High-reliability healthcare, ‘preoccupation with failure’ and a valuable workshop

By: February 1st, 2018 Email This Post Print This Post

Gary L. Sculli, MSN, ATP, brings a unique perspective to safety in healthcare. In addition to being a registered nurse for more than three decades, he has served as an officer in the United States Air Force Nurse Corps and for many years worked as a pilot for a major U.S. airline.

Three years ago, Sculli shared some of his experiences and many of the insights gained during a diverse career in an HCPro book, “Building a High-Reliability Organization: A Toolkit for Success,” which was coauthored by Douglas E. Paull, MD, MS, FACS, FCCP, CHSE. Below is a book excerpt from a chapter on failure, in which the authors urged healthcare leaders, in the pursuit of high reliability, to embrace the concept of “preoccupation with failure.”

At the core, much of patient safety is dealing with uncertainties and unexpected events, the cardiac arrest being a prime example. In moments like these, not only do organizations rely on the technical expertise of staff and best practice guidelines, but also benefit from teams that are flexible, can adapt, and in essence, are resilient. Organizations themselves must be resilient to deal effectively with the changing face of healthcare.

Let’s examine a disaster from forest firefighting history—the Mann Gulch Fire in 1949. Young firefighters parachuted into Mann Gulch, near Helena, Montana, to combat what they believed was a rather routine forest fire. They were led by foreman Wag Dodge. But when the fire jumped from the south to the north side of the gulch, the firefighters were trapped and isolated from their escape route to the Missouri River. There were two possible routes for survival; either join Wag Dodge in his newly devised “circle of fire” or run to the top of the north ridge. This was the first time the circle of fire had been utilized during forest firefighting. Essentially, Dodge lit the grasslands on fire depriving the oncoming fire of any fuel to spread, thus protecting anyone within the circle. Whether due to a lack of trust, leadership, or communication, none of the other firefighters joined Dodge within the circle, despite his efforts to encourage them to do so. In addition, the young firefighters would not drop their heavy backpacks, slowing their ascent to the top of the north ridge. Thirteen firefighters died with their backpacks on and within sight of safety in the circle of fire or beyond the ridge. Dodge survived because he was able to pivot and adjust to rapidly changing and unexpected conditions.   

Several authors have discussed resilience, flexibility, innovation, and adaptability as attributes of successful organizations, including those in healthcare. Healthcare organizations must be able to learn from their mistakes. They must be able to face reality, “drop their old tools,” and accept the fact that the landscape can and will change suddenly and that unexpected events will occur. They must also accept that the best solutions to navigate the unexpected may be found in high-reliability industries. When viewed in this manner, leaders are not afraid to actively demand, even when faced with obstacles, such things as perpetual team training, mass standardization, briefings and handoffs, situational awareness support, just culture, staffing increases, and other patient safety initiatives. Leaders model open-mindedness and embrace innovation when unforeseen or novel situations arise. They talk with and listen to staff at the frontline when it comes to identifying and solving systemic challenges and failures. In many ways, current healthcare leaders are in a position similar to Wag Dodge. They must be resilient, prepared to build a circle of fire, and change course in order to solve unexpected and complex problems.

This spring, Sculli is again partnering with HCPro to give healthcare leaders the needed tools and guidance to create a culture of high reliability and safety within their organizations.

On April 16, Sculli will lead an intensive one-day workshop at Renaissance Orlando at SeaWorld® in Orlando, Florida. For more information on this upcoming HCPro workshop — which targets healthcare safety professionals, CEOs, COOs, VPMAs, risk managers, and quality/performance improvement professionals — please check out the event page at hcmarketplace.com.

 

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