Planning web frame
In this page we introduce the administration of a AWF dark web. 


Administration
In this page we introduce the adaptive plans covered in the frame. 

Each plan is an aggregate of data and analysis focused by the mission of the particular business within the corporate portfolio.

Context sensitive help
Planning web

Developing Business Plans for complex environments


Summary

In this page we first introduce the problem of complexity increasingly affecting business.  We discuss how adaptive planning can help cope with complexity.  The adaptive planning process that is supported by the AWF is the adaptive web framework.   is outlined. 

Each plan is an aggregate of data and analysis focused by the mission of the particular business within the portfolio.  AWF's set of template documents, tools and processes is introduced

Introduction


On any given day in the United States alone, some ninety thousand people are admitted to intensive care.  Over a year, an estimated five million Americans will be, and over a normal lifetime nearly all of us will come to know the glassed bay of an ICU is intensive care unit.  It is now being realized that the procedures and environment of the ICU is highly stressful for the patients.  In particular sedation with benzodiazepines is suspected to enhance the risk of inducing PTSD.  Intubation and catheterization are also traumatic.  Sometimes seperated into MICU and SICU.  eICU skill centralization may bring down costs. 
from the inside.  Wide swaths of medicine now depend on the life support systems that ICUs provide: care for premature infants; for victims of trauma, strokes, and heart attacks; for patients who have had surgery on their brains, hearts, lungs, or major blood vessels.  Critical care has become an increasingly large portion of what hospitals do.  Fifty years ago, ICUs barely existed.  Now, to take a recent random day in my hospital, 155 of our almost 700 patients are in intensive care.  The average stay of an ICU patient is four days, and the survival rate is 86 percent.  Going into an ICU, being put on a mechanical ventilator; having tubes and wires run into and out of you, is not a sentence of death.  But the days will be the most precarious of your life. 

Fifteen years ago, Israeli scientists published a study in which engineers observed patient care in ICUs for twenty four hour stretches.  They found that the average patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed some risks.  The Checklist Manifesto by Atul Gawande p23

Gawande provides a vivid example of 50 years of accelerating complexity.  His example is specific to surgery but the point applies generally across a broad range of markets.  Powerful infrastructure now interconnects us and amplifies previously localized effects.  The environment has become more complex because we are effectively connected by global infrastructure.  That infrastructure provides us with enough power to generate broadly noticeable signals.  Other aspects of the system respond to these signals creating complex adaptive adjustments. 

Businesses in environments subject to significant complexity must adapt to the multitude of changes.  To adapt effectively they must perceive and represent the changes.  Otherwise the situation seems chaotic and adjustments by the business just make matters worse.  That occurs because we miss apply our usual strategies.  We fail to cope with side effects and long term repercussions.  We take too aggressive or unaggressive corrective measures.  And we generally ignore the key premises through mechanisms described by Dorner

