August 11, 2011 | | Comments 1
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Since when should we let folks consider safety as an option?

Dipping into the mailbag once again, I recall a conversation I had with a client who was, with increasing frequency running in to the “everybody is so busy that they are being careless” situation. At that point, the folks around the table would nod their heads and the discussion would come to a screeching halt. Now the characterization of this (please excuse use of the congressional vernacular) filibuster was “counterproductive,” a characterization with which I could not agree more. So in thinking about this perennial sticking point, I offer the following:

There is no doubt that everybody is really busy these days and it is just as clear that the “busyness” contributes to accidents. So it boils down to being able to move beyond the busyness excuse/defense to make a real difference in behaviors.

The fact of the matter is that everyone is really busy, and that has only increased over the last decade—we don’t have more staff, more money, more time—all we have is more to do. Clearly there is a challenge to work “smarter” but sometimes getting to that smarter level takes more time than the end results provide as benefit. So then folks tend to “hide” from anything that might be representative of a “real” change—operationally, behaviorally, etc. So the question then becomes how do we decide what can we afford to be “too busy” to do? As I noted in an earlier blog entry, just after Christmas last year, I read “What If Disney Ran Your Hospital” by Fred Lee. Now I will absolutely say that not everything in the book was of particular value in this discussion, but one point that I keep returning to is the Disney concept of a ladder representing what things are most important: an actual hierarchy, as opposed to a lot of what is common in healthcare, like pillars, which all have (more or less) equal value. The Disney ladder places safety at the top—so naturally I am a bit biased—but one of the things I’ve always noted (and not particularly liked, to be honest) about the Studer columns and Magnet pillars, etc., is that neither structure truly gives safety its due. It’s like cleanliness—if a place isn’t clean it is almost impossible to control infection, but it’s frequently something of an afterthought—and left in the capable hands of the lowest compensated folks in the mix.

So, I guess it comes back to the decision point of “this is where we are too busy to worry about: being safe, providing an appropriately clean environment, whatever issue we are dealing with in the moment. I would like to think that folks could at least agree that something is important enough to merit some attentions, so maybe the follow-up question becomes—how can we be safe, be clean, be attentive, in a way that doesn’t get in the way of other things? I’m a great believer (coming from the land of the New English) that common sense, simple approaches can bear substantial fruits, but it’s back to the forest and the trees—picking the simple path is not always so simple.

Hopefully there’s something in there that’s useful. To close on the Disney thought, at orientation, Disney employees are instructed to hold safety as the most important part of their job, regardless of their “role.” If they see something that is unsafe, the expectation is that they will act on that. If we can get everyone (or even more than half) to actually live that, I think we’ll find that a lot of the stupid stuff will resolve itself before it gets to the point of conflagration. There will always be malcontents (discontents?) in the crowd, but we need to get the rest of the folks to recognize that type of attention-seeking behavior for what it is and understand that it brings nothing to the table in terms of moving things along/ahead/forward.

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Steve MacArthur About the Author: Steve MacArthur is a safety consultant based in Bridgewater, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at

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  1. Thank you so much! It is difficult- everyome is busy but if they take the time at first to learn and understand then many behaviours such as hand hygiene, putting on PPE either for standard or transmission-based precautions should become something you just do. And I really wish all were where the institutions were where everyone with sound safety records was at. They are out of the mode of “no one is to blame- it must be the process. If the P&P are well written and staff is trainned, then facilities need to implement corrective action. In this case, if you CHOOSE to violate the policy, you need to be put into the corrective action process. So much of what I see as infectionprevention violations are not because the policies are complex and hard to do- people are just too lax!!!!!

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