Carrying the Load Through Tough Times

Added on Apr 23, 2015

I recently heard Dave Ramsey, a well-known financial expert and author, tell a story about the Belgian Draft Horse. If you’re unfamiliar with these horses as I was, suffice it to say that this particular breed is known for its size and strength, weighing in at 2,000 pounds, standing nearly 6 feet tall and capable of pulling 8,000 pounds in competition.

Healthcare Safety

What really struck me though was not the size of the horse or how much a single horse could pull, but the fact that when yoked together, a team of two is capable of pulling not 16,000 pounds, but 24,000 pounds. Two Belgian Draft Horses can pull three times the weight of one. Further, if those two horses are raised and trained together, they can pull 32,000 pounds – four times the weight that can be pulled by a single horse.


I think the same can be said for hospitals striving to become High Reliability Organizations. Healthcare team members are generally well trained to perform the technical skills appropriate to their professions or given tasks. But when “raised and trained” together in Error Prevention Behaviors, the load they can carry together becomes more impressive. The outcome, in our terms, can reach Zero.

Zero Events of Harm. How is this possible? It’s possible because the eyes, minds, hands, and hearts of two or more team members yoked together with non-technical skills (sometimes referred to as behaviors for error prevention, reliability behaviors, or safety behaviors) can carry a much greater load and keep patients safe - even in the riskiest and most complex of situations.

As I reflected on this story of the Belgian Draft Horse, I considered its application to a High Reliability Organization. I recalled a recent email I received from Primary Children’s Hospital (PCH) in Salt Lake City, Utah. They are in the midst of an unprecedented patient census due to a convergence of RSV and flu seasons. In order to provide optimal care for patients, staff normally working in Surgical Services had to float to other areas of the hospital, a high risk situation.

What is remarkable to me is the fact the two Surgical Services Safety Coaches, Alison Barrington and Jennifer Millett, took it upon themselves to increase their team’s pulling capacity by doing what Safety Coaches do – maintaining focus on Error Prevention Behaviors - especially when faced with high risk situations over which they had no control...

The message was simple.

“It has been such a busy few months for all of us here in the hospital and some of us have had to do things that might be a little out of our comfort zone. Lucky for us, we have learned some safety tools (Error Prevention Behaviors) to help with those stressful times! A few things to remember...

  • • If you are floating to a new unit, try to get there a little earlier than usual and get to know the area and your surroundings.
  • • Use the 5P Handoff – (Patient/Project, Plan, Purpose, Problems, Precautions) when you are floating to assist you with your shift. Remember, this can be used for your patients, or as a plan for your shift!
  • • Use STAR (Stop, Think, Act, and Review) when you float!
  • • Remember to Speak Up for safety!
  • • Always make sure you have a buddy for the shift and know your resources before you need them. We are all in this together!

Remember when we are busy it is even more important to use your safety tools!

It is said that “amateurs practice until they can get it right, professionals practice until they can’t get it wrong” (source unknown). This story shows that Primary Children’s Hospital is doing Error Prevention right.

When considering where your organization is in its own journey to High Reliability, consider the following:

  • • Challenges to capacity, financial pressures, leadership changes, or many other potential distractions will come to your organization. How will your team respond?

  • • Are your Error Prevention Behaviors so embedded that when your organization is squeezed with a high risk situation, it’s the Error Prevention Behaviors that prevail?