Landing Forums Leadership Default Aggressive Reply To: Default Aggressive

  • Stephanie Avallone

    June 30, 2020 at 1:34 pm


    Hello Debra – I’ve both enjoyed and learned from your questions that have been discussed on the Q&A Zoom sessions. It sounds like you have great ideas and work in play to achieve your results. I used to work in healthcare and we found the patient safety goals to be some of the hardest to set. We also found them to be the goals with the strongest emotional reactions. Everyone was always on board for patient safety, but the goals made some clinicians (physicians, advanced practitioners, nurses, MAs, pharmacists) feel exposed for the pressure of what could be out of their control, including being human.

    We did a few things that at the time I did not agree with. I found the approach to be less than “fierce”, especially for something that impacted the health and safety of people. By nature, I fall into a default aggressive bucket. From a culture perspective, my organization (large research Universtiy with a large medical system) does not, especially on things that feel like “oversight” or “judgement”. Honing our approach was the best thing we could have done – the results were amazing. As I look back, my leader at the time was helping our team to not fight the tactical battle over the goal at the expense of the strategy for sustainable patient safety. Some things that we did overall that helped set the tone to for engagement and ultimately decentralized command:

    • We did not use the word harm or safety. We used Medical Event. If I am honest, this name change still does sit well with me, but it relaxed people from feeling judged in what sometimes felt like impossible circumstances where the decision making involved was not as easy as “right” answer, “wrong” answer. Most of our after-action reviews demonstrated that we needed to change a process, invest in technology, or increase training. It made after-action reviews better. Early on they were down-right hostile
    • We set a goal to zero over a number of years – we needed to demonstrate that those of us who were non-clinical, or clinical, but no longer working as a clinician (or not full time as one) that we understood that the road to no “med events” needed financial support, projects to redesign workflow or reorganize work/staff, more staff (our work design sessions demonstrated that some extra help would be meaningful than not to safety – especially given our rich PTO benefits), technology investments, training investments, work through change with our bargaining unit)
    • We decentralized command – the various clinics either had their people as leads or co-leads on all improvement efforts, led trainings, were chief architects in the design of work and teams – basically, as the quality and process management person, they became my partners in all work and that taking a backseat to them increased my credibility and ability to help make change happen (still hard for me to hand my stuff over sometimes and patience is not my virtue. When I actively work to partner at this level and give in that it does not need to be fast all of the time (or at all in some cases), I usually win and am energized by my work).

    Your passion is evident. Good luck!