October 9, 2025 • 45 mins
Safety isn’t a side project. It’s the operating system.
We sit down with Paul Lambrecht, a rare blend of front line paramedic sensibility and executive discipline, to unpack how high reliability organizing moves from idea to front line work. From standing up daily safety huddles to building a just culture where ARCC and SBAR actually get used, Paul explains how to turn near misses into gold, flatten authority gradients, and create a system where performance as intended becomes the norm.
We trace his journey through a post-merger health network that unified on a single EMR and chose safety as its identity, leading to dramatic reductions in preventable harm. Paul breaks down the five principles of high reliability—preoccupation with failure, sensitivity to operations, reluctance to simplify, deference to expertise, and commitment to resilience—and shows how to operationalize each with simple, durable tools. You’ll hear how a 20-minute, whole-house huddle can give real-time situational awareness, how a shared dashboard closes loops fast, and why top-down sponsorship paired with frontline ownership changes behavior at scale.
We also look forward. Human factors is reshaping patient safety by designing systems that make the right action the easy action—clear interfaces, standardized kits, cognitive offloading, and smarter workflows. Paul shares candid lessons on psychological safety and just culture, how to coach leaders who default to blame, and where to start if you’re resource-constrained: round for safety, mine near misses, train in ARCC and SBAR, and build reliability into daily routines.
If this conversation sparks ideas for your team, follow and share the show, leave a review to help others find it, and tell us: what’s the one safety ritual you’ll start this week?
Connect with Paul Lambrecht on LinkedIn
Additional Resources
Foundational Books
- Managing the Unexpected — Karl E. Weick & Kathleen M. Sutcliffe (Wiley). The classic HRO text outlining the five principles.
- The Engaged Caregiver — Joseph A. Cabral & Timothy R. Clark (McGraw-Hill). Discusses the “virtuous cycle” linking safety → engagement → quality → efficiency.
- The Fearless Organization — Amy C. Edmondson (Wiley). Psychological safety as the backbone for speaking up and graded escalation.
Peer-Reviewed / Authoritative Articles & HRO Background
- “High-Reliability Health Care: Getting There from Here” — Mark R. Chassin & Jerod M. Loeb, The Milbank Quarterly (open access). Seminal roadmap for healthcare HROs from the Joint Commission.
- Joint Commission — High Reliability (overview, maturity model, and training).
- NJ Hospital Association HRO Collaborative — origin of the “New Jersey Strong” safety behaviors later adapted locally (e.g., “CooperStrong”).
Practical Tools & Frameworks
- Five Principles of HROs (Weick & Sutcliffe): Preoccupation with Failure; Reluctance to Simplify; Sensitivity to Operations; Deference to Expertise; Commitment to Resilience. (See Managing the Unexpected above.)
- SBAR – Situation, Background, Assessment, Recommendation (IHI tool + PDF).
- ARCC / ARC – Ask, Request, Concern, (Chain of Command) — graded escalation method; overviews and clinical examples.
- STAR – Stop, Think, Act, Review — commonly included in error-prevention toolkits (organizational examples).
- Daily Safety Huddles — Joint Commission HRO guidance for leadership behaviors that enable whole-house situational awareness.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
What we find with high reliability is because
you're trying to instill asafety culture in an
organization, you really have tohave the buy-in from the top of
the organization all the waythrough.
Otherwise, you're going to haveteam members trying to deploy
and use these skills andbehaviors and the leaders of the
organization not being on thesame page.
SPEAKER_00 (00:22):
Welcome to Leading Quality, the podcast
spotlighting the people movinghealthcare forward from the
front lines to the C suite.
I'm your host, Jason Meadows.
Today's guest, Paul Lambrecht,is a rare blend of frontline
(00:45):
sensibility and executivediscipline.
He's the Vice President ofQuality and Patient Safety at
Cooper University Healthcare andan assistant professor of
medicine at Cooper MedicalSchool of Rowan University.
With 30 plus years of healthcareleadership, Paul Nell set
strategy for quality, safety,and high reliability at Cooper,
(01:06):
overseeing infection prevention,regulatory readiness, medical
staff services, documentationintegrity, and environmental
safety.
Before Cooper, Paul spent adecade at Inspira Health,
leading system-wide safety,earning consecutive leapfrog A
grades and top hospital awards.
He sponsored Inspira's highreliability journey and the
(01:29):
network's move to Cerner.
And he led the COVID response asincident commander.
I wanted Paul on the podcastbecause he's actually made
leading with safety work,standing up daily safety huddles
and using practical tools likeS-Bar, ARC, and Red Rules.
First at Inspira and now atCooper.
(01:52):
In this conversation, we'lltrace that playbook, talk about
the nuts and bolts of culturechange, and explore what's next
for high reliability in an eraof burnout and AI.
Let's dive in.
Paul, welcome to the podcast.
Thank you, Jason.
My pleasure.
Thanks for having me.
I'd love to dive in.
(02:13):
Full disclosure, we've knowneach other for a little while
now, and I've really beenlooking forward to this
conversation because it gave mea chance to dig a little deeper
myself into your background.
But I am curious to know alittle more about you having
started as a paramedic and maybeamong people with your title
now, this is uh maybe a lesscommon background.
(02:34):
Maybe there's more kind ofphysicians or nurses in in this
world.
I'm curious how your journey ledyou from being a paramedic to
maybe a leader of paramedics andthen into quality and safety.
SPEAKER_01 (02:47):
Yeah, it was it was definitely a non-traditional
start for somebody stepping intouh quality and patient safety
work today.
While I was working as aparamedic initially, I had the
opportunity to do some whatwe'll call old school quality
assurance work, which reallyamounted to, you know,
conducting chart reviews forprotocol and regulatory
(03:08):
adherence and things of thatnature.
And then as my work continued inthat space, I had the
opportunity to step intoeducation.
I was involved in educating andprecepting new paramedics, and
then ultimately had theopportunity to move into a
leadership role as a director ofthe paramedic program.
And at the same time, since wewere a hospital-based service,
(03:31):
moving into that director'sposition gave me the opportunity
to become more involved in otherhospital operations, inpatient
operations as well.
And that's where I actuallystepped into the safety world
initially from an environmentalperspective as the hospital
safety officer.
And then as patient safety grew,I began to take uh more
(03:51):
responsibility on for patientsafety as well.
SPEAKER_00 (03:54):
That's great.
And I wonder if you you noticedthat kind of skills that were
forged in the in the fires ofparamedic life translate well
into this role, or are there anykind of unique features of of
the skill set you developedclinically that then translates
well into the patient safetyworld?
SPEAKER_01 (04:13):
Well, it's interesting.
What I didn't know then that Iknow now is that some of the
tools that I was using in myclinical practice as a
paramedic, such as SBAR three,three we repeat back, phonetic
and numeric clarifications, theywere all tools that I was using
on a daily basis, workingclinically, that were actually
(04:33):
the initial step into leveraginghigh reliability tools to keep
patients safe.
So I was doing it back then anddidn't realize that it was
actually high reliability toolsthat I was using.
But you know, flashing forwardto my current work, I think the
skill sets that I bring with mefrom that time were around
critical thinking andcommunication skills.
(04:55):
I think leaders in thehealthcare space today have to
have solid communication skillsfor both verbally and written,
be able to effectivelycommunicate horizontally and
vertically in an organizationand across varied audiences.
And I find myself speaking toboard members, to executive
teams, and then to the frontlinestaff.
(05:17):
So leaders in today's space needto be very flexible in their
ability to communicate acrossall of those audiences.
SPEAKER_00 (05:24):
And it's interesting to me, coming from the physician
side, that that things likeS-BAR and these kind of
structured communication toolsuh were such a big part of your
daily life and and maybe theyhaven't permeated as as much
into your you know usual MDpathway.
Yeah, that that's neat that thatyou know it was kind of
foreshadowing what was come whatwas to come without you knowing
(05:46):
it at the time.
Exactly.
And was this you knowintentional that once you
started to get into the thequality and safety world that
you gravitated in particular?
Because I think there's a lot offlavors that that quality
improvement work can take.
And I'm curious if there'ssomething that led you to uh
high reliability in particular.
And maybe you can just kind ofbriefly explain for people who
(06:09):
don't know, you know, what ahigh reliability organization is
and then what what made youchoose it.
SPEAKER_01 (06:16):
My res my scope of responsibility in quality safety
is is really kind of broad.
I've got a lot of differentareas that kind of report up to
me.
But what's unique about highreliability is that the
principles of high reliabilityare really kind of foundational
that really sets the tone forreally all of the work that we
do within the quality and safetyspace.
(06:37):
I think what we've found is, youknow, like other industries such
as commercial aviation andnuclear power, if we lead with
safety first and we get thatright, everything else is going
to follow.
So when you look at the scope ofhealthcare quality and safety,
you know, we're focused onquality outcomes, we're focused
on patient experience.
And, you know, what we found andwhat the data has shown us is
(07:00):
that if you lead with a strongsafety culture, you're gonna
have strong team memberengagement.
And together, that safetyculture and your team member
engagement is really gonna drivethe organization's success with
respect to quality, patientexperience, and ultimately the
efficiency of the organization.
SPEAKER_00 (07:17):
That's great.
Uh, I'd like to shift a littlebit into some of the background
of how you got where you aretoday and some of the work that
you've done, specifically inhigh reliability and and how you
kind of built up this safety,quality and safety career.
You joined Inspira in uh 2013,as I understand it.
And um, I wonder how you woulddescribe the culture around
(07:41):
quality and safety at that timeand and maybe how it changed
over the time you were there.
SPEAKER_01 (07:47):
Yeah, sure.
So in 2013, we were really justa brand new health network at
the time.
The merger that created InSpearoccurred in November of 2012.
And I joined, I came from one ofthe organizations and into uh
the new role as the vicepresident of quality and patient
safety.
(08:07):
So at that point, uh I woulddescribe the culture as really
evolving.
