eDocTalk article

On Red Rules, Big Aims and national recognition

November 2013

Lewis Low, M.D.

It took only about 15 seconds. But it put me more at ease and no doubt gave everyone on the team more reassurance for what we were about to do.

The patient was severely obese and highly agitated, so the intubation was high risk. Before we started I asked everyone in the ICU room to tell me what their primary task was for the procedure and what they would do to help if we ran into trouble. Who would hold cricoid? Who would get the LMA if it was needed?

Once everyone spoke and we all knew not only our own but each other’s roles, we proceeded with our checklist. Now we were a team with a single focus. It felt good and my own heart rate decreased. Fortunately, everything went without complication.

Red rules and culture

Atul Gawande, M.D., surgeon and author of "The Checklist Manifesto," notes two benefits of red rules — rules that require specific processes and must be performed every time.

They hardwire a system of checks and double checks through the use of a list, freeing the team from having to recall the steps and allowing physicians to focus on the complex nuances of the case in front of them.

The second benefit is that red rules create a culture where everyone on the team feels comfortable speaking up.

I was in Washington, D.C. late last month and Assistant Secretary for Health, Howard K. Koh, M.D., told me that there have been research findings that people who were asked to simply say their name at the start of a procedure were more willing to speak up later.

I absolutely want my team to say something if I am about to harm a patient. Anything I can do ahead of time to make them more comfortable speaking up is better for my patient, for Legacy and for me personally.

National recognition

The reason I was hobnobbing with top officials, among others, was because Legacy had been invited to lead a national discussion on reducing surgical site infections. We were asked because of our success through the Big Aims initiative.

It was a little heady being at a conference with 200 movers and shakers from across the country, and to have Legacy Health leading the break-out session on SSI. I took tremendous pride in what brought me there — the accomplishments of many of you and our clinical teams.

One of the main reasons for our success is the culture of safety we are developing within our organization. Red rules are a part of this.

Not everyone buys into red rules or Big Aims. Some say they never have had a wrong-site event, so they don’t need a checklist. I say, good for you, and I hope you never do. But anything we can do to make every member of our clinical teams comfortable enough to speak up and stop a potential mistake is good for everyone.

I am extremely proud of Legacy’s success with SSI reduction. And with implementing red rules for all-invasive procedures requiring consent.

Our safety work is making a difference and while we often forget this during our busy days of taking care of patients, I hope you take some pride in knowing that together, you and Legacy are among the leaders nationally.

Lewis

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