Infrastructure versus culture: How does one support the other?

I’ve had an interesting couple of weeks scrambling up and down ladders while engaged in a focused above-the-ceiling life safety compliance assessment. The experience gave me time to think about one of the basic tenets (at least, for me) of managing the physical environment, which I will characterize as the “see something, say something” dynamic. As I have noted many times over the years, the organizations that fare the best during survey are the ones for whom the management of the environment is truly a shared responsibility. While that “sharing” includes everyone in the organization, it most particularly includes the folks at point of care/point of service, because that’s where most of the aberrant conditions (I hesitate to call them deficiencies, though that’s certainly how they would play during a regulatory survey) occur. I suppose there might be things that occur of their own volition, but I would venture to guess that 90-95% of the conditions in the environment that would require some sort of intervention after the fact, involve some level of human interaction. Things don’t tend to break on their own, walls don’t tend to damage themselves, etc.

So, my faith (as it were) has always been based on folks seeing the issue and then reporting it for resolution. But, my friends, that faith has been shaken. As I was standing atop my ladder, the most common scene was folks looking at their phones as they were walking. (I don’t think any of them were using apps to identify environmental conditions.) Over the course of the two weeks I was “laddering,” it gave me much pause. How is anyone going to see anything with their attentions “buried” in their phones? Clearly, there has been a shift in, not only the ubiquity of phones, but in the ubiquity of phones being the sole focus of attentions. I can’t say that I haven’t noticed it in other environments, for instance at airports (an environment in which I frequently find myself), but I don’t think I had had the opportunity to see how phones had encroached so thoroughly upon the healthcare environment. I know that it still holds true that constant (more or less) vigilance in the care environment will set the stage for early identification and correction of environmental “opportunities,” but it makes me wonder if this shift in the culture will allow for the continued, effective management of said environment. It may be that this has been in place for a long time, and I’ve just never stood still long enough to really observe this. (I always tell folks that I am never more dangerous as a surveyor than when I am standing still—keep me moving and the nuances are less apparent). At any rate, I guess something to ponder and something of which to be mindful as one prepares for the next survey. Maybe someone can develop an app like Pokemon, but people search for environmental conditions to be eligible for fun prizes.

About the Author: Steve MacArthur is a safety consultant with The Chartis Group. 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 an advisory board member for Accreditation and Quality Compliance Center. Contact Steve at stevemacsafetyspace@gmail.com.