Skip to main content

Michigan Medicine

A Minute with Marschall

Everyone’s Mission – Safety First

March 8th, 2022

As we know, the best laid plans often go awry. And certainly, when we thoughtfully planned the organization-wide launch of our High Reliability Organization (HRO) back in 2019, we could not have foreseen how quickly and completely COVID-19 would become a 24×7 distraction. Unfortunately, we had to postpone in-person universal skills and leadership courses, and redefine how we pursue and maintain a safety first culture. 

Despite this two-year diversion, however, many of us have clearly embraced our HRO principles. This is evident to me when I hear the HRO safety phrases used across the organization, see groups sharing safety stories and even receive information as SBARs (Situation, Background, Assessment, Recommendation) to support a proposed project or a pivot in operations.

I also see team efforts determined to keep us focused on the HRO journey, such as the C&W team at Mott moving forward with safety coaches, and the quality team promoting enhanced leadership rounding with additional safety materials.    

Below are just a few examples of the stories I’ve heard from across the organization, which remind us that Safety First is everyone’s job, and not just relevant within clinical settings.

  • When a transferred patient from another hospital arrived at the NICU with the wrong faxed information, the NICU Clerk realized the patient’s name sounded different and checked and verified with the other hospital and reported the error. The transport team, MiChart team and the business office all collaborated to resolve the error.
  • The Mott and Patient Experience teams joined together to institute the “button project,” which allows children to see their masked care givers wearing pins with their photos. This was a creative way to support the HRO communication and relationship skills during the pandemic.
  • A nurse identified that an IV infusion did not match the orders in the medical record. She verified that no new bag of IV fluids had been scanned since the previous day. By not just assuming everything was correct and putting safety first, she avoided a critical medical error. 
  • Staff members on the 4th floor of the University Hospital didn’t recognize the sender of suspicious mail, and no one was expecting a package so they contacted K9 Security Officers. The officers also noted that the package was weighted strangely and felt small, hard objects inside. Two K9 dogs checked it for explosives and, once cleared, the officers opened it and determined it was not dangerous, just mislabeled. All involved considered safety first before proceeding. 
  • A respiratory therapist had a questioning attitude about some critical medical information and partnered with an RN to cross check and correct a document error.
  • In planning ahead, with safety in mind, the new Pavilion hospital rooms will all be private to improve patient safety, quality and experience.

What can leaders do to promote Safety First?

  • Put safety first in every decision and start meetings with  Safety Stories
  • Reinforce, reward and model Safety First behavior through  5:1 Feedback
  • Communicate frequently and transparently through consistent huddles and Rounding
  • Listen to all safety concerns and always stand up for those who speak up for safety. This will build trust and foster psychological safety for everyone.

But no matter where you work or what role you have in the organization, we all have an obligation to put Safety First.

March 13-19 is Patient Safety Awareness Week. This is a great time to help us to re-focus on maintaining and sustaining the foundation we have established through High Reliability Skills.

We have much work ahead of us, but it’s important to remind ourselves and our teams of the progress we have made toward continuous improvement in patient safety. We are already on a proven path and adopting a Safety First approach has served us well. That is clear from the high level of care we maintained throughout four pandemic surges. I appreciate all your efforts in prioritizing patient and staff safety throughout these challenging years.

How have you or your team practiced HRO skills to keep Safety First? Please share your story in the discussion box below.


  • I’m so proud to be a part of a high reliability organization that strives to achieve error free performance and safety in every procedure, every time – all while operating in a complex environment due to the more volatile and uncertain challenges we now face on the local and global level.

    Reaching a high level of clinical and operational excellence requires transformation of culture, true commitment to improvements in patient experience and safety and adjusting everyone’s mindset to improve clinical results. Eliminating variation in care delivery will help reduce costs and support consistent operations with zero harm that eliminates potential catastrophic errors before they happen.

    It takes time to develop a deep rooted organizational culture and mindfulness to safety. We must create a culture where constant improvement is everyone’s responsibility. I believe that our resilience and commitment to safety and excellence, learning from previous errors and making necessary adjustments to prevent them in the future would allow us to achieve together our goal of zero harm high reliability organization.

    • Marschall Runge

      Thank you for your comments, Lamia. I agree we are on a path to building a strong HRO culture but we have a ways to go to reach zero harm. I appreciate your support of our HRO journey.

Comments are closed.