Friday, January 9, 2015


In the GBMC HealthCare System, we are students of high reliability. We have to be if we are working towards our vision of patient-centeredness and treating everyone, every time, the way we want our own loved ones treated. The defining characteristic of high reliability organizations, according to Dr. Karl Weick, the internationally recognized expert in this field, is “mindfulness.” You can think of mindfulness as a heightened awareness of what is going on around you coupled with an unwillingness to believe that since everything is going along smoothly, things will continue to progress smoothly. Highly reliable organizations have robust processes (standard work) that can be relied upon, but they also anticipate and become aware of the unexpected faster so that they can deal with it.

In previous blogs I have discussed one of the fundamental underlying concepts of mindfulness - preoccupation with failure. This week, because of the outstanding work that our people have done in dealing with the influenza epidemic, it occurs to me that I should write about another of the concepts – a commitment to resilience. Dr. Weick points out that highly reliable organizations develop better capabilities to detect, contain, and bounce back from unexpected events. They learn from things that don’t go well and refine their processes. They try and plan to be ready for whatever might come their way, but still they can get caught unprepared for a rare event or for the magnitude of a less rare event. Such is the case with our current influenza epidemic.

Over the last 3 winters, we have not had huge increases in demand due to the flu.  One day last week, our emergency department saw 238 patients in a 24 hour period. Our normal average number of patients is around 150 per day. Imagine any business that needs to serve over 50% more customers than the usual! The ED nurses, physicians, nurse practitioners and physician assistants came in early, stayed late, and came in on their days off in order to serve those in need.  

And clearly all of the extra work has not been limited to the Emergency Department. Our hospitalists have also had huge increases in workload. Our hospitalists normally cover around 70 patients per day and they peaked earlier this week at 98. Our inpatient nurses and nursing technicians have also been tirelessly caring for a higher number of patients than usual. We opened Unit 37 to care for more acutely ill patients, and the intensivists and critical care nurses made it work.  All of our other clinicians, from therapists and phlebotomists to lab and radiology technicians, have all dealt admirably with the influx of patients. Of course our environmental services and food services teams have also had to rise to the occasion and cover the increased demand. Every member of the GBMC team has pitched in at some level to get the job done.   

I am very grateful to all of my colleagues for their expertise, hard work, and resiliency. Our patients and our community are so much better off because of their efforts.

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