Sustain? Hell, Move Forward

Added on Jun 24, 2015

That is my thought exactly whenever a healthcare leader asks me about sustaining patient safety culture. Sustain, hell, we are advancing our safety culture. (The motto of the 2nd battalion 5th Marine Regiment is “retreat, hell." 2/5 is the most decorated battalion in the United States Marine Corps. Their motto comes from World War I France, where they arrived to the front only to be ordered to retreat. “Retreat, hell, we just got here.”)

Socio-technical systems are far too complex to sustain. You cannot maintain the same position. So if you are not moving forward you are falling back.

Guiding complex systems forward is a continuous stream of interventions, adjustments, unintended consequences, readjustments, and then on to next interventions. Here is a chain of actual events to illustrate that complexity. Note that progress is always two-steps forward and one-step back.

Hospital Safety

Thomas Midgley, Jr. was a brilliant US engineer. Midgley worked in research and development for General Motors, and he solved big problems for the good of society. Midgley contracted poliomyelitis in 1940 at age 51. He developed a system of ropes and pulleys so that he could reposition himself in bed. In 1944, Midgley died when he became entangled in his system of ropes and pulleys. He was killed by his own invention.

Midgley had other unintended consequences. His research team developed tetraethyl lead as an anti-knock compound for gasoline. And his team, in collaboration with Dupont, developed Freon– the first chlorofluorocarbon for use as a refrigerant. His work enabled large-scale refrigeration and automotive transportation at the expense of poisoning the environment and destroying the ozone layer. Author Bill Bryson in his book A Short History of Nearly Everything observed that Midgley had “an instinct for the regrettable.”

Interestingly, Midgley worked for Charles Kettering at GM. Kettering, along with another GM executive, Alfred P. Sloan, founded the hospital we know today as Memorial Sloan Kettering. Kettering led innovations through his Dayton Engineering Laboratories Company (Delco) to the regrettable solutions of leaded gasoline and fluorocarbons, all in the name of safety. Kettering answered the call of the American Medical Association to make refrigeration safe following an increasing trend in deaths associated with dangerous ammonia, methyl chloride, and sulfur dioxide refrigerants. In fact, the call to action was a 1929 explosion and fire at The Cleveland Clinic killing more than 100 people. Refrigeration was made safe at the expense of the ozone layer. And automobile travel was made affordable at the expense of lead in the air and in the soil. Two-steps forward and one-step back.

There is more. Kettering originally went into the automotive business in the name of safety when Byron Carter was killed crank-starting a car in 1908. Carter was struck in the jaw when the engine kicked-back. His jaw was fractured by the crank. He developed pneumonia while recovering from the fractured jaw and died. Carter died of complications of a jaw fracture. The owner of Cadillac, Wilfred Leland, vowed that no Cadillac should ever kill an owner. Kettering accepted the challenge and developed the electric starter.

That is a lot of unintended consequence in the name of safety.

So if you as a patient safety leader can manage all of that complexity – you can merely sustain your safety culture. For the rest of us – we need to “sustain” our safety cultures by advancing our safety cultures. So the big question for us as safety leaders is - what will we be doing next to advance our patient safety culture?

If we are not moving forward then we are falling back.

More leadership wisdom from our HRO colleagues of the US Marine Corps – they train their frontline leaders (platoon leaders) in 3 principles:

1.Take the high ground (important details first)

2.Two-steps forward, one-step back (work for the best, anticipate the worst)

3. Hot chow for the troops (build the team).

 Pretty smart.