HRO Tools of the Month: Cross-checking and coaching

November 15, 2021  //  FOUND IN: Updates & Resources, ,

The HRO Tool of the Month comes from the Reliability Skill: Attention to Detail

With less than two months left in the year, time may seem to be passing by in a flash. While many are preparing for the holidays, others are preparing for flu season and potential COVID-19 cases. 

In both personal and professional life, distractions or a sense of rushing may occur. That means now is the perfect time to pay attention to detail and use crossing-checking to help yourself and those around you.  

What is cross-checking? 

Cross-checking is a habit of the mind that keeps our attention on the people, equipment and environment around us. This habit provides for instant awareness of problems. If you suspect there may be a problem, never hesitate to speak up as you just may save a life or help solve a problem. 

  • Cross-checking is watching out for each other and sharing situational awareness. Cross-checking with an assist is providing an on-the-spot second opinion. 

A Michigan Medicine employee shared: “When I worked in the NICU, I remember when residents were filling out medicine orders for our tiniest patients after birth and they would always turn to a coworker and ask, ‘would you check my math?’” 

A simple cross-check reduces the percentage of error for patient harm while building trusting relationships among colleagues. 

The companion leadership skill to cross-checking is safety first. This skill encourages leaders to think of safety first before every decision and model this behavior for others. This skill also supports encouraging and congratulating staff when they speak up when they believe something is wrong. 

What to know about cross-checking and safety first

Use cross-checking at all times — keep an eye and ear out for trouble. Use cross-checking with an assist for the quick and easy helping of others. This can be as simple as a polite, “stop — you are about to back into the wet floor sign” followed by a “thanks” reply from your coworker. 

If you are uncomfortable speaking directly regarding a situation, the Speak Up for Safety tool ARCC instead of cross-checking with an assist, will help you make a difference.

Start with Asking a simple question. If the question does not draw attention to the problem, Request a change, quickly explain why, and hand the dialogue back to the other person by adding “what do you think?” If the request did not change their thinking, use the safe word “Concern” using the phrase “I am concerned that…” Even then, you still have Chain of Command. Use your Chain of Command to check your thinking and help you advocate for safety. 

Cross-checking has several positive effects on the workplace. 

  • We can share situational awareness, a mental model of our work and environment. This gives us the advantage of more eyes and ears to catch things we might not notice. 
  • We can ask for a check or a second opinion. This gives us the advantage of detecting unintended slips or lapses, critical thinking problems, and even knowledge and skill deficiencies before they become unintended errors 
  • We can reinforce the best practices in each other. And we can also help reduce unsafe practices in our surrounding environments. 

A teachable moment: Coaching and 5-to-1 feedback

Situations will arise where more action is needed after a cross-check. Coaching, sometimes called peer teaching, is a practice habit that reinforces good habits in others and works to replace poor practice habits with good ones. 

Everyone is encouraged to use coaching at all times. Non-verbal reinforcements are the best because they are quick, easy and always taken as sincere. When you see good practice: reading signs before opening doors, hand washing-in or hand washing-out of a patient room, labeling specimens at the bedside, etc., give your peer a quick nod, smile, thumbs up or a “thanks” or, if you feel comfortable, a short compliment on their good practice. In this use, the word “peer” means anyone other than your supervisor. 

If you see a poor practice habit, non-verbal feedback is still the best. Look a little put-off or shake your head. And, if you feel comfortable, ask “may I point out something to you?” and explain what is the correct practice and why that correct practice is important to us for patient or personal safety. 

The technique to use is called 5-to-1 feedback because we are most helpful to our peers when we average five positive reinforcements for every one negative reinforcement. Most people are closer to 1:1. This means that to be more helpful to our peers, we need to increase the number of positive reinforcements. People respond to and remember positive feedback. Countless studies show that feedback from others affects our behavior as we work to shape a safety-centered culture. 

General tips about giving feedback 

  • Based on observation and facts 
  • As close in time as possible to the act 
  • Be specific — describe what you observed and state how the action either met or did not meet agreed expectation(s) 
  • No sandwich approach — don’t attempt to soften negative feedback with positive feedback

Did you know? 

  • Coaching improves accountability. Accountability is one’s self-motivation to meet an expectation or standard. 
  • Improving accountability is one of the few system changes that reduces all types of human error. People with high accountability pay more attention, are more compliant, are more conservative in judgments, communicate more often, and are more prone to seek help when unsure. 
  • Accountability systems that use a high volume of feedback are most effective in improving people’s practice. Accountability systems that are based on punishment, especially those that punish human error, do not improve accountability. 

Specific tips about giving positive feedback 

Seek opportunities to catch someone in the act of “doing it right” and build it into your everyday routine. Small, spontaneous gestures go a long way. Paying an unannounced visit to an employee or sending a handwritten note to the employee’s home, for example, reinforces a good practice and also makes the individual feel appreciated and valued. 

Give feedback across professional lines and reporting relationships — remember that leaders and physicians need positive feedback, too. 

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.