A SHELL FOR SAFETY
Learning from other industries is important,
airlines and pilots have been the common sources for healthcare; the oil
industry, especially SHELL is also a very good source.
THE CHALLENGE THROWN TO HEALTHCARE
The oil company SHELL has an extremely high
priority for safety. When SHELL do any construction work the area is marked
'This is a safe work place'. It is not a warning or an
advisory, it is a statement. At the International Forum for Quality and Safety
in Healthcare at Amsterdam in 2011, the question and the challenge that was
posed was, which hospital actually has a sign that says 'this is a safe
hospital' and which hospitals are working towards that explicit
goal?
That is very interesting. Would it be possible
to guarantee safety in healthcare? As an enthusiast I would argue that it would
be possible in many areas, well at least in some areas, but as a realist I know
it would be difficult.
Mr. Rein Willems was the Chairman of SHELL
and is now a member of the upper house in Netherlands. He has authored the brief
but powerful report which is now the basis of improving safety and quality of
healthcare in Netherlands. He spoke at the Forum in Amsterdam. I share some of
the messages here.
RED LINES AND DISCIPLINE
In Shell, the by-line for 'this is a
safe work place' is ''here you work safely or you don't work
here at all''. Willems said that there was an occasion when
a worker despite adequate warning and training persisted in the unsafe practise
of smoking in a non-smoking zone in a production site and the CEO physically
escorted that employee out of the premises and the employee was sacked on the
spot.
Though it is a dramatic example it illustrates
the seriousness with which safety is taken in Shell. What is our equivalent
example in healthcare? We may do that for fraud or for smoking near the oxygen
tanks – those are important but are general to any facility – what is the
example that relates to clinical care delivery?
MANAGING VERSUS SOLVING
Willems went on to use the iceberg analogy that
for every single fatality there were 50s of 'lost time accidents', 100s of
property damage or minor injury, 1000s of accidents/incidents with no injury and
10000s of small events/breaches. To avoid that single fatality the underlying
causes of 'small incidents' have to be fixed. Managing small events without
fixing the underlying causes will eventually escalate into major problems.
In healthcare we are very good at
emphasising on 'risk management'. As far as I am aware risk management is about
identifying and understanding risks and minimising them. Which is at least a bit
different from enhancing safety – which is about continuously increasing the
standard of practice to the best that is currently possible. In terms of
quality, risk management could probably equate to the principle of quality
control by checking the products. Safety in healthcare would probably be the
equivalent of getting it right as we go along. There lies the
difference.
Having said that, it is possible that some of
the people who are currently doing governance and risk are also doing safety;
hats off to them since they have to cope with varying threads within a concept.
I suspect most people may not be doing this.
EVERYONE DOING THE SAME THING
Willems also touched on the concept of
uniformity of shared practices. In Shell they have a policy where 'all employees
should have one hand on the stair rail when they are going up or down stairs'
this was implemented in their sites (oil fields and refineries). On one occasion
Willem and his CEO were photographed in the head office walking the stairs with
papers in hand without holding the side-rails. An employee wrote to Willem
querying if the rule applied only to lower level staff. With a view to leading
by example and with a view to having similar rules for everyone in Shell it is
now the policy that whether one is on the field/rig/factory sites or in offices
that one hand must be on the rails while going up or down
stairs.
We in healthcare are no SHELL but to be fair I have
seen a senior board director removing her jewellery before entering a ward, though she was there for administrative reasons.
That is a good sign.
I think the core idea was that senior
leadership has to play a very visible, proactive and hands-on role in the area
of shared baselines, analysing data, resolving issues and safety. These concepts
are essential for safe healthcare but are not often done in comprehensive or
meaningful ways; that is what we ought to get right.
Shell and Willems do have generic lessons for
us in healthcare.
NOTE: The writing in italics are my personal
views. The normal type is what Mr Willems said or his views.