You know, we were two, you know,previously independent health
systems that have come together.
Each had their own culture, eachhad, you know, very strong work
going on within the quality andsafety space.
And as a new system, we werelooking to define who we were
going to be going forward.
(08:29):
So there was a lot ofopportunity to really develop
something new when that systemwas first formed.
SPEAKER_00 (08:36):
And it sounds like there was an appetite to lean
into this more.
And I think I read in one of theuh an article written, I don't
know if it was by by you orabout you, but that there was, I
guess, a lot of of a sense thatthere was a lot of good work
that had been done within thequality department and that you
were looking to to kind of leaninto that more.
(08:57):
Had the the principles, kind ofthe the kind of five core
principles of high reliabilitybeen at all part of the DNA of
that system, and and if uh ifnot, how did you kind of start
introducing them?
SPEAKER_01 (09:11):
Yeah, I think they were in part, although many of
us maybe not have realized thatthey were in fact the five
principles of high reliability.
So what we found was as we gotinto this new environment, this
new health system, we wanted todefine who we were as a new
system and kind of in a way setus apart from others, so to
(09:33):
speak, because we were a verycompetitive space.
There are a lot of healthsystems around us.
So we really were looking tolooking for something to define
who we were.
And there were two things thatkind of emerged immediately
post-merger that were definingfor the new health system.
One was the conversion of ourelectronic medical records from
SORI into CERN.
So at the time coming together,we had close to 17 different uh
(09:59):
or disparate health informationsystems that were operating
throughout each of thefacilities and in the inventory
environment.
So we wanted to bring that alltogether into the CERN platform,
and to do that, it was going torequire organizations that
previously did things indifferent ways to kind of come
together and do things from asystem perspective.
(10:19):
So that was the one step that wetook into coming together as a
system.
The second was our work in highreliability.
At that time, there werehospitals uh over in
Pennsylvania just across thebridge from us in the
Philadelphia market who wereinvolved in a collaborative to
(10:40):
develop high reliability withintheir operations.
So we had heard about that andwe were following that for a
little bit.
And then around that same time,uh Mark Chasen, who was then the
president, CEO of the JointCommission, had actually
published an article about highreliability healthcare.
So there was a lot of visibilityaround this concept of high
(11:01):
reliability and how we can beginto apply the learnings from
other uh industries into thehealthcare industry.
So that visibility caught ourattention, and we viewed this uh
as an opportunity to kind ofstep into the high reliability
journey and begin to developthis new culture of safety uh
around error prevention andpatient safety as part of a way
(11:25):
to develop this new network.
It was really hard to argue withthat approach.
We're trying to focus onenhancing safety culture and
minimizing error in this newnetwork.
It was really hard to argue withtaking a step in that direction.
So that was really how wedecided to take that step into
the high reliability journey.
SPEAKER_00 (11:44):
Yeah, it sounds, it sounds like a theme that I've
I've heard elsewhere as well,which is if you start with
safety, it's it's such an easysell for anyone who who decided
to devote their life and theircareer to being in healthcare
that it's uh a natural on-rampto kind of unite people around a
common vision.
Is that was that yourexperience?
SPEAKER_01 (12:04):
It it is.
And there's actually a textbookcalled The Engaged Caregiver
that actually gets into thisidea of the virtuous cycle and
how if we lead with safety andutilize high reliability as a
lever, together, safety and highreliability will generate
positive outcomes in quality,experience, engagement, and
(12:25):
ultimately efficiency.
So it's uh it's been it's beenpublished in uh in the engaged
caregiver.
SPEAKER_00 (12:33):
Yeah, I remember you recommending that one actually
uh a few months ago when yougive a talk about this.
That's uh that's one to checkout.
We'll keep we'll include that inthe show notes.
So, you know, I I imagine thatthere are uh some people in the
audience hearing the term highreliability and maybe not sure
what that means or uh what thethe core principles are
underlying it.
So this was something um youknow published by uh Wyke and
(12:56):
Sutcliffe uh back in 2001, uhManaging the Unexpected.
And and this is where theydefine five core principles of
high reliability.
Can you just walk us throughwhat those five principles are
and uh what they mean forhealthcare?
SPEAKER_01 (13:12):
Certainly.
So the five principles canreally be divided into two
buckets.
There is what we call theprinciples of anticipation,
which are designed to keep youout of trouble, and then there
are the principles ofcontainment, which are going to
be used to get you out oftrouble when you find yourself
in trouble.
So when we talk about theprinciples of anticipation,
(13:33):
there are the first three.
So we have preoccupation withfailure, reluctance to simplify,
and then sensitivity tooperations.
So when we talk aboutpreoccupation with failure,
here's where we really focus onstudying small errors before
they become big problems.
We're constantly looking forfailure loops and where
processes can break down.
(13:54):
And that allows us to preventlarge errors from happening when
we keep our focus on, you know,trying to prevent those small
failures from occurring.
The second principle issensitivity to operations.
And here's where, you know, asleaders, we kind of have our
head on the swivel.
Uh, we maintain situationalawareness of what's going on in
our space at any given time.
(14:16):
Uh, we want to make sure we'vegot a line of sight into what
our team members are doing on adaily basis.
So that that really encompassesthe whole idea of sensitivity to
operations.
And then the third is reluctanceto simplify interpretations.
And here, you know, we're tryingnot to take the first
explanation for things when theygo right or wrong.
(14:37):
It's it's really an idea ofdigging a little deeper and
having diversity of thought andopinion, making sure that we're
not just taking the easy answeror the easy explanation for
something.
So they are the three principlesof anticipation that are
designed to keep you out oftrouble.
When you find yourself introuble, the principles of
containment come into play.
(14:58):
And those are deference toexpertise and commitment to
resilience.
And deference to expertise, youknow, simply stated, is
listening to those who areclosest to the work.
So when you want to understand,you know, why something is the
way it is or why an error hasoccurred, you really want to
talk to those at the sharp end,you know, those who are at the
(15:19):
point of care delivery doing thework every day, have the
clearest picture as to what'sgoing on.
So that true deference toexpertise, pushing the decision
making down to the people whoare doing the work every day,
they really have the mostexpertise and know uh how those
processes are really working ornot working.
And then lastly, commitment toresilience.
(15:42):
What this simply means is whenerrors do occur, we don't allow
them to paralyze theorganization.
So high reliability organizingwho practices commitment to
resilience, they're not going tobe paralyzed by an error.
They're going to learn from thaterror, they're going to take
those learnings and apply themto make sure that that same
error doesn't happen in thefuture.
(16:02):
So there are the fiveprinciples.
You know, it's it's key tounderstand those and how they
play in a high reliabilityorganization.
But then what's most importantis how you operationalize those
principles using the varioustools and skills that we have
available to us.
SPEAKER_00 (16:18):
I think that's that's really helpful.
And as I'm thinking about thesemore, you know, the
preoccupation with failure, Ithink a few of these principles,
it does take some digging alittle bit to internalize what's
going on there, what they mean.
So preoccupation with failuresounds like almost the opposite
of what of what you might wantto do if you're if you're trying
to succeed in an organization.
(16:40):
But uh, but I as I think aboutit, I imagine things like near
misses in healthcare, wheresomething almost went wrong, is
what you're talking about there.
You're you're preoccupied withfinding the ways we could go
wrong or we almost went wrong.
Is that am I along the righttrack there?
You are.
SPEAKER_01 (16:58):
I mean, near misses are a perfect learning
opportunity because you haveknowledge of a potential failure
that was caught by some strongbarrier that you had in place to
prevent the failure from gettingto a patient.
And as long as that near miss isreported, and that is some of
the challenge a lot of thetimes, where team members don't
think to report near misses, butthey are the premier learning
(17:22):
opportunity.
We want to know about those nearmisses so we can dissect them
and understand how theyhappened, and then put the plate
the fixes in place to preventthem from actually reaching a
patient going forward.
SPEAKER_00 (17:34):
Yeah.
One of the others that strikesme as a little counterintuitive,
and I think is worth digginginto to make sure I understand
is you know, deference toexpertise sounds different than
the way we normally think aboutexpertise, which is very
hierarchical.
It's very um experts are thepeople who sit at the top.
And I think what you're sayingis actually uh very different,
(17:56):
that the expertise is derivedfrom doing the actual work.
I I remember um I remember amentor once saying to me
something like, the people whodo the work know the work better
than the people who manage thework.
And so how how has that beenrelevant in your work?
How where have you found that tobe important?
SPEAKER_01 (18:14):
Well, your your mentor was spot on there.
So when you talk about deferenceto expertise, whenever you are
analyzing a safety event thathas occurred, you know, part of
that process, part of thatrecause analysis process is the
individual interviews that we dowith the team members who are
involved in the event.
And we want to understand fromtheir perspective what made them
(18:35):
do what they did that day.
You know, is there, you know, abreakdown in a process?
Is there a breakdown intraining?
Is there a breakdown insupervision?
And the folks who are doing thatwork understand where the need
for workarounds are, where theneed, where the potential uh
failure points are in a processbecause they're living and using
(18:55):
it every day.
It's nice for us as leaders, youknow, we're the ones that are
you know designing all thesepolicies and all these workflows
and you know, putting in theplay for our teams to execute.
But at the end of the day,they're the folks that are
executing it.
So they know the most about whatdoes and does not work on a
daily basis.
SPEAKER_00 (19:14):
I I wonder actually if you can share, not to put you
on the spot too much, but uhshare an example of a near miss
that might have surfaced inyour, you know, your daily
safety huddles at some point inyour journey that might be a
good example.
SPEAKER_01 (19:29):
One that comes to mind it was a potential
medication near mix.
There was a unit that hadidentified that a particular
medication was stockedincorrectly within their
automated dispensing system.
And that was raised uh by thatunit on the daily huddle that
morning and shared with theothers who were who were on that
(19:51):
huddle.
So we can talk a little bit moreabout daily huddles, but what
the one thing that it does allowyou to do is maintain that
situational awareness of what'sgoing on in the organization.
