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Michigan Medicine

A Minute with Marschall

Our High Reliability Skills Will Help Us Get Through COVID-19

April 13th, 2020
Communicating clearly, cross checking and validate and verify are high reliability skills that will help us fight COVID-19

Over the last several weeks, I have watched faculty and staff across our organization collaborate and innovate to care for our patients during this crisis. I can never say it enough – I am incredibly proud of how well everyone has come together to fight this deadly COVID-19 disease. 

I am also extremely grateful for the work we started on our journey to becoming a highly reliable organization (HRO). Although we have only just begun our HRO journey, we are already putting the skills into practice, and nowhere is this work more beneficial and powerful than in our war against COVID-19.

I am personally seeing it in action every day. At the command center, where leaders come together to tackle the challenges of our rapidly evolving response to COVID-19, I hear team members asking clarifying questions or repeating information back to one another to verify something they may not fully understand. These are universal skills we all must embrace.

The command center has also received recommendations on how we should adjust a process or handle a new situation using the SBAR (Situation, Background, Assessment, Recommendation) format.  When complex information is presented in this way, the rationale and thinking behind a new idea is clear and it becomes much easier to make decisions.   

The power of high reliability skills can inform significant decisions that happen in the command center, but also on the clinical floors. A great example of this is the Post-Anesthesia Care Unit (PACU) in UH, where we paused on opening the unit when clinical staff raised concerns about patient safety and having adequate ICU-level supplies. Deferring the opening until the next day, when adequately stocked and inventoried for high acuity patients, was definitely the right thing to do to avoid additional issues and problems for our care teams.

From the front line, to the back office, we can help ourselves by using HRO techniques. Three skills in particular are extremely valuable during this highly reactive time:

  • Communicating Clearly and assuming positive intent
  • STAR (stop, think, act, review)
  • Speaking Up for Safety using ARCC (ask, request, concern, chain of command)

In these hectic times when we are so focused on COVID-19, it’s easy to push aside HRO as less important. But these skills are more relevant now than ever. Tensions are high and it’s easy to say, ‘I just don’t have time,’ but these safety skills will improve our communication, teamwork and efficiency which, in the end, help us provide better care for our patients.

The training may seem so long ago, or, for some of you, you may not have even had the chance to take the Universal Skills course. To help you become familiar or reacquaint yourself with key HRO skills, we have developed useful one-page overviews of each skill. I encourage you to visit this site and utilize these resources.

I’m working hard to make sure I continue utilizing these skills, and, based on the dedication and hard work I am seeing all across the organization, I know many of you are practicing them as well. Take a moment, and think about how you can incorporate more of these practices in your daily interactions with your teams. We are all in this together!

See more resources on the HRO website, or email for additional support.

How have you seen high reliability skills in action? Tell your HRO story using the comment box below.