The Room Where it Happens - Getting to Zero Harm

Like many of you, I watched the streaming performance of “Hamilton” over the holiday weekend. I thought the creative and energetic portrayal of American history was amazing!

Is it bad that even while enjoying Hamilton, patient safety is on my mind?  The song “The Room Where It Happened”  got my attention.  In the song, a character laments he was not in the room where a deal was reached among three of the Founding Fathers. As healthcare leaders we often wish we were in the “room where it happened ” - those places where adverse events happen, and harm happens to one of our patients.

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If I Could Have Been There…

We might think “if I had been there” I could have intervened and redirected the process to prevent the harm, to avoid the impact on the patients, the family, and our team members. The reality is we cannot be in “the room where it happens.”  There are too many “rooms” in our hospitals where decisions are made every day, for a leader to be part of every decision.

We might think “if I had been there” I could have intervened and redirected the process to prevent the harm, to avoid the impact on the patients, the family, and our team members.

What does a leader do? How do you have a role in those rooms, in those hundreds, thousands, of decisions every day?

High Reliability DNA Allows You to Be “In the Room”

Administrative, physician and nursing leaders create the culture that empowers the people making those decisions. We as leaders weave those behaviors into our organizational DNA and use our voices and platform to build those behaviors into habits. We need to use the principles of high reliability to create behavioral ingredients that will set expectations for everyone in the organization.

We need to use the principles of high reliability to create behavioral ingredients that will set expectations for everyone in the organization.

High reliability behaviors have expectations for mindfulness, creating and maintaining situational awareness, and standard communication principles. High reliability organizations  are continuously learning. They expect their team to have trust and transparency to report defects in processes; not only where harm occurred, but if a near miss or great catch prevented harm.

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The High Reliability Leader’s Role

As leaders we need to harvest every one of those opportunities to learn and improve. We need to share those improvements with our teams to demonstrate they were heard, and action was taken to avoid that problem in the future.

For leaders, the “room where it happens” can be our conference rooms, our offices, our daily huddles, our debriefs, our rounds – every place where we have a chance to role model high reliability behaviors and engage our team in building those behaviors into habits.

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Even though we cannot be in “the room where it happened” at the moment it happens, if we empower our teams to function with highly reliable behaviors and strengthen their growth, we can have an impact on those decisions. Our team members come to work every day to do their very best for every patient, every time.

Let’s use our leadership “rooms” to equip our people for success in their “rooms.” In healthcare those ”rooms where it happens” is where we can create zero harm.

Marty Scott, MD, MBA, is the Vice President of HRO Consulting.