So as soon as that unit reportedthat they observed this error in
stocking, that prompted all theother nursing units on the
huddle, as soon as theycompleted their huddle, to go
(20:11):
and do that cross-check on theirunits to see if they too had any
variance in how their medicationdispensing systems were stocked.
And the pharmacy team wasengaged as well.
And we were able to, you know,identify where that error
occurred before any dispensingerrors occurred that would
impact the patient.
SPEAKER_00 (20:32):
Yeah, I can imagine it must be, it must be hard to
get the the visibility and theinsight into operations like
you're alluding to there.
And I'm wondering if you can,since you offered, uh, walk us
through the uh like what doessafety, what do the daily safety
huddles actually look like ifyou were going to design from
(20:53):
scratch?
What does it look like?
Where does the information go?
What information is shared?
Um, I'm wondering if you cankind of walk us through the nuts
and bolts of that.
Yeah, sure.
SPEAKER_01 (21:02):
So the daily safety huddle really builds off of the
individual unit huddles.
So, you know, if you're familiarwith the clinical space, you
know, nursing units typicallyhave a change of shift report.
They have a huddle at the changeof their shift to kind of go
over what happened throughoutthe prior shift and what they're
faced with on the current shift.
So the daily safety huddle kindof builds upon that process, and
(21:25):
it's a whole house event.
So we have representatives fromevery department present, so
clinical areas, ancillarysupport, non-clinical areas, and
they're really there to reporton their current state.
So uh at my currentorganization, that accounts for
about 62, 62 different areasthat are reporting on that daily
(21:45):
huddle.
Uh generally takes about 20minutes, uh, and in that 20
minutes we have completesituational awareness on the
state of the house that day.
The model that we follow isreally a brief statement of the
current state of that particularunit or department.
We ask them to look back overthe prior 24 hours to share any
(22:06):
safety issues that may haveoccurred.
They ask them to look forward 24hours to see if there are any
particular challenges thatchallenges they are faced with
and any anticipated safety needsor concerns that need to be
addressed.
And then the huddle servesreally as a forum to resolve
problems quickly.
So if a unit or a department hasa particular issue, they can
(22:28):
raise it on the huddle, and youhave the benefit of all the
other departments and serviceson the huddle with you, they
could jump right in and begin toassist in solving problems.
More often than not, issues thatare raised during the huddle are
typically resolved immediately,same day at the most, and really
(22:48):
uh prevents those nagging thingsthat could go on for days to be
resolved immediately, and reallysaves uh particular issues from
going on for longer than theyneed to.
So that's really what theconstruct of the huddle looks
like.
When we teach it to leaders, weshare with them that it's not
the kind of thing that you cango from your car to the call and
(23:10):
participate.
It really does involve theleader getting into their space,
getting that debriefing from thenight before, what are they
faced with for that day, andthen coming to the huddle with,
you know, their current stateand what they might need from
others on the call who canassist them in solving their
issues.
SPEAKER_00 (23:29):
Gotcha.
So you're you're saying that thehuddle is occurring with
frontline people and seniorleaders in the same place, or is
there an escalation process thatthe frontline huddle escalates
to uh in order to get thoseproblems resolved?
There is both.
SPEAKER_01 (23:44):
So there are senior leaders who are on the call and
listening to it and canintervene immediately.
And if for some reason there's aparticular leader that's not
that we need to escalate to,then whoever is facilitating the
call that day, the huddle thatday, can assist with that
escalation.
SPEAKER_00 (24:02):
And so I'm imagining if I'm a frontline person in
that huddle, there must be, youknow, some template, some format
that I'm that I'm given toreport on the safety issues such
that I can, at the end of thatreport, it's clear this is going
to go to somebody.
It doesn't just, I'm I'mimagining a big Zoom meeting and
I say there's a problem and itcould float off into the ether
(24:24):
if we don't have enoughstructure.
Is there is there some specificstructure that everyone's
following that then causes theescalation?
SPEAKER_01 (24:32):
They do follow a similar report out structure,
like I just described.
So they're doing that look back,look forward, and current state,
and then raising any issues thatthey have.
And then in our particularhuddle, uh, the way we construct
it, we operate in Teams,Microsoft Teams.
So uh during the huddle, one ofour patient safety coordinators
(24:53):
is actually sharing theirscreen, and on that screen is a
dashboard.
So we have you know keyindicators for the day with
respect to like census and EDvolumes, borders, things like
that.
But then we have a specific areawhere as reports are being
given, the patient safetycoordinator who's on is actually
capturing action items.
(25:14):
So if there's a particular unitthat raises a problem, that uh
that particular problem iscaptured by the patient safety
coordinator on the dashboard.
And we can refer to that throughthe day to make sure that that
event gets resolved.
Or we come on for the nexthuddle the next morning, we're
going back over that dashboardto make sure that the issues of
(25:34):
the prior day had been resolved.
SPEAKER_00 (25:37):
Gotcha.
That sounds like uh like areally robust framework for kind
of closing the loop and alsomaking sure that the things get
escalated that need to getescalated do get escalated.
I'm curious, you had this robustjourney, and I don't think we've
even touched on it enough,frankly, but at Inspira, where
you reduced the preventable harmby 90% over your time there.
(26:00):
I wonder what the secret sauceis there, or what were some of
the the key components to thatsuccess, and and then you know,
how did you bring that to a newand and I think a much bigger
institution at Cooper?
SPEAKER_01 (26:16):
Yeah, so the the work during my time in Inspira,
that was really it was reallydriven from the top down.
And when you think about thistype of work or quality
improvement work specifically,you always like to think of it
from the grassroots, right?
You like to have team membersreally driving the improvement
(26:37):
work.
And what we find with highreliability is because you're
trying to change a culture andinstill a safety culture in an
organization, you really have tohave the buy-in from the top of
the organization all the waythrough.
Otherwise, you're gonna haveteam members trying to deploy
and use these skills andbehaviors and the leaders of the
organization not being on thesame page.
(26:59):
So the work in high reliabilityis really driven from the top
down to get that buy-in.
And in spirit, when we steppedinto this path, we had the
support of our board.
They were fully vested in movingforward with this concept of
high reliability organizing.
We're fully supported by thepresident and CEO and the
(27:19):
executive team and moving thework forward.
It was a significant investmentthat we were making in our
people to train everybody in theorganization uh in these high
reliability skills andbehaviors.
So we really had that top-downsupport to make this work.
We trained the executive team,we trained our leadership first,
we trained our medical staff,and interestingly enough, uh at
(27:42):
InSpira, the medical staff hadactually had during a couple of
their retreats in the yearsprior, outside speakers come in
and talk about high reliability.
So the medical staff leadershipwas actually already in tune
with this concept of highreliability.
So when we introduced it as aninitiative that we wanted to
move forward, we had the supportof the medical staff leadership
(28:05):
as well.
So all of that's important tohave out of the gate in order to
really gain traction and embedit all the way down uh to the
sharp end for the frontlinestaff.
SPEAKER_00 (28:17):
I remember you giving this talk uh a few months
back in a community of qualityleaders that that we're both
part of.
And you were talking about toolsthat you use in high
reliability.
So SBAR and ARC.
I remember being ARCC being uhtwo of those.
I'm curious to know what thosetools are and then how you how
(28:38):
you actually use them in whatsettings do you use them and and
what is their their functionwithin this broader framework of
high reliability.
SPEAKER_01 (28:46):
Yeah, so the the beauty of the high reliability
tools is they could be used inany setting.
So one of the greatestmisconceptions when you when you
hear this work, we hear peopletalk about this work is that
it's just clinical of nature.
And that's certainly not thecase.
I mean, there are errors thatcan occur in the patient care
setting as well as in you knowthe the non-patient care areas
(29:10):
as well.
So these tools are tools thatcould be used in in any setting.
They could be used in yourprofessional life, they could be
used in your personal life toprevent errors from happening.
And in our current organizationat Cooper, we utilize a tool set
which is known as CooperStrong.
And it was born out of work thatwas done through the New Jersey
(29:30):
Hospital Associationpre-pandemic, where they
convened hospitals across NewJersey into a high reliability
collaborative, and everybodystepped in and learned and
shared this work together.
So out of that came this toolboxknown as originally New Jersey
Straw, and we have kind ofadopted that to CooperStrong for
(29:50):
our use at Cooper UniversityHealthcare.
And at the highest level, uhStrong stands for speaking up
for safety.
We have Thinking critically,reliably communicate on task, no
harm, and got your back.
And when you get into what eachof those safety behaviors are
and the tools that we havethere, when we talk about
(30:13):
speaking up for safety, we'retalking about team members being
able to escalate safetyconcerns.
So we use a tool known as ARC,where we ask a question, request
a change, express a concern, andthen escalate through the chain
of command if necessary.
When we talk about thinkingcritically, we ask a lot of
(30:34):
clarifying questions.
We validate and we verify whenwe're unsure of the information
that we're presented with.
Under reliably communicate, wehave tools such as SBAR, which
we're very familiar with in theclinical space to help uh focus
and make our communications morestreamlined.
We also have tools such asreadback and repeat back and the
(30:56):
use of uh phonetic and numericclarification, for example.
When we talk about being ontask, we use a tool known as
STAR, where we stop, think, act,and review uh with respect to
the concept of no harm.
Uh we want our team members tobe able to stop the line when
they're uncertain.
And then when we talk about gotuh the idea of got your back,
(31:16):
that's where we cross-check andcoach.
And we were able to cross-checkeach other.
And if we have concerns aboutdoing something in a particular
way, we've got the ability tocross-check each other and coach
each other up uh to preventerrors from happening.
So at a very high level, that'sthe toolbox known as Cooper
Strong and some of the toolsthat we use on a daily basis to
(31:38):
uh promote high reliability.
SPEAKER_00 (31:40):
You know, one thing that strikes me uh among many in
that description is you youdescribe the ARCC tool, and this
is a tool for escalation, kindof effective escalation with the
lightest touch possible, as Iunderstand it.
