocean, was praised for its handling of Patient New York City area had to be evacuated. Medical Evacuation of unable to Services Goal centers in the impacted areas are still recovering, while the storm - and assistance it provided to other healthcare facilities. Says their administrator, Loyola patients adequately Impacted trying to determine what should be done to prevent future Princivil-Barnett, "Our executive team have been taking, and are taking, emergencies very seriously. function risk - and who should be responsible. It's a matter of life and death." Possible solution: Flood barriers 3 Solutions Damage from More Detailed Cause Map - Add detail as information becomes available. Damage to high winds, infrastructure flooding

Patient Safety Risk to patient Area struck by Goal Impacted safety, health Solution: hurricane Effect Cause Failure of normal power Inadequate Evidence: Possible solution: Inadequate government Patient AND sources Move backup power Evacuation of preparedness requirements, Services Goal equipment above patients Impacted ground level funding Evidence: Most Backup power participating hospitals equipment Possible solution: AND met most measures located below Employee Risk to Closures/ State or regional for all-hazard preparedness in 2009 Safety Goal employee partial closures disaster planning flooded levels Impacted safety, health of hospitals Hospitals AND Insufficient unable to Codes not standards for adequately updated Schedule/ function Backup power accreditation AND Operations equipment Evidence: Per Joint Evidence: Goal Impacted flooded Commission, hospitals Expectations for Lack of power with failed backup generated power have For a free copy of our Root Cause Analysis Template in systems would still not changed; code is Microsoft Excel, used to create this page, visit our web site. meet standards for 13 years old Property/ Failure of accreditation Equipment backup power AND Goal Impacted supply systems Flooding See same cause Repairs, Investigate Problems. Prevent Problems. response, long- Houston, Texas 281-412-7766 ThinkReliability.com term protection Backup power Labor/ Time equipment Copyright ThinkReliability 2013 Goal Impacted inadequately tested ?