HRO Tools of the Month: Know Why and Comply & Safety First 

The HRO Tool of the Month comes from the Reliability Skill: Know Why and Comply. The companion leadership skill is Safety First in Every Decision. 

This month, we will explore: Use Source Policies, Procedures, Protocols and Checklists. 

Know Why and Comply is a habit of the mind that ensures that choices are compliant with the organization’s best practices. Compliance has always been an important and vital piece of building a culture of safety. Without compliance, there would be chaos, fines, unethical practices and likely, patient harm. 

This tool has been shared across the organization in many ways to help raise awareness about compliance and to enhance processes. 

For example, more than 40% of safety events have a root cause in policy, procedures or protocols. PolicyStat is a tool that provides on-demand access to all policies, procedures, guidelines (PP&G) and other important documentation staff and faculty need to do their jobs. By having all PP&Gs in one centralized location, the percentage of errors (due to difficulty locating documents) will decrease. 

All departments are encouraged to upload their PP&Gs by Dec. 31 in order to be compliant. 

How to use Know Why and Comply

Use Know Why and Comply when making choices based on policy, procedure and protocols. It’s important to review the rule and the reasons the rule exists. Apply a questioning attitude. If the rule makes sense — then apply the rule in a way that meets the action and the intent of the rule. Blind compliance is not safe and rule-based errors occur when policies and protocols are not followed. 

If the rules don’t make sense, stop. And if you do not know, do not go or do.  

Having a protocol in hand makes employees four times more reliable in applying that protocol. This is called continuous use. The protocol (or PP&G) is with the employee whether in hand or on the computer. It is then read and understood. As a final step, the employee will often initial or sign for task tracking. 

Reference use is performing familiar tasks per policy, procedure, protocol from memory. The issue with this is that our memory is not always right. 

Remember the expression related to memory, “if you don’t use it, you lose it”? When was the last time you really reviewed the reference use policy, procedure or protocol? 

Leaders are expected to reinforce and role model the Know Why and Comply HRO skill. Having this skill as the tool of the month provides a great opportunity to lead discussions about how team members can use the skill in their day-to-day work. In fact, leaders should always consider Safety First in Every Decision, which is the leadership tool of the month. Every interaction is an opportunity to build a safety culture. 

Here is an example of this tool: 

A nurse knew her patient very well from several stays in her unit. This nurse chose to short-cut the patient identification check — thinking she was perfectly confident, she was with the correct patient. She was. What she did not realize was the patient identification check is a three-way matching of patient identity, medication administration record, and the medication. She had the right patient but the wrong medication. Her patient survived the error, but required an 11-day stay in the intensive care unit (ICU).

September was Sepsis Awareness Month and reminders have been shared across the organization emphasizing the importance of spotting the signs of sepsis. By properly using policies, procedures, protocols and checklists, clinical staff could detect sepsis early enough to save lives.  

As a reminder, the Michigan Medicine Safety Promise is: 

Our promise to patients, families and employees: Your Safety is our most important priority. 

We are open and transparent about errors, and will stand up for those who speak up. We are accountable for our actions. We learn from our errors without blame. We do not tolerate reckless or disrespectful behavior.