And so thinking about how we howwe do that in a healthcare
(32:01):
organization, which, like manyand maybe more than many, is is
intrinsically hierarchical.
Um, some, you know, with someinstitutions being more uh kind
of deeply ingrained in thesehierarchical ideas, I can
imagine this is a hard thing toadopt, hard to kind of get
people to escalate if a culturedoes exist in a hierarchy.
(32:24):
And I'm wondering how this, howthis went in the in the two, you
know, healthcare systems, mainhealthcare systems that you've
worked in, and how much thiskind of intertwined with the
idea of psychological safetythat's been getting you know so
much traction in the recent kindof decade or so, uh, with you
know Amy Emmonson's book leadingthe way on this, The Fearless
(32:46):
Organization, um, and many otherthinkers.
SPEAKER_01 (32:50):
Yeah, so psychological safety kind of
sets the foundation for you tobe able to execute ARC
appropriately.
What's important to keep in mindwith a tool such as ARC is it's
not a verb, right?
So you're not arcing somethingup.
It's a it's a process, it's aframework.
So it's it's presenting the teammember with a framework to be
able to escalate their concernwith the lightest touch possible
(33:13):
to get the response that they'relooking for.
So you really, when you startinto ARC, you focus on asking
clarifying questions andrequesting needed changes.
And more often than not, simplyasking a clarifying question is
enough to resolve the safetyconcern.
But if it's not, it gives youthat framework to follow where
(33:33):
you follow the lightest touchpossible to get the response
that you're looking for.
And the good news is that youknow, you get to that chain of
command piece, that last C inARC, that may not always be
needed.
I mean, you you're we're givingteam members the chance to
address the concerns on theirown before you have to escalate
to a chain of command.
So it really just provides anice, easy process for a team
(33:57):
member to follow, using, as yousaid, the lightest touch
possible to resolve a safetyconcern.
But at the end of the day, totruly leverage ARC, you have to
have that psychologically safeenvironment for the team to
really function.
And the way you get there is byleveraging a just culture and
building trust.
(34:18):
And you build that trust oneconversation at a time.
So as you interact with teammembers on a daily basis, you're
you're building trust with everyconversation you have so that
when a team member does comeforward and express a safety
concern and begin to utilizethat art framework, it's
accepted more freely, it'saccepted more freely.
(34:39):
And it kind of flattens thatauthority grading that we see in
so many healthcare organizationsand allows team members to
operate on equal footing.
SPEAKER_00 (34:49):
Yeah, I can see the theme you mentioned before of
top-down or leaders being the,you know, leaders being the
leaders being at the helm ofthis change.
I can see how important thatwould be if one of the things
you're trying to promote isgiving people this ARC framework
where the last step is chain ofcommand and they need to know
(35:09):
that that if they get to thatstep, if they're escalating it
up the chain of command, thereception needs to be
supportive, positive, warm, suchthat they are incentivized to
keep escalating when they needto rather than being shut down.
I'm I'm curious if uh if thatwas an easy, easy sell in the
places you've worked, or ifyou've needed to, you know, if
(35:31):
it's required kind of ongoing,ongoing reinforcement, ongoing
coaching of leaders.
SPEAKER_01 (35:35):
I I think it's ongoing coaching of leaders.
I mean, I've seen more recentlyin my in my current
organization, we looked at oursafety culture results, that we
had some challenges with respectto safety culture and uh some
team members feeling that theywere operating in a, they were
not operating in a non-punitiveenvironment, that they felt that
(35:56):
they were a little hesitant tospeak up or report because of a
they felt like there was goingto be a punitive response to
that.
But from that, and we we tookthose results and we worked with
various leaders across theorganization who had some
challenges and worked with them,coached them up, coached their
teams up.
And what we found in subsequentsurveys was significant
(36:19):
improvement in our overallsafety culture, especially in
the areas where we saw thosepockets of concern.
So it just goes to share that ifif it's a constant topic of
conversation, if it's bought infrom the top down, you will
eventually break down thosebarriers and uh achieve that
(36:39):
environment of psychologicalsafety.
SPEAKER_00 (36:42):
Yeah, I mean, we could talk about this for hours.
This is um this is really greatstuff.
How do you uh people that you'veworked with, you know, leaders
that you've worked with, havethey been tempted to kind of
change the idea of it beingleader-led or leaders, you know,
top-down can sometimes implythat there's not a lot of
(37:03):
frontline buy-in.
How do you maintain frontlineownership of new processes of
the high reliability work whilealso telling leaders this is
going to be top-down?
SPEAKER_01 (37:16):
Yeah, I think just stressing the overall importance
as part of their culture.
So you can't look at highreliability organizing and the
work around that as somethingthat's done in a silo.
So, you know, when we talk aboutit in our organization, we talk
about safety and highreliability organizing being the
being the foundation upon whichwe do all of our other work.
(37:39):
So our organization, like manyothers, has a mission and vision
statement and values that youknow are designed to guide the
organization.
But at the end of the day, theway that you execute on your
mission, vision, and values isfrom a position of safety and
leveraging high reliabilityorganizing as that foundation.
So when you talk about what is ahigh reliability organization,
(38:03):
what does that really mean?
It's really performance asintended consistently over time.
And it's it's the tools andskills and behaviors that allow
you to build that consistencyinto the work that you do.
So I think from a team member'sperspective, having those tools
and building it into their dailystandard work as part of the way
(38:24):
they consistently do their workallows them to do their best
work.
And then as leaders, we have theskills that are necessary to
lead in a high reliabilityenvironment so that we are
constantly keeping safety first.
We're messaging on safety on aregular basis, we're providing
feedback through routing on ourteam members.
(38:45):
And I think together that allowsboth the leaders and those at
the sharp end to see it as animportant uh piece of work for
the organization.
SPEAKER_00 (38:56):
Taking a step forward or a look forward into
the future, you've been doingthis kind of uh quality and
safety, high reliability workfor a while.
Is there a change in the safetylandscape or a safety practice
that you see emerging, you know,maybe tech enabled, uh, that you
think will be transformative inthe future?
SPEAKER_01 (39:19):
What I see currently, and when I've been uh
diving into myself morerecently, is the concept of
human factors in healthcare andhow looking at process and
system design intersects withsafety and designing best
practices or designing safepractices.
So when we do cause eventanalysis, we try to look at
(39:40):
things through a human factorslens to see how the system was
designed, how the process wasdesigned.
Was the work carried out asintended?
Are there different things thatwe can do in that design process
to make it easier for the humanto do the work?
Can we design the systemdifferently so that the humans
can operate differently and makeit safer?
(40:02):
So I think this whole concept ofhuman factors in healthcare uh
is emerging and becoming moreembedded in some of the patient
safety work that we're doing.
SPEAKER_00 (40:12):
I can imagine over this journey you've uh you've
learned a lot of hard lessonstoo.
And I wonder what advice youwould uh you would impart to uh
your younger self or or someoneelse who is uh looking to start
on a high reliability journey intheir healthcare system or is
looking to lead with with safetyas a strategy for for engagement
(40:34):
of staff and working towardshigh reliability.
What kind of advice would youshare?
SPEAKER_01 (40:41):
So the times are different now.
A lot of the work that a lot ofthe learning that I did was
on-the-job learning, basically,because at the time we didn't
have various degree programs andcertifications out there
specifically around quality andsafety.
And that has changeddramatically today.
So there are a lot ofundergraduate and graduate
(41:01):
degree programs, certificateprograms specifically in quality
and safety.
We have them designed for boththe physician world and the
non-physician world.
So there are members of themedical staff where I work who
have pursued uh degrees inquality and patient safety to
further their knowledge.
Uh, and then like I said,there's various certification
(41:21):
programs now, whether it's thecertification in healthcare
quality, the certification as apatient safety professional, and
now more recently, acertification in human factors
and healthcare.
So there's a lot of learningopportunities that are out there
where you can really dig deepand dive into uh to this work.
(41:42):
So to the younger me coming intothis world, I would encourage
them to take advantage of thoseopportunities and get that
formal education to do this typeof work.
And then just leverage theprocesses that you have in
place.
I mean, today with healthcarebeing what it is, resources can
be kind of tight.
(42:02):
Not all organizations have a lotof resources at their disposal,
but leverage what you currentlyhave in place.
You know, I'm sure that most, ifnot all, organizations do a unit
huddle of some type.
So leverage that unit huddle.
Talk to the team members, makesafety a topic during those unit
huddles.
(42:23):
Leader rounding is another gooduh good topic where I know
leaders are out rounding ontheir team members and talking
to their team members on aregular basis.
We can always manipulate ourtime and utilize our time to get
out there and talk to our teammembers, talk about safety, ask
them what their challenges are,what's making it hard to do
(42:44):
things the way they need to bedone.
And then most importantly,listen.
And when you get that feedback,be prepared to act on it and try
and break some of those barriersdown.
The daily safety huddle is agreat tool.
Uh, if you can leverage yourunit huddles and get an
organization to put a dailysafety huddle in place, that's a
(43:05):
great way to give yousituational awareness and begin
to solve problems uh in a timelyfashion.
And then the last thing I wouldsay is begin to look at your
harm.
You know, take a look back overyour harm events to see what
trends, what themes areemerging, and how you begin to
adapt some of these tools that Italked about earlier to address
(43:26):
some of those harm events andbegin to build out your high
reliability toolbox.
So there's a couple of thoughtsfor folks that are stepping into
this work now on how they can uhhow they could get themselves
started.
SPEAKER_00 (43:39):
I mean, I think we could go on for for a long time
with this.
You you opened up the humanfactors door just a moment ago,
and I thought, oh, this is awhole new episode.
And maybe it will be.
I I think it's uh I'm hearingmore and more about that as
well.
I know that there are more andmore certificates for human
factors in particular.
Um, and uh, and as you said,degree programs and uh and much
(44:02):
many more resources to uh todive deeper into these areas.
