Hospitals strive to be highly reliable organizations (HROs), a concept built around strict avoidance of catastrophes in complex, high-risk environments. This means following the five principles of high reliability outlined by Karl Weick and Kathleen Sutcliffe: 1) preoccupation with failure, 2) reluctance to simplify, 3) sensitivity to operations, 4) commitment to resilience, and 5) deference to expertise.
Tidelands Health’s commitment to high reliability was put to the test a few weeks ago, when a fire broke out in one of the units at Georgetown Memorial Hospital.
“It was a high-capacity ion lithium battery that’s used to power our mobile workstations for the clinical staff,” explains Patrick Devlin, Director of Safety, Security and Emergency Preparedness at the hospital. “Our clinical director was actually walking through the unit to plug in another device and heard a ‘pop.’ She looked down and saw a little smoke sputter out of the unit, then the whole thing became completely engulfed in flames and smoke.”
Fortunately, the staff was well-trained for such a moment. The first clinical director quickly pulled the alarm, activating a security guard and another clinical director who arrived immediately with fire extinguishers. Other staff members responded by checking on patients and beginning the complex process of evacuating patients while maintaining quality of care.
“We started with a horizontal evacuation,” recalls Devlin. “Other staff members started putting towels at the doors of rooms with patients we couldn’t move [easily].” Eventually, all patients were evacuated and some moved vertically in the hospital, but the process was orderly and safe. While some staff members and visitors were treated for smoke inhalation following the incident, no patient was harmed.
For Devlin, the emergency response of his operation was quite successful.
“From a best practices standpoint, the training we do on initial hire and then annually works. People were familiar with R.A.C.E. [Rescue, Alarm, Contain, Extinguish] and P.A.S.S. [Pull the pin, Aim at the base of the fire, Squeeze the handles together, and Sweep from side to side], and they knew what their role was when responding to a fire. The fire department praised our organization and how everybody responded exactly as they were supposed to do.”
The staff’s immediate response shows the hallmarks of “collective mindfulness,” something preached by HROs as a way to manage unexpected events by maintaining resilience during an event through anticipation and containment. They showed a “deference to expertise” by trusting on-the-ground experts rather than a strict hierarchy of emergency services, and relied on their training with an eye towards “preoccupation with failure” and a “reluctance to simplify.”
And while the organization’s response proved their preparation effective, a key to any HRO means that the focus on failure looks towards any weakness, however small or slight, as a chance to innovate. Devlin talked with both the frontline staff that responded to the event as well as senior leadership and the fire department about what occurred, and the decision was made to pull all of the culprit batteries out of Tideland Health’s facilities. They also implemented what Devlin considers a truly “comprehensive management program” of the hospital’s high capacity batteries.
“We had a [almost] comprehensive program before, but it did not include those [workstation] batteries,” he explains. “We do a really good job with our biomedical equipment—our pumps, our ventilators, things like that—but since these are really information systems equipment, they weren’t covered under that program. So we’re doing a full risk assessment of all high-capacity batteries in our organization now.”
Such is the life of an HRO—even when everything goes to plan, a collective mindfulness pervades, with constant commitment to resilience and improving processes where things can go wrong. A seemingly random fire isn’t tossed off as an aberration, but rather used as a learning and process improvement opportunity.
“It’s all about being safety first, patient first,” concludes Devlin.