March 21, 2016 | | Comments 0
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The physics of compliance: If you have no friction, you likely have no traction

Or those wheels are going to be slipping all over the place…

This week’s offering is a little bit towards the random musings category, so hang on tight!

Friction vs. traction: I think that just about everyone in the safety community has experienced some level of pushback when they’ve tried to enact some change of process/expectation/behaviors to enhance the safety of their organization. And in so doing, you’ve discovered that the healthcare culture really does embrace change—it grabs change by the throat, throws it on the ground, and kicks it until it stops moving. This usually comes down to the classic “I’ve worked here for umpty-ump years and it’s never been a problem before,” etc., and while it doesn’t always seem so helpful in the moment, it does give you something in the way of useful feedback—they’ve actually noticed what you’re trying to do. For example, I can recall a time when the thought of physicians actually wearing ID badges seemed like a fantasy. And yet, as we speak, it is actually happening in a whole bunch of places (maybe not as much as we would like, but you’ve got to start somewhere). Now admittedly, a lot of the move towards the use of ID badges comes down to the proliferation of access control technology, the end result is that compliance became more convenient (in the ongoing battle between convenience and compliance, all too often convenience kicks compliance’s tailbone).

I would ask you to think about those stubborn deficiencies/behaviors that are perennially on your “needs attention” list and look at whether compliance is sufficiently convenient or has the operationalization of a compliance activity, say, the segregation of full and not full compressed gas cylinders, resulted in a process so complicated that it does not encourage compliance. In this case, I would say that more than 50% of the instances in which I find partially full or empty cylinders in the rack designated for full cylinders is because the racks for the “not full” cylinders were jammed with empties or partials and the only place left to safely store (remember, we’ve been nagging folks for about a decade on the proper storage of cylinders) the partial or empty cylinder is in the full rack. Perhaps the question that needs to be asked is whether there is enough space for the partial/empty cylinders; you can usually control the number of full cylinders being provided, but the number of partial/empties can ebb and flow over the course of a shift, a day, even over a week. I know it’s tough to get folks to own up to having put a cylinder in the wrong place (or damaged a wall, but that’s for another day), but I am fascinated by the action that results in someone doing something that they know they are not supposed to do. By the way, this is based on my firm belief that we’ve done enough education on this subject—and I would like to believe that the education that we’ve provided is sufficiently effective to at least get the message across. In looking at the misfiled cylinder as a failure mode—what happened in the process to result in the cylinder being in the wrong place. I can’t imagine that it’s being done purposely (it happens way too often—if it’s purposeful, we might just as well give up), but there has to be something we can discern from these instances/practices that we can use to encourage compliance—make it more convenient, as it were. So, don’t be afraid of a little friction as you pull these stubborn compliance issues apart. If things go too smoothly, there’s probably a workaround lurking somewhere in the background. Remember, it’s taking the path of “least resistance,” not “no resistance.”

The other random musing for the week is for those of you that may be in the middle of your post-survey process; be very judicious when you are creating your corrective actions plans. All too often, I see folks that have way overcommitted on their corrective action plans. Look very carefully at what the standard or performance element is actually requiring you to do and try to pick the route to compliance that work best operationally (meaning choose strategies that encourage compliance without overwhelming the participants—this is an analogue of the eternal question of how to eat an elephant). Don’t commit to daily activities if you can get where you need to be by doing it weekly; don’t commit to weekly if you can get where you need to be by doing it every other week; and so on. Also, I would advise trying to stay away from activities that don’t make sense—operationally, logically, etc. I tend to say that logic doesn’t always prevail, but I reserve that for direct dealings with regulatory surveyors. Once the surveyors are on their way, take the compliance results as data to make improvements—and focus on determining how you’ll measure those improvements. It puts you in a much better position to avoid those findings in the future (and at some point, the regulatory folks are no doubt going to get ugly when it comes to repeat offenses). As with so many things in the safety and compliance realm: this is a journey, not a destination. And on that quasi-Zen note, I bid you a safe week!

Entry Information

Filed Under: Emergency managementEnvironment of careThe Joint Commission


Steve MacArthur About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, 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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