So I do really appreciate yourtime and and us chatting today.
I think you're a bit of a socialmedia guy.
Where can people find you onsocial media?
You have a LinkedIn, I think.
LinkedIn is the easiest way.
SPEAKER_01 (44:18):
My LinkedIn profile is out there and up to date, so
feel free to uh to reach out andconnect.
Networking is a huge part ofthis work.
We've learned so much uh in the10 plus years that I've been
doing high reliability work bysimply networking with
organizations and folks allacross the country with similar
interests.
So happy to network uh withanybody who wants to reach out.
SPEAKER_00 (44:41):
That's a great place to end.
I appreciate it.
Paul, thank you uh so much forsharing your insights on leading
quality, safety, and highreliability.
Thank you, Jason.
It was uh it was a fun time.
Appreciate it.
Thanks so much for listening totoday's episode of Leading
Quality.
If you enjoyed the show, pleasetake a moment to like,
subscribe, and share it withsomeone who might find it
(45:03):
useful.
You can find all our episodes atleadingquality.bugsprout.com or
in your favorite podcast app.
The show is written and hostedby me, Jason Meadows, edited by
Milan Milostafievich, andproduced by Thrive Healthcare
Improvement.
See you next time.
What we find with high reliability is because
you're trying to instill asafety culture in an
organization, you really have tohave the buy-in from the top of
the organization all the waythrough.
Otherwise, you're going to haveteam members trying to deploy
and use these skills andbehaviors and the leaders of the
organization not being on thesame page.
SPEAKER_00 (00:22):
Welcome to Leading Quality, the podcast
spotlighting the people movinghealthcare forward from the
front lines to the C suite.
I'm your host, Jason Meadows.
Today's guest, Paul Lambrecht,is a rare blend of frontline
(00:45):
sensibility and executivediscipline.
He's the Vice President ofQuality and Patient Safety at
Cooper University Healthcare andan assistant professor of
medicine at Cooper MedicalSchool of Rowan University.
With 30 plus years of healthcareleadership, Paul Nell set
strategy for quality, safety,and high reliability at Cooper,
(01:06):
overseeing infection prevention,regulatory readiness, medical
staff services, documentationintegrity, and environmental
safety.
Before Cooper, Paul spent adecade at Inspira Health,
leading system-wide safety,earning consecutive leapfrog A
grades and top hospital awards.
He sponsored Inspira's highreliability journey and the
(01:29):
network's move to Cerner.
And he led the COVID response asincident commander.
I wanted Paul on the podcastbecause he's actually made
leading with safety work,standing up daily safety huddles
and using practical tools likeS-Bar, ARC, and Red Rules.
First at Inspira and now atCooper.
(01:52):
In this conversation, we'lltrace that playbook, talk about
the nuts and bolts of culturechange, and explore what's next
for high reliability in an eraof burnout and AI.
Let's dive in.
Paul, welcome to the podcast.
Thank you, Jason.
My pleasure.
Thanks for having me.
I'd love to dive in.
(02:13):
Full disclosure, we've knowneach other for a little while
now, and I've really beenlooking forward to this
conversation because it gave mea chance to dig a little deeper
myself into your background.
But I am curious to know alittle more about you having
started as a paramedic and maybeamong people with your title
now, this is uh maybe a lesscommon background.
(02:34):
Maybe there's more kind ofphysicians or nurses in in this
world.
I'm curious how your journey ledyou from being a paramedic to
maybe a leader of paramedics andthen into quality and safety.
SPEAKER_01 (02:47):
Yeah, it was it was definitely a non-traditional
start for somebody stepping intouh quality and patient safety
work today.
While I was working as aparamedic initially, I had the
opportunity to do some whatwe'll call old school quality
assurance work, which reallyamounted to, you know,
conducting chart reviews forprotocol and regulatory
(03:08):
adherence and things of thatnature.
And then as my work continued inthat space, I had the
opportunity to step intoeducation.
I was involved in educating andprecepting new paramedics, and
then ultimately had theopportunity to move into a
leadership role as a director ofthe paramedic program.
And at the same time, since wewere a hospital-based service,
(03:31):
moving into that director'sposition gave me the opportunity
to become more involved in otherhospital operations, inpatient
operations as well.
And that's where I actuallystepped into the safety world
initially from an environmentalperspective as the hospital
safety officer.
And then as patient safety grew,I began to take uh more
(03:51):
responsibility on for patientsafety as well.
SPEAKER_00 (03:54):
That's great.
And I wonder if you you noticedthat kind of skills that were
forged in the in the fires ofparamedic life translate well
into this role, or are there anykind of unique features of of
the skill set you developedclinically that then translates
well into the patient safetyworld?
SPEAKER_01 (04:13):
Well, it's interesting.
What I didn't know then that Iknow now is that some of the
tools that I was using in myclinical practice as a
paramedic, such as SBAR three,three we repeat back, phonetic
and numeric clarifications, theywere all tools that I was using
on a daily basis, workingclinically, that were actually
(04:33):
the initial step into leveraginghigh reliability tools to keep
patients safe.
So I was doing it back then anddidn't realize that it was
actually high reliability toolsthat I was using.
But you know, flashing forwardto my current work, I think the
skill sets that I bring with mefrom that time were around
critical thinking andcommunication skills.
(04:55):
I think leaders in thehealthcare space today have to
have solid communication skillsfor both verbally and written,
be able to effectivelycommunicate horizontally and
vertically in an organizationand across varied audiences.
And I find myself speaking toboard members, to executive
teams, and then to the frontlinestaff.
(05:17):
So leaders in today's space needto be very flexible in their
ability to communicate acrossall of those audiences.
SPEAKER_00 (05:24):
And it's interesting to me, coming from the physician
side, that that things likeS-BAR and these kind of
structured communication toolsuh were such a big part of your
daily life and and maybe theyhaven't permeated as as much
into your you know usual MDpathway.
Yeah, that that's neat that thatyou know it was kind of
foreshadowing what was come whatwas to come without you knowing
(05:46):
it at the time.
Exactly.
And was this you knowintentional that once you
started to get into the thequality and safety world that
you gravitated in particular?
Because I think there's a lot offlavors that that quality
improvement work can take.
And I'm curious if there'ssomething that led you to uh
high reliability in particular.
And maybe you can just kind ofbriefly explain for people who
(06:09):
don't know, you know, what ahigh reliability organization is
and then what what made youchoose it.
SPEAKER_01 (06:16):
My res my scope of responsibility in quality safety
is is really kind of broad.
I've got a lot of differentareas that kind of report up to
me.
But what's unique about highreliability is that the
principles of high reliabilityare really kind of foundational
that really sets the tone forreally all of the work that we
do within the quality and safetyspace.
(06:37):
I think what we've found is, youknow, like other industries such
as commercial aviation andnuclear power, if we lead with
safety first and we get thatright, everything else is going
to follow.
So when you look at the scope ofhealthcare quality and safety,
you know, we're focused onquality outcomes, we're focused
on patient experience.
And, you know, what we found andwhat the data has shown us is
(07:00):
that if you lead with a strongsafety culture, you're gonna
have strong team memberengagement.
And together, that safetyculture and your team member
engagement is really gonna drivethe organization's success with
respect to quality, patientexperience, and ultimately the
efficiency of the organization.
SPEAKER_00 (07:17):
That's great.
Uh, I'd like to shift a littlebit into some of the background
of how you got where you aretoday and some of the work that
you've done, specifically inhigh reliability and and how you
kind of built up this safety,quality and safety career.
You joined Inspira in uh 2013,as I understand it.
And um, I wonder how you woulddescribe the culture around
(07:41):
quality and safety at that timeand and maybe how it changed
over the time you were there.
SPEAKER_01 (07:47):
Yeah, sure.
So in 2013, we were really justa brand new health network at
the time.
The merger that created InSpearoccurred in November of 2012.
And I joined, I came from one ofthe organizations and into uh
the new role as the vicepresident of quality and patient
safety.
(08:07):
So at that point, uh I woulddescribe the culture as really
evolving.
You know, we were two, you know,previously independent health
systems that have come together.
Each had their own culture, eachhad, you know, very strong work
going on within the quality andsafety space.
And as a new system, we werelooking to define who we were
going to be going forward.
(08:29):
So there was a lot ofopportunity to really develop
something new when that systemwas first formed.
SPEAKER_00 (08:36):
And it sounds like there was an appetite to lean
into this more.
And I think I read in one of theuh an article written, I don't
know if it was by by you orabout you, but that there was, I
guess, a lot of of a sense thatthere was a lot of good work
that had been done within thequality department and that you
were looking to to kind of leaninto that more.
(08:57):
Had the the principles, kind ofthe the kind of five core
principles of high reliabilitybeen at all part of the DNA of
that system, and and if uh ifnot, how did you kind of start
introducing them?
SPEAKER_01 (09:11):
Yeah, I think they were in part, although many of
us maybe not have realized thatthey were in fact the five
principles of high reliability.
So what we found was as we gotinto this new environment, this
new health system, we wanted todefine who we were as a new
system and kind of in a way setus apart from others, so to
(09:33):
speak, because we were a verycompetitive space.
There are a lot of healthsystems around us.
So we really were looking tolooking for something to define
who we were.
And there were two things thatkind of emerged immediately
post-merger that were definingfor the new health system.
One was the conversion of ourelectronic medical records from
SORI into CERN.
So at the time coming together,we had close to 17 different uh
(09:59):
or disparate health informationsystems that were operating
throughout each of thefacilities and in the inventory
environment.
So we wanted to bring that alltogether into the CERN platform,
and to do that, it was going torequire organizations that
previously did things indifferent ways to kind of come
together and do things from asystem perspective.
(10:19):
So that was the one step that wetook into coming together as a
system.
The second was our work in highreliability.
At that time, there werehospitals uh over in
Pennsylvania just across thebridge from us in the
Philadelphia market who wereinvolved in a collaborative to
(10:40):
develop high reliability withintheir operations.
