Sustaining improvement—it’s the trick before the treat!
I apologize for not pushing this out a few weeks earlier than now—I’m writing this a few days after Daylight Savings Time, so my brain is wonky and erasing my thoughts like an Etch A Sketch (you all know about that, yes? If not, this will serve as a quick primer.
One of the recurring themes of my work life (going all the way back to the very beginning some 46 years ago—imagine that!) has been dealing with risk management approaches that embrace the prohibition of a practice or a condition (classic examples being the presence of cardboard in patient care areas or storing stuff under sinks). Now I absolutely understand that prohibitions, as absolutes, are the easiest thing to “police” (if it’s a hard “no” and you find it, that’s an issue), but I’ve also noted that absolutes tend to drive the creativity of the folks in the environment to develop workarounds. I think at least part of that comes from the enforcement activities that usually accompany the absolutes and the fall-outs—safety tours are completed and lists of deficiencies sent to managers to resolve. It is a classic form, but I think it might be time to retire that approach. Bold words, I know, but hear me out.
My take on this is that the true purpose of safety tours/surveillance rounds/environmental tracers (whatever you want to call them) is not so much to identify deficiencies in the environment (there will always be stuff to find, just ask the accreditation organizations), but to identify effective processes for managing risk and to identify what opportunities exist to work with the folks in the environment, and perhaps provide some education as to why “x” is important as a strict interpretation. If I have learned nothing, facilitating the understanding of the end users when it comes to those absolutes can be absolute gold when it comes to sustaining compliance. The example I keep coming back to is the proper storage of compressed gas cylinders, particularly making sure that they are properly secured from falling. If you don’t know the impact of a compressed gas cylinder as a pressure vessel, then the reality of what could happen can be a real eye-opener. This video is a good one to show folks. Any time you encounter a workaround, it’s generally because the “reality” of the absolute/prohibition/etc. is getting in the way of the workflow.
Another good example is taping over the latching mechanism on a door. In many instances, that condition will never be reported because it’s so much easier to open a door (especially when your hands are full) by pushing on it than having to turn a handle. These failure modes can be frustrating to find, but are often borne out of frustration with the end-user’s environment. We need to find the middle ground where compliance is sustained, but not at the expense of workflow efficiencies.
At any rate, I think that using the safety touring activity as an exercise in collecting performance data will help you identify education opportunities and knowledge gaps that will help to drive creativity towards compliance and not to developing workarounds.
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.