Escape Fire and high reliability

I have bene rereading two books recently, Managing the Unexpected, (a fantastic read) and Berwicks Escape Fire. Berwick spoke about the Mann gulch fire disaster in Montana, about which Weick has written. Although at first pass, one wonders what lessons a forest fire in Montana has to delivering safe care in health, there are many deep lessons to be learned. This is a paper well worth reading. A few examples.

To be wise is not to know particular facts but to know without excessive confidence or excessive cautiousness. Wisdom is thus not a belief, a value, a set of facts, a corpus of knowledge or information in some specialized area, or a set of special abilities or skills. Wisdom is an attitude taken by persons toward the beliefs, values, knowledge, information, abilities, and skills that are held, a tendency to doubt that these are necessarily true or valid and to doubt that they are an exhaustive set of those things that could be known.
In a fluid world, wise people know that they don't fully understand what is happening right now, because they have never seen precisely this event before. Extreme confidence and extreme caution both can destroy what organizations most need in changing times, namely, curiosity, openness, and complex sensing. The overconfident shun curiosity because they feel they know most of what there is to know. The overcautious shun curiosity for fear it will only deepen their uncertainties. Both the cautious and the confident are closed-minded, which means neither makes good judgments. It is this sense in which wisdom, which avoids extremes, improves adaptability.

Partners and partnership are critical.

A partner makes social construction easier. A partner is a second source of ideas. A partner strengthens independent judgment in the face of a majority. And a partner enlarges the pool of data that are considered. Partnerships that endure are likely to be those that adhere to Campbell's three imperatives for social life, based on a reanalysis of Asch's (1952) conformity experiment:

(1) Respect the reports of others and be willing to base beliefs and actions on them (trust);

(2) Report honestly so that others may use your observations in coming to valid beliefs (honesty); and, 

(3) Respect your own perceptions and beliefs and seek to integrate them with the reports of others without deprecating them or yourselves (self-respect). 

Motivation and work satisfaction.

Reading Quality by Design; well worth delving into. A quote by Paul O'Neill, ex CEO of Alcoa and Former Secretary of the US Treasury.

"I am treated with dignity and respect everyday by everyone i encounter... and it doesn't have anything to do with hierarchy. I'm given the opportunity and the tools that i need to make a contribution and this gives meaning to my life. Someone noticed that I did it.

 O'Neill states that a high level of work-life satisfaction exists when every employee can strongly agree with these three statements. A simple approach, too often disregarded in health organisations.

 

Disruptive Innovation

From one of my fave blogs, The Big Picture, comes a great graphic about disruptive innovation. Bottom line;

Disruptive innovations don't have to rule the market, they just have to change the market and force others to follow suit. The goal of disruptive companies is to challenge the conventional market and create a new one. 

Improve patient experience and staff experience

I read a few days ago two articles in BMJ Quality and Safety, (here and here, sorry sub required) in which patients recounted their experiences, (pretty bad). A letter in response makes the point that addressing the defects that result in poor care not only improves the patient experience, but also makes work more satisfying for staff. A true win-win.

"Frontline staff frequently struggle with infrastructure issues that inhibit their ability to deliver high quality care, undermine their work flow and also affect their morale. Many of these same infrastructure problems frustrate patients as much as they do staff. Some patient safety problems thus represent a win–win situation from an organisation's point of view: addressing them improves patient safety and increases the efficiency of frontline staff, as well as the quality of their work life."

Safety in Primary Care

Safety in hospital care (or the lack of) gets the lions share of attention. However, little is known about safety in primary care; even if substantially safer, there may still be substantial risks given the huge numbers who access care through their GP as compared to the numbers accessing hospital services. A piece that discussed this subject is published here by BMJ.

"Do we really know how safe general practice is? And where we identify problems, what sort of mechanisms do we have to ensure that the sort of poor practice that the programme identified is addressed? "

ZDOGG

I must admit, I love ZDOGG MD. This piece is a classic. Mental Illness on Sesame Street. Check it out, it will cheer your day.

Whistleblowing

I hate the term "whistleblower". It has all sorts of negative connotations, for doing something that is intended to stop bad behaviour, bad practice, and harm. At a meeting in London two years ago, i heard 3 "whistleblowers", all non-medical talk about their experience. they found it very harrowing, and i seem to recall all three saying they would never do it again. See here for a link to one of the speakers. Just a few days ago, I came across this piece, the story of the anesthetist who raised concerns about poor outcomes in children and babies undergoing heart surgery in Bristol.

Leaving the UK with my wife and family was an incredibly sad and disappointing time but I am sure now that there could never have been ‘Clinical Governance’ or a change in medical attitudes while I remained in the UK. Only when I had a contract in a new hospital, in a new country did I feel secure enough to report the mortality rate in the Bristol paediatric cardiac surgery unit to the GMC. Sadly despite the Presidents and Council Members of 2 Royal Colleges, the Dean of the Medical School, numerous Professors, some members of the Trust Board, members of the Department of Health and many local clinicians all knowing about Bristol, no other doctors in the UK reported these events to the GMC. I believe that this is a serious and permanent indictment of the attitudes of the profession that prevailed at that time and persist in some quarters in the UK. At least 12 sets of parents had reported deaths to the GMC, but their complaints would not have been investigated without a complaint from a doctor.

A damning indictment.