So we had heard about that andwe were following that for a
little bit.
And then around that same time,uh Mark Chasen, who was then the
president, CEO of the JointCommission, had actually
published an article about highreliability healthcare.
So there was a lot of visibilityaround this concept of high
(11:01):
reliability and how we can beginto apply the learnings from
other uh industries into thehealthcare industry.
So that visibility caught ourattention, and we viewed this uh
as an opportunity to kind ofstep into the high reliability
journey and begin to developthis new culture of safety uh
around error prevention andpatient safety as part of a way
(11:25):
to develop this new network.
It was really hard to argue withthat approach.
We're trying to focus onenhancing safety culture and
minimizing error in this newnetwork.
It was really hard to argue withtaking a step in that direction.
So that was really how wedecided to take that step into
the high reliability journey.
SPEAKER_00 (11:44):
Yeah, it sounds, it sounds like a theme that I've
I've heard elsewhere as well,which is if you start with
safety, it's it's such an easysell for anyone who who decided
to devote their life and theircareer to being in healthcare
that it's uh a natural on-rampto kind of unite people around a
common vision.
Is that was that yourexperience?
SPEAKER_01 (12:04):
It it is.
And there's actually a textbookcalled The Engaged Caregiver
that actually gets into thisidea of the virtuous cycle and
how if we lead with safety andutilize high reliability as a
lever, together, safety and highreliability will generate
positive outcomes in quality,experience, engagement, and
(12:25):
ultimately efficiency.
So it's uh it's been it's beenpublished in uh in the engaged
caregiver.
SPEAKER_00 (12:33):
Yeah, I remember you recommending that one actually
uh a few months ago when yougive a talk about this.
That's uh that's one to checkout.
We'll keep we'll include that inthe show notes.
So, you know, I I imagine thatthere are uh some people in the
audience hearing the term highreliability and maybe not sure
what that means or uh what thethe core principles are
underlying it.
So this was something um youknow published by uh Wyke and
(12:56):
Sutcliffe uh back in 2001, uhManaging the Unexpected.
And and this is where theydefine five core principles of
high reliability.
Can you just walk us throughwhat those five principles are
and uh what they mean forhealthcare?
SPEAKER_01 (13:12):
Certainly.
So the five principles canreally be divided into two
buckets.
There is what we call theprinciples of anticipation,
which are designed to keep youout of trouble, and then there
are the principles ofcontainment, which are going to
be used to get you out oftrouble when you find yourself
in trouble.
So when we talk about theprinciples of anticipation,
(13:33):
there are the first three.
So we have preoccupation withfailure, reluctance to simplify,
and then sensitivity tooperations.
So when we talk aboutpreoccupation with failure,
here's where we really focus onstudying small errors before
they become big problems.
We're constantly looking forfailure loops and where
processes can break down.
(13:54):
And that allows us to preventlarge errors from happening when
we keep our focus on, you know,trying to prevent those small
failures from occurring.
The second principle issensitivity to operations.
And here's where, you know, asleaders, we kind of have our
head on the swivel.
Uh, we maintain situationalawareness of what's going on in
our space at any given time.
(14:16):
Uh, we want to make sure we'vegot a line of sight into what
our team members are doing on adaily basis.
So that that really encompassesthe whole idea of sensitivity to
operations.
And then the third is reluctanceto simplify interpretations.
And here, you know, we're tryingnot to take the first
explanation for things when theygo right or wrong.
(14:37):
It's it's really an idea ofdigging a little deeper and
having diversity of thought andopinion, making sure that we're
not just taking the easy answeror the easy explanation for
something.
So they are the three principlesof anticipation that are
designed to keep you out oftrouble.
When you find yourself introuble, the principles of
containment come into play.
(14:58):
And those are deference toexpertise and commitment to
resilience.
And deference to expertise, youknow, simply stated, is
listening to those who areclosest to the work.
So when you want to understand,you know, why something is the
way it is or why an error hasoccurred, you really want to
talk to those at the sharp end,you know, those who are at the
(15:19):
point of care delivery doing thework every day, have the
clearest picture as to what'sgoing on.
So that true deference toexpertise, pushing the decision
making down to the people whoare doing the work every day,
they really have the mostexpertise and know uh how those
processes are really working ornot working.
And then lastly, commitment toresilience.
(15:42):
What this simply means is whenerrors do occur, we don't allow
them to paralyze theorganization.
So high reliability organizingwho practices commitment to
resilience, they're not going tobe paralyzed by an error.
They're going to learn from thaterror, they're going to take
those learnings and apply themto make sure that that same
error doesn't happen in thefuture.
(16:02):
So there are the fiveprinciples.
You know, it's it's key tounderstand those and how they
play in a high reliabilityorganization.
But then what's most importantis how you operationalize those
principles using the varioustools and skills that we have
available to us.
SPEAKER_00 (16:18):
I think that's that's really helpful.
And as I'm thinking about thesemore, you know, the
preoccupation with failure, Ithink a few of these principles,
it does take some digging alittle bit to internalize what's
going on there, what they mean.
So preoccupation with failuresounds like almost the opposite
of what of what you might wantto do if you're if you're trying
to succeed in an organization.
(16:40):
But uh, but I as I think aboutit, I imagine things like near
misses in healthcare, wheresomething almost went wrong, is
what you're talking about there.
You're you're preoccupied withfinding the ways we could go
wrong or we almost went wrong.
Is that am I along the righttrack there?
You are.
SPEAKER_01 (16:58):
I mean, near misses are a perfect learning
opportunity because you haveknowledge of a potential failure
that was caught by some strongbarrier that you had in place to
prevent the failure from gettingto a patient.
And as long as that near miss isreported, and that is some of
the challenge a lot of thetimes, where team members don't
think to report near misses, butthey are the premier learning
(17:22):
opportunity.
We want to know about those nearmisses so we can dissect them
and understand how theyhappened, and then put the plate
the fixes in place to preventthem from actually reaching a
patient going forward.
SPEAKER_00 (17:34):
Yeah.
One of the others that strikesme as a little counterintuitive,
and I think is worth digginginto to make sure I understand
is you know, deference toexpertise sounds different than
the way we normally think aboutexpertise, which is very
hierarchical.
It's very um experts are thepeople who sit at the top.
And I think what you're sayingis actually uh very different,
(17:56):
that the expertise is derivedfrom doing the actual work.
I I remember um I remember amentor once saying to me
something like, the people whodo the work know the work better
than the people who manage thework.
And so how how has that beenrelevant in your work?
How where have you found that tobe important?
SPEAKER_01 (18:14):
Well, your your mentor was spot on there.
So when you talk about deferenceto expertise, whenever you are
analyzing a safety event thathas occurred, you know, part of
that process, part of thatrecause analysis process is the
individual interviews that we dowith the team members who are
involved in the event.
And we want to understand fromtheir perspective what made them
(18:35):
do what they did that day.
You know, is there, you know, abreakdown in a process?
Is there a breakdown intraining?
Is there a breakdown insupervision?
And the folks who are doing thatwork understand where the need
for workarounds are, where theneed, where the potential uh
failure points are in a processbecause they're living and using
(18:55):
it every day.
It's nice for us as leaders, youknow, we're the ones that are
you know designing all thesepolicies and all these workflows
and you know, putting in theplay for our teams to execute.
But at the end of the day,they're the folks that are
executing it.
So they know the most about whatdoes and does not work on a
daily basis.
SPEAKER_00 (19:14):
I I wonder actually if you can share, not to put you
on the spot too much, but uhshare an example of a near miss
that might have surfaced inyour, you know, your daily
safety huddles at some point inyour journey that might be a
good example.
SPEAKER_01 (19:29):
One that comes to mind it was a potential
medication near mix.
There was a unit that hadidentified that a particular
medication was stockedincorrectly within their
automated dispensing system.
And that was raised uh by thatunit on the daily huddle that
morning and shared with theothers who were who were on that
(19:51):
huddle.
So we can talk a little bit moreabout daily huddles, but what
the one thing that it does allowyou to do is maintain that
situational awareness of what'sgoing on in the organization.
So as soon as that unit reportedthat they observed this error in
stocking, that prompted all theother nursing units on the
huddle, as soon as theycompleted their huddle, to go
(20:11):
and do that cross-check on theirunits to see if they too had any
variance in how their medicationdispensing systems were stocked.
And the pharmacy team wasengaged as well.
And we were able to, you know,identify where that error
occurred before any dispensingerrors occurred that would
impact the patient.
SPEAKER_00 (20:32):
Yeah, I can imagine it must be, it must be hard to
get the the visibility and theinsight into operations like
you're alluding to there.
And I'm wondering if you can,since you offered, uh, walk us
through the uh like what doessafety, what do the daily safety
huddles actually look like ifyou were going to design from
(20:53):
scratch?
What does it look like?
Where does the information go?
What information is shared?
Um, I'm wondering if you cankind of walk us through the nuts
and bolts of that.
Yeah, sure.
SPEAKER_01 (21:02):
So the daily safety huddle really builds off of the
individual unit huddles.
So, you know, if you're familiarwith the clinical space, you
know, nursing units typicallyhave a change of shift report.
They have a huddle at the changeof their shift to kind of go
over what happened throughoutthe prior shift and what they're
faced with on the current shift.
So the daily safety huddle kindof builds upon that process, and
(21:25):
it's a whole house event.
So we have representatives fromevery department present, so
clinical areas, ancillarysupport, non-clinical areas, and
they're really there to reporton their current state.
So uh at my currentorganization, that accounts for
about 62, 62 different areasthat are reporting on that daily
(21:45):
huddle.
Uh generally takes about 20minutes, uh, and in that 20
minutes we have completesituational awareness on the
state of the house that day.
The model that we follow isreally a brief statement of the
current state of that particularunit or department.
We ask them to look back overthe prior 24 hours to share any
(22:06):
safety issues that may haveoccurred.