Porter and Lee argue that the environment of health care providers is becoming much more strategic.  They suggest that as FFS is fee-for-service payment.  For health care providers the high profits were made in hospitalizations, imaging and surgery.  Due to its inducing excessive treatment activity it may be replaced by FFV bundled payment.   shifts to FFV is fee-for-value payment.   and Medicare is a social insurance program that guarantees access to health insurance for Americans aged 65 and over, and younger people with disabilities and end stage renal disease or ALS.  Medicare includes:
  • Benefits
    • Part A: Hospital insurance.  As of Dec 2013 Medicare pays for home care in only limited circumstances, such as when a person needs temporary nursing care after a hospitalization. 
    • Part B: Medical insurance
    • Part C: Medicare Advantage 
    • Part D: Prescription drug coverage 
  • Eligibility
    • All persons 65 years of age or older who are legal residents for at least 5 years.  If they or a spouse have paid Medicare taxes for 10 years the Medicare part A payments are waived. 
    • Persons under 65 with disabilities who receive SSDI. 
    • Persons with specific medical conditions:
      • Have end stage renal disease or need a kidney transplant. 
      • They have ALS. 
    • Some beneficiaries are dual eligible.  
  • Premiums
    • Part A premium
    • Part B insurance premium
    • Part C & D premiums are set by the commercial insurer. 
and narrow network insurance - When all health insurance plans are comparable on line people are expected to choose narrower less costly plans.  This has the effect of encouraging providers and PCP to compete to be part of the narrow plan by reducing their charges and driving down the prices of the plans.  By limiting the number of providers/doctors offered in the plans the few that are included should get more business.  Across the US in 2015 39% of health plans offered in public exchanges are narrow (30 - 70% of areas providers) or ultra-narrow (30% or less of providers).  In large cities narrow networks are even more common.  Typically if consumers go outside of the choices offered in their narrow network they will be responsible for the high bills.  There are problems induced by narrow network constraints:
  • Queuing issues - while a surgeon and a hospital may be in-network other agents in an operation, such as anesthesiologists or anesthetists, may not have the same set of insurance contracts.  Even if a subset do, once these are allocated to a task the hospital must then manage a complex set of resource constraints to keep its ORs running.  If it does this by ignoring the 'out of network' status of these necessary resources the patient will be impacted by a high bill.  
  • Success is more likely when the plan maintains a broad list of PCPs but a narrow list of specialists and hospitals (Oct 2016). 
strategies bite, hospitals will have to shift from 'do it all' to aligning their resources and compentencies with high value offers. 

AWF is the adaptive web framework.   provides tools, templates and processes to support the development and operation of adaptive planning under conditions of increasing environmental complexity. 

There are many approaches to coping with complexity.  One has helped the car manufacturer Toyota, the health care provider Geisinger, and the personal computer maker Apple to become business icons.  It uses enterprise wide techniques to:
  • Characterize what is happening,
  • Respond coherently and effectively to failures,
  • Integrate successes,
  • Smooth transient peaks and troughs across the value delivery system, and to
  • Support continuous learning across the organizations as they work to integrate their many parallel activities into a coherent whole. 

Representing the environment

Under conditions of increasing complexity it is necessary to gather information about all detectable aspects of the system.  This must be done for a period long enough to assess trends that are happening in the environment and your own business.  Using the AWF is the adaptive web framework.   adaptive planning methodology the details of the system are represented in a set of HTML documents organized by:
  • The use of documents, in contrast to databases or wikis,
  • How HTML is used to link aspects together within and between the documents and
  • The processes used to structure the documents. 
Documents are used rather than a wiki or database to:

Developing an analysis of the system

Analysis of the data can allow models of the system to be developed or updated.  Finally a series of hypothesis can be formulated.  These hypotheses are based on the models predictions of possible future outcomes for the environment and businesses.  The alternative predictions are used as flags of how the real environment is changing.  As certain flags are detected the business can respond based on raising the priority of strategies that matched the most accurate hypothesis. 

Integrating the plan with the operations

Adjusting to the new strategic priorities can be challenging.  The strategy shift must be reflected broadly through the business.  Change can be an opportunity for creativity or a stimulus for induced fear, functional push back and paralysis. 

Introducing the adaptive web framework (AWF)

The AWF is the adaptive web framework.   provides a set of template documents, tools and processes to support:

AWF includes:

This planning web frame is a set of HTML files grouped together by a common theme in a dark web. 
  • Each page of a frame aims to include only information, and links, relevant to the specific focus of the web page.  A frame of pages allows different points of focus to be constructed, each linked together to provide the reader with a paced and, hopefully, comprehensive perspective.  Other pages of a frame can be reached by clicking the within-frame navigation buttons. 
includes pages that add more detail about each of the aspects just introduced.  These include, in
The AWF approach to planning is introduced and the need for generated dark webs is discussed.  Suggested goals include cycles of refinement, an organizational common place book and empowering operational groups.  Facilities provided to support the writing and reading of the plan are introduced.  Installation options, pre-deployment planning, external dependencies and typical customizations and launch modes of AWF are outlined.  An outline of a planning process is described. 

getting started
, a discussion of both the:
  • Challenges that the system is designed to mitigate and the
  • Details about how to use the tools and processes to build out the planning source documents from the skeletons.