Ranger Leads the Way

How One Dog Helped Hospitals and Veterinarians Find Common Ground in Bringing Just Culture to Their Care Systems

Thornton Kirby, President and CEO of the South Carolina Hospital Association, is a committed advocate for a zero harm approach to high reliability in healthcare systems and is a champion of Just Culture in the workplace. He’s also a dog lover.

That’s Thornton and Ranger, his beloved family dog. Ranger is named for the 75th Ranger Regiment, also known as Army Rangers, which is a light infantry airborne special operations force and elite members of our military. Their motto, borne in the heroics of the Normandy beach landings on D-Day during World War II, is “Rangers lead the way,” something the pup has also surprisingly done as well.

Near the end of Ranger’s life, though, he got really sick and was diagnosed with cancer. To prolong his life, Kirby took Ranger to the South Carolina Veterinary Specialists & Emergency Care, an advanced animal hospital with oncology and radiation services. Ranger would undergo chemotherapy there.

Unfortunately, just as they occur in hospitals, medical errors can happen when caring for animals, too. In this case, one of the attending veterinarian technicians noticed that burn marks on Ranger’s fur didn’t make sense given where his cancer was. 

“An error had occurred based on where he had been set up on the table for the radiation therapy,” says Gretchen A. Sauer, the SCVSEC Hospital Administrator. 

The hospital—while they ultimately did not compromise Ranger’s treatment or general health in the long-term—believes in full transparency, so Sauer explained to Kirby what happened. 

“The first thing he said was, ‘How is the technician doing? I’m really concerned how she’s taking it,’” Sauer recalls. It was not a response she expected, but one that makes sense given the CEO’s dedication to workforce resiliency in the quest for high reliability and zero harm. Sauer explained that the hospital’s policy was not to terminate the staff for the error, but rather address the root cause and provide employee retraining or system improvements.

Without knowing it, Sauer was invoking the basic tenets of Just Culture, a concept that advocates setting aside the severity of the outcome in favor of examining the choices and chain of events that led to that outcome. 

Sauer recalls Kirby telling her, “This is really close to what you are actually already doing.”

Kirby put Sauer in touch with Lorri Gibbons, Vice President of Quality & Patient Safety at SCHA, who introduced the administrator more formally to just culture precepts and philosophies. 

“SCHA has really been a champion for our facility [in terms of just culture],” Sauer points out. 

Through the Association, she was able to attend a Just Culture course in Florence and flesh out the animal hospital’s use of Just Culture. Later, the Association arranged for David Marx, CEO of Outcome Engenuity and a Just Culture pioneer, to visit Sauer’s facility.

“One of the first things [David] asked me was, ‘how many near-misses do you have?,’ and I wasn’t able to tell him,” she admits. “We’ve had two catastrophic events in 17 years, but we weren’t tracking near-misses.”

The lack of awareness of Just Culture in the animal care community has led Sauer to become a champion of the philosophy for the entire industry, pushing veterinary hospitals throughout the Southeast to adopt the approach. 

“There’s a lot we [as an industry] don’t address that we should,” Sauer argues. “We look at human lives very differently than animal’s lives, and we don’t track the things we should. The industry is behind the times.”

She’s been traveling to speak at veterinary conventions, extolling the importance of just culture and emphasizing the importance of highly reliable care for animals as well as humans. 

“We live in a first world country,” she concludes. “We should expect that [kind of care] for our animals too.”

As for Kirby and Ranger, the care SCVSEC provided ultimately prolonged the dog’s life so that the family could spend a few more precious months with him and ultimately make their peace with his departure.

“Our family is so thankful for everything SCVSEC did for Ranger, and we’re so proud of the extraordinary care available to animals in our community,” Kirby says. “SCHA as a team is just honored that we could contribute in some small way to making that great care even better.”