They ask them to look forward 24hours to see if there are any
particular challenges thatchallenges they are faced with
and any anticipated safety needsor concerns that need to be
addressed.
And then the huddle servesreally as a forum to resolve
problems quickly.
So if a unit or a department hasa particular issue, they can
(22:28):
raise it on the huddle, and youhave the benefit of all the
other departments and serviceson the huddle with you, they
could jump right in and begin toassist in solving problems.
More often than not, issues thatare raised during the huddle are
typically resolved immediately,same day at the most, and really
(22:48):
uh prevents those nagging thingsthat could go on for days to be
resolved immediately, and reallysaves uh particular issues from
going on for longer than theyneed to.
So that's really what theconstruct of the huddle looks
like.
When we teach it to leaders, weshare with them that it's not
the kind of thing that you cango from your car to the call and
(23:10):
participate.
It really does involve theleader getting into their space,
getting that debriefing from thenight before, what are they
faced with for that day, andthen coming to the huddle with,
you know, their current stateand what they might need from
others on the call who canassist them in solving their
issues.
SPEAKER_00 (23:29):
Gotcha.
So you're you're saying that thehuddle is occurring with
frontline people and seniorleaders in the same place, or is
there an escalation process thatthe frontline huddle escalates
to uh in order to get thoseproblems resolved?
There is both.
SPEAKER_01 (23:44):
So there are senior leaders who are on the call and
listening to it and canintervene immediately.
And if for some reason there's aparticular leader that's not
that we need to escalate to,then whoever is facilitating the
call that day, the huddle thatday, can assist with that
escalation.
SPEAKER_00 (24:02):
And so I'm imagining if I'm a frontline person in
that huddle, there must be, youknow, some template, some format
that I'm that I'm given toreport on the safety issues such
that I can, at the end of thatreport, it's clear this is going
to go to somebody.
It doesn't just, I'm I'mimagining a big Zoom meeting and
I say there's a problem and itcould float off into the ether
(24:24):
if we don't have enoughstructure.
Is there is there some specificstructure that everyone's
following that then causes theescalation?
SPEAKER_01 (24:32):
They do follow a similar report out structure,
like I just described.
So they're doing that look back,look forward, and current state,
and then raising any issues thatthey have.
And then in our particularhuddle, uh, the way we construct
it, we operate in Teams,Microsoft Teams.
So uh during the huddle, one ofour patient safety coordinators
(24:53):
is actually sharing theirscreen, and on that screen is a
dashboard.
So we have you know keyindicators for the day with
respect to like census and EDvolumes, borders, things like
that.
But then we have a specific areawhere as reports are being
given, the patient safetycoordinator who's on is actually
capturing action items.
(25:14):
So if there's a particular unitthat raises a problem, that uh
that particular problem iscaptured by the patient safety
coordinator on the dashboard.
And we can refer to that throughthe day to make sure that that
event gets resolved.
Or we come on for the nexthuddle the next morning, we're
going back over that dashboardto make sure that the issues of
(25:34):
the prior day had been resolved.
SPEAKER_00 (25:37):
Gotcha.
That sounds like uh like areally robust framework for kind
of closing the loop and alsomaking sure that the things get
escalated that need to getescalated do get escalated.
I'm curious, you had this robustjourney, and I don't think we've
even touched on it enough,frankly, but at Inspira, where
you reduced the preventable harmby 90% over your time there.
(26:00):
I wonder what the secret sauceis there, or what were some of
the the key components to thatsuccess, and and then you know,
how did you bring that to a newand and I think a much bigger
institution at Cooper?
SPEAKER_01 (26:16):
Yeah, so the the work during my time in Inspira,
that was really it was reallydriven from the top down.
And when you think about thistype of work or quality
improvement work specifically,you always like to think of it
from the grassroots, right?
You like to have team membersreally driving the improvement
(26:37):
work.
And what we find with highreliability is because you're
trying to change a culture andinstill a safety culture in an
organization, you really have tohave the buy-in from the top of
the organization all the waythrough.
Otherwise, you're gonna haveteam members trying to deploy
and use these skills andbehaviors and the leaders of the
organization not being on thesame page.
(26:59):
So the work in high reliabilityis really driven from the top
down to get that buy-in.
And in spirit, when we steppedinto this path, we had the
support of our board.
They were fully vested in movingforward with this concept of
high reliability organizing.
We're fully supported by thepresident and CEO and the
(27:19):
executive team and moving thework forward.
It was a significant investmentthat we were making in our
people to train everybody in theorganization uh in these high
reliability skills andbehaviors.
So we really had that top-downsupport to make this work.
We trained the executive team,we trained our leadership first,
we trained our medical staff,and interestingly enough, uh at
(27:42):
InSpira, the medical staff hadactually had during a couple of
their retreats in the yearsprior, outside speakers come in
and talk about high reliability.
So the medical staff leadershipwas actually already in tune
with this concept of highreliability.
So when we introduced it as aninitiative that we wanted to
move forward, we had the supportof the medical staff leadership
(28:05):
as well.
So all of that's important tohave out of the gate in order to
really gain traction and embedit all the way down uh to the
sharp end for the frontlinestaff.
SPEAKER_00 (28:17):
I remember you giving this talk uh a few months
back in a community of qualityleaders that that we're both
part of.
And you were talking about toolsthat you use in high
reliability.
So SBAR and ARC.
I remember being ARCC being uhtwo of those.
I'm curious to know what thosetools are and then how you how
(28:38):
you actually use them in whatsettings do you use them and and
what is their their functionwithin this broader framework of
high reliability.
SPEAKER_01 (28:46):
Yeah, so the the beauty of the high reliability
tools is they could be used inany setting.
So one of the greatestmisconceptions when you when you
hear this work, we hear peopletalk about this work is that
it's just clinical of nature.
And that's certainly not thecase.
I mean, there are errors thatcan occur in the patient care
setting as well as in you knowthe the non-patient care areas
(29:10):
as well.
So these tools are tools thatcould be used in in any setting.
They could be used in yourprofessional life, they could be
used in your personal life toprevent errors from happening.
And in our current organizationat Cooper, we utilize a tool set
which is known as CooperStrong.
And it was born out of work thatwas done through the New Jersey
(29:30):
Hospital Associationpre-pandemic, where they
convened hospitals across NewJersey into a high reliability
collaborative, and everybodystepped in and learned and
shared this work together.
So out of that came this toolboxknown as originally New Jersey
Straw, and we have kind ofadopted that to CooperStrong for
(29:50):
our use at Cooper UniversityHealthcare.
And at the highest level, uhStrong stands for speaking up
for safety.
We have Thinking critically,reliably communicate on task, no
harm, and got your back.
And when you get into what eachof those safety behaviors are
and the tools that we havethere, when we talk about
(30:13):
speaking up for safety, we'retalking about team members being
able to escalate safetyconcerns.
So we use a tool known as ARC,where we ask a question, request
a change, express a concern, andthen escalate through the chain
of command if necessary.
When we talk about thinkingcritically, we ask a lot of
(30:34):
clarifying questions.
We validate and we verify whenwe're unsure of the information
that we're presented with.
Under reliably communicate, wehave tools such as SBAR, which
we're very familiar with in theclinical space to help uh focus
and make our communications morestreamlined.
We also have tools such asreadback and repeat back and the
(30:56):
use of uh phonetic and numericclarification, for example.
When we talk about being ontask, we use a tool known as
STAR, where we stop, think, act,and review uh with respect to
the concept of no harm.
Uh we want our team members tobe able to stop the line when
they're uncertain.
And then when we talk about gotuh the idea of got your back,
(31:16):
that's where we cross-check andcoach.
And we were able to cross-checkeach other.
And if we have concerns aboutdoing something in a particular
way, we've got the ability tocross-check each other and coach
each other up uh to preventerrors from happening.
So at a very high level, that'sthe toolbox known as Cooper
Strong and some of the toolsthat we use on a daily basis to
(31:38):
uh promote high reliability.
SPEAKER_00 (31:40):
You know, one thing that strikes me uh among many in
that description is you youdescribe the ARCC tool, and this
is a tool for escalation, kindof effective escalation with the
lightest touch possible, as Iunderstand it.
And so thinking about how we howwe do that in a healthcare
(32:01):
organization, which, like manyand maybe more than many, is is
intrinsically hierarchical.
Um, some, you know, with someinstitutions being more uh kind
of deeply ingrained in thesehierarchical ideas, I can
imagine this is a hard thing toadopt, hard to kind of get
people to escalate if a culturedoes exist in a hierarchy.
(32:24):
And I'm wondering how this, howthis went in the in the two, you
know, healthcare systems, mainhealthcare systems that you've
worked in, and how much thiskind of intertwined with the
idea of psychological safetythat's been getting you know so
much traction in the recent kindof decade or so, uh, with you
know Amy Emmonson's book leadingthe way on this, The Fearless
(32:46):
Organization, um, and many otherthinkers.
SPEAKER_01 (32:50):
Yeah, so psychological safety kind of
sets the foundation for you tobe able to execute ARC
appropriately.
What's important to keep in mindwith a tool such as ARC is it's
not a verb, right?
So you're not arcing somethingup.
It's a it's a process, it's aframework.
So it's it's presenting the teammember with a framework to be
able to escalate their concernwith the lightest touch possible
(33:13):
to get the response that they'relooking for.
So you really, when you startinto ARC, you focus on asking
clarifying questions andrequesting needed changes.
And more often than not, simplyasking a clarifying question is
enough to resolve the safetyconcern.
But if it's not, it gives youthat framework to follow where
(33:33):
you follow the lightest touchpossible to get the response
that you're looking for.
And the good news is that youknow, you get to that chain of
command piece, that last C inARC, that may not always be
needed.
I mean, you you're we're givingteam members the chance to
address the concerns on theirown before you have to escalate
to a chain of command.
So it really just provides anice, easy process for a team
(33:57):
member to follow, using, as yousaid, the lightest touch
possible to resolve a safetyconcern.
