Monday, June 1, 2009

The pay-off for investing in natives

The picture of the oak leaf hydrangeas, now in full bloom in my southern garden, says a lot about what you get when you invest in natives.

The thirsty, showy, flashy things I tote home from the sick-plant outlet I patronize can be counted on to demand time and tax my talent. But the natives pretty much do their thing, reliably and predictably. And they always "wow"!

I use Florence dot com, sometimes as a primer, sometimes as a bully pulpit, advancing the idea that front line healthcare providers are natives in the patient safety garden. We should pay them some attention, invest to give them what they need to get started, then be ready to get out of the way.

Most seasoned healthcare professionals grew up in traditions that emphasized the primacy of individual effort over collaborative processes, traditions that neglected science-based approaches for managing the systems that inform performance. (If we wouldn't expect a fight crew to get from New York to Denver by "heading west, young man" why does anyone tolerate a system that tells nurses to deliver medications without more procedural guidance than "follow the 5 Rights"?)

Building reliability into work processes comes more readily when professionals are schooled in human factors and applied cognitive science. Schooling is part of the reason other industries reap the wisdom of the front line in a way that healthcare, as a whole, isn't yet doing. The tradition of "counseling" the last person to touch a process-gone-wrong is hard to give up (apparently it's akin leaving your roots). And healthcare workers often don't recognize, or can't do anything about, the bad soil they're planted in.

So I was happy to receive a tweet yesterday that led me to a partnership between Auburn University and Baptist Health in Montgomery, AL. Synergistic Management and Resource Team (SMART) training will teach highly reliable communication strategies, like those used in the airline industry, to front line healthcare practitioners and students and promote the use of these modalities at the front lines of care. SMART Training combines the tactics of crew resource management, purpose-based decision making, evidence-based practice and simulation.

It's worth noting that the curriculum was developed using the expertise of Auburn's Aviation and Supply Chain Management faculty in collaboration with professionals from Baptist Health's Institute for Patient Safety and Simulation Training. Applying knowledge that comes from studying the root causes of communication snafus to develop strategies that prevent recurrence is more rewarding, but far more difficult, than focusing on "who-didn't-hear-what-right-this-time." Teaching the science behind measures that are often seen by front line clinicians as "compliance-driven" rather than "safety-essential" may help cultivate healthcare's holy grail, the culture of safety.

Turned out it was in the garden all along. Smart. Or is that SMART?

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