Red Rules - First Do No Harm!

Hospitals are complex organizations. One one hand, its nothing short of amazing that we can orchestrate dozens of departments to work in concert with each other to provide care to literally hundreds of patients each day with relative ease. On the other hand, it takes hundreds of policies, procedures, and protocols to make sure that each that each patient gets the right care at the right time and in the right manner. Given that these are mainly human processes, there is obviously a high potential for things to go astray despite everyone's best efforts. At best, this can create a service delay or dissatisfaction, but at worst, the results can be catastrophic. Therefore, we must have a way to both navigate and differentiate the multitudes of rules that we depend upon to make our organization run.

With that thought in mind and in recognition of National Time-Out Day, today we officially kick-off our first organizational "Red Rule." Our first Red Rule addresses pre-procedural time-outs within the hospital. While not a new concept, this is one policy and practice that when done right has been proven to save lives in hospitals across the country and one that we feel is of utmost importance to the hospital and our patients.

Below is a copy of a communication I recently sent out to our team at the hospital. I would be interested in hearing how others are dealing with this same issue or thoughts on how we can continue to improve.

"As many of you are aware, our organization, led by Chief Medical Officer Dr. Lynn Simon, has embarked on a goal of achieving “Zero Harm” to patients by 2013. While this is an aggressive goal, it is a worthwhile one and one that we are focused on reaching. When patients trust us with their care, our objective should not only be to get them well and home soon, but to also have no harm done to them while they are in our care.

One way that we will be focusing on achieving this goal is through the creation of “Red Rules.” Red Rules are non-negotiable behaviors that are expected and supported throughout the organization. As such, the rules are not difficult but we must have complete compliance to be effective. Sanctions will be administered to any individual— including physicians and team members —who do not support and adhere to these behaviors. The purpose is not to be punitive, but rather to instill accountability in our team for practicing safe behaviors in helping our patients.

Our first Red Rule is to require all departments to conduct an “active time out” prior to the start of a procedure. We’ve found that previously, many departments had different definitions of what an “active time out” is so we have clarified by developing a consistent definition that will be used across the facility. The steps of an active time out are:

1. Announcement of the “time out.”
2. Verification: all other activity stops and the patient’s name, site/side and procedure are stated and confirmed.
3. Verbal confirmation: each person involved in the procedure in any way confirms.
4. Announcement of “time out completed.”

Part of being able to enforce Red Rules is having a culture to give team members the freedom to stop a procedure at any time if they feel that the process has not been appropriately followed or the patient’s safety is at risk. Let me take this moment to reassure each of you that you have my, and the rest of Administration’s, utmost support in this initiative. While it may not always be comfortable to have a confrontation of this sort with a fellow team member or physician, it is what is in the best need for the patients we serve and as a result, you need not fear being reprimanded if you are simply ensuring that a Red Rule or patient safety is being followed. In fact, I would argue that this is not only what is allowed of you, but what is expected.

Achieving our goal of Zero Harm by 2013 is going to be an aggressive target—but I am confident that through the Red Rules and our culture, we can absolutely achieve it! Please feel free to reach out to me at any time should you have concerns or suggestions about the adherence to Red Rules. Our patients are depending on you. Thank you for your support."

Red Rules - First Do No Harm!