But at the end of the day, totruly leverage ARC, you have to
have that psychologically safeenvironment for the team to
really function.
And the way you get there is byleveraging a just culture and
building trust.
(34:18):
And you build that trust oneconversation at a time.
So as you interact with teammembers on a daily basis, you're
you're building trust with everyconversation you have so that
when a team member does comeforward and express a safety
concern and begin to utilizethat art framework, it's
accepted more freely, it'saccepted more freely.
(34:39):
And it kind of flattens thatauthority grading that we see in
so many healthcare organizationsand allows team members to
operate on equal footing.
SPEAKER_00 (34:49):
Yeah, I can see the theme you mentioned before of
top-down or leaders being the,you know, leaders being the
leaders being at the helm ofthis change.
I can see how important thatwould be if one of the things
you're trying to promote isgiving people this ARC framework
where the last step is chain ofcommand and they need to know
(35:09):
that that if they get to thatstep, if they're escalating it
up the chain of command, thereception needs to be
supportive, positive, warm, suchthat they are incentivized to
keep escalating when they needto rather than being shut down.
I'm I'm curious if uh if thatwas an easy, easy sell in the
places you've worked, or ifyou've needed to, you know, if
(35:31):
it's required kind of ongoing,ongoing reinforcement, ongoing
coaching of leaders.
SPEAKER_01 (35:35):
I I think it's ongoing coaching of leaders.
I mean, I've seen more recentlyin my in my current
organization, we looked at oursafety culture results, that we
had some challenges with respectto safety culture and uh some
team members feeling that theywere operating in a, they were
not operating in a non-punitiveenvironment, that they felt that
(35:56):
they were a little hesitant tospeak up or report because of a
they felt like there was goingto be a punitive response to
that.
But from that, and we we tookthose results and we worked with
various leaders across theorganization who had some
challenges and worked with them,coached them up, coached their
teams up.
And what we found in subsequentsurveys was significant
(36:19):
improvement in our overallsafety culture, especially in
the areas where we saw thosepockets of concern.
So it just goes to share that ifif it's a constant topic of
conversation, if it's bought infrom the top down, you will
eventually break down thosebarriers and uh achieve that
(36:39):
environment of psychologicalsafety.
SPEAKER_00 (36:42):
Yeah, I mean, we could talk about this for hours.
This is um this is really greatstuff.
How do you uh people that you'veworked with, you know, leaders
that you've worked with, havethey been tempted to kind of
change the idea of it beingleader-led or leaders, you know,
top-down can sometimes implythat there's not a lot of
(37:03):
frontline buy-in.
How do you maintain frontlineownership of new processes of
the high reliability work whilealso telling leaders this is
going to be top-down?
SPEAKER_01 (37:16):
Yeah, I think just stressing the overall importance
as part of their culture.
So you can't look at highreliability organizing and the
work around that as somethingthat's done in a silo.
So, you know, when we talk aboutit in our organization, we talk
about safety and highreliability organizing being the
being the foundation upon whichwe do all of our other work.
(37:39):
So our organization, like manyothers, has a mission and vision
statement and values that youknow are designed to guide the
organization.
But at the end of the day, theway that you execute on your
mission, vision, and values isfrom a position of safety and
leveraging high reliabilityorganizing as that foundation.
So when you talk about what is ahigh reliability organization,
(38:03):
what does that really mean?
It's really performance asintended consistently over time.
And it's it's the tools andskills and behaviors that allow
you to build that consistencyinto the work that you do.
So I think from a team member'sperspective, having those tools
and building it into their dailystandard work as part of the way
(38:24):
they consistently do their workallows them to do their best
work.
And then as leaders, we have theskills that are necessary to
lead in a high reliabilityenvironment so that we are
constantly keeping safety first.
We're messaging on safety on aregular basis, we're providing
feedback through routing on ourteam members.
(38:45):
And I think together that allowsboth the leaders and those at
the sharp end to see it as animportant uh piece of work for
the organization.
SPEAKER_00 (38:56):
Taking a step forward or a look forward into
the future, you've been doingthis kind of uh quality and
safety, high reliability workfor a while.
Is there a change in the safetylandscape or a safety practice
that you see emerging, you know,maybe tech enabled, uh, that you
think will be transformative inthe future?
SPEAKER_01 (39:19):
What I see currently, and when I've been uh
diving into myself morerecently, is the concept of
human factors in healthcare andhow looking at process and
system design intersects withsafety and designing best
practices or designing safepractices.
So when we do cause eventanalysis, we try to look at
(39:40):
things through a human factorslens to see how the system was
designed, how the process wasdesigned.
Was the work carried out asintended?
Are there different things thatwe can do in that design process
to make it easier for the humanto do the work?
Can we design the systemdifferently so that the humans
can operate differently and makeit safer?
(40:02):
So I think this whole concept ofhuman factors in healthcare uh
is emerging and becoming moreembedded in some of the patient
safety work that we're doing.
SPEAKER_00 (40:12):
I can imagine over this journey you've uh you've
learned a lot of hard lessonstoo.
And I wonder what advice youwould uh you would impart to uh
your younger self or or someoneelse who is uh looking to start
on a high reliability journey intheir healthcare system or is
looking to lead with with safetyas a strategy for for engagement
(40:34):
of staff and working towardshigh reliability.
What kind of advice would youshare?
SPEAKER_01 (40:41):
So the times are different now.
A lot of the work that a lot ofthe learning that I did was
on-the-job learning, basically,because at the time we didn't
have various degree programs andcertifications out there
specifically around quality andsafety.
And that has changeddramatically today.
So there are a lot ofundergraduate and graduate
(41:01):
degree programs, certificateprograms specifically in quality
and safety.
We have them designed for boththe physician world and the
non-physician world.
So there are members of themedical staff where I work who
have pursued uh degrees inquality and patient safety to
further their knowledge.
Uh, and then like I said,there's various certification
(41:21):
programs now, whether it's thecertification in healthcare
quality, the certification as apatient safety professional, and
now more recently, acertification in human factors
and healthcare.
So there's a lot of learningopportunities that are out there
where you can really dig deepand dive into uh to this work.
(41:42):
So to the younger me coming intothis world, I would encourage
them to take advantage of thoseopportunities and get that
formal education to do this typeof work.
And then just leverage theprocesses that you have in
place.
I mean, today with healthcarebeing what it is, resources can
be kind of tight.
(42:02):
Not all organizations have a lotof resources at their disposal,
but leverage what you currentlyhave in place.
You know, I'm sure that most, ifnot all, organizations do a unit
huddle of some type.
So leverage that unit huddle.
Talk to the team members, makesafety a topic during those unit
huddles.
(42:23):
Leader rounding is another gooduh good topic where I know
leaders are out rounding ontheir team members and talking
to their team members on aregular basis.
We can always manipulate ourtime and utilize our time to get
out there and talk to our teammembers, talk about safety, ask
them what their challenges are,what's making it hard to do
(42:44):
things the way they need to bedone.
And then most importantly,listen.
And when you get that feedback,be prepared to act on it and try
and break some of those barriersdown.
The daily safety huddle is agreat tool.
Uh, if you can leverage yourunit huddles and get an
organization to put a dailysafety huddle in place, that's a
(43:05):
great way to give yousituational awareness and begin
to solve problems uh in a timelyfashion.
And then the last thing I wouldsay is begin to look at your
harm.
You know, take a look back overyour harm events to see what
trends, what themes areemerging, and how you begin to
adapt some of these tools that Italked about earlier to address
(43:26):
some of those harm events andbegin to build out your high
reliability toolbox.
So there's a couple of thoughtsfor folks that are stepping into
this work now on how they can uhhow they could get themselves
started.
SPEAKER_00 (43:39):
I mean, I think we could go on for for a long time
with this.
You you opened up the humanfactors door just a moment ago,
and I thought, oh, this is awhole new episode.
And maybe it will be.
I I think it's uh I'm hearingmore and more about that as
well.
I know that there are more andmore certificates for human
factors in particular.
Um, and uh, and as you said,degree programs and uh and much
(44:02):
many more resources to uh todive deeper into these areas.
So I do really appreciate yourtime and and us chatting today.
I think you're a bit of a socialmedia guy.
Where can people find you onsocial media?
You have a LinkedIn, I think.
LinkedIn is the easiest way.
SPEAKER_01 (44:18):
My LinkedIn profile is out there and up to date, so
feel free to uh to reach out andconnect.
Networking is a huge part ofthis work.
We've learned so much uh in the10 plus years that I've been
doing high reliability work bysimply networking with
organizations and folks allacross the country with similar
interests.
So happy to network uh withanybody who wants to reach out.
SPEAKER_00 (44:41):
That's a great place to end.
I appreciate it.
Paul, thank you uh so much forsharing your insights on leading
quality, safety, and highreliability.
Thank you, Jason.
It was uh it was a fun time.
Appreciate it.
Thanks so much for listening totoday's episode of Leading
Quality.
If you enjoyed the show, pleasetake a moment to like,
subscribe, and share it withsomeone who might find it
(45:03):
useful.
You can find all our episodes atleadingquality.bugsprout.com or
in your favorite podcast app.
The show is written and hostedby me, Jason Meadows, edited by
Milan Milostafievich, andproduced by Thrive Healthcare
Improvement.
See you next time.
Popular Podcasts
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by Audiochuck Media Company.
The Brothers Ortiz
The Brothers Ortiz is the story of two brothers–both successful, but in very different ways. Gabe Ortiz becomes a third-highest ranking officer in all of Texas while his younger brother Larry climbs the ranks in Puro Tango Blast, a notorious Texas Prison gang. Gabe doesn’t know all the details of his brother’s nefarious dealings, and he’s made a point not to ask, to protect their relationship. But when Larry is murdered during a home invasion in a rented beach house, Gabe has no choice but to look into what happened that night. To solve Larry’s murder, Gabe, and the whole Ortiz family, must ask each other tough questions.