Chain of Command: New policy supports speaking up for safety

Approximately a 4-minute read

Key takeaways:

• When observing a situation that we believe compromises the safety of a patient, employee or visitor, we have a responsibility to raise a concern.
• High reliability is only possible when we recognize the need to speak up and feel safe doing so.
• Safety concerns can be escalated using the powerful HRO universal tool called ARCC. The fourth step of ARCC, chain of command, is an important tool with details and expectations clearly defined in a new Chain of Command Policy. Chain of command documents should be in place by May 1, 2023.

Speaking up when something doesn’t feel right is part of our everyday lives. Hearing a strange noise coming from underneath our vehicle usually warrants a trip to the mechanic shop, or having a tree leaning too close to the house might mean it’s time for removal. We could voice our concerns in these scenarios for different reasons, but it’s likely that one reason stands out above the rest: safety.

Here at Michigan Medicine, when observing a situation that we believe compromises the safety of a patient, employee or visitor, we have a responsibility to raise a concern. This is an important part of cultivating a culture of safety on our HRO journey and acting as advocates for patients, families and each other.

A clear chain of command and standard process for escalating concerns can help all employees speak up for safety and respond appropriately when concerns are raised.

Psychological safety is key

High reliability is only possible when we recognize the need to speak up and feel safe doing so. Creating psychological safety for team members is a job we all share – it consists of acting as equals regardless of our formal positions and valuing the opinions of everyone around us.

“We know that fear of how others will respond can sometimes prevent team members from voicing or escalating concerns,” said Nicole Templeton, administrative director of patient safety. “By working together to promote a culture of safety and making tools and resources available across the organization, we can ensure that every employee, in every role, feels safe, supported and appreciated when they speak up for safety.” 

Escalating safety concerns with ARCC

Whether you work in a patient care area or an office setting, there is always a possibility for safety concerns to arise. These could involve professional conduct, communication breakdowns, medical emergencies or medication errors.

Safety concerns can be escalated using the powerful HRO universal tool called ARCC – Ask a question, Request a change, Communicate a concern and use Chain of command.

Throughout the months of April and May, this tool and its use across all areas of the organization will be highlighted.

Chain of command policy

The fourth step of ARCC, Chain of command, is an important tool with details and expectations clearly defined in a new Chain of Command Policy. The policy specifies that leaders in all areas must have a visible, accessible chain of command clearly posted for their teams. These chain of command documents should be in place by May 1, 2023. 

Knowing and understanding the chain of command in your area is crucial – if an immediate supervisor cannot resolve a safety issue needing to be quickly escalated, it is important that team members know who to contact for resolution.

“A lack of clear direction about how, and to whom, concerns should be raised can impact patient safety and outcomes,” said Templeton. “The new chain of command policy is meant to ensure that all team members have the knowledge and tools to effectively escalate concerns and ensure the safety of patients, visitors and employees.”

Everyone is safer when swift escalation of concerns is possible. An effective chain of command is particularly important within health care organizations because it facilitates, rather than impedes, communication, teamwork and collaboration between care teams. For more information on the upcoming chain of command deadline or HRO skills and tools of the month, visit the High Reliability Website.