Escalator to compliance: You don’t (always) have to do everything

In pondering the “enormity” of the most frequently cited conditions and/or practices (I’m trying to force myself to move away from using the old standards/performance elements descriptor; now that the requirements have been distilled into it their most basic elements, it seems like a good time to move beyond), the mental loop I have playing in my head revolves around the notion of the importance of escalating compliance considerations when the principals (and principles) responsible for managing the physical environment have taken things as far as they can, but the organization as a whole remains vulnerable to survey findings. In some ways, its analogous to the notion of perfection and how we (and I’m using the universal “we” here) are not really designed that way. To paraphrase a quote from Ted Lasso: “Human beings are never going to be perfect. The best we can do is keep asking for help and accepting it when you can. And if you keep on doing that, you’ll always be moving toward better.”

So, the question becomes this: how do we (a slightly less universal “we”) as safety and facilities professionals get better about asking for, and accepting, assistance from above. I’ve listened to many frustrated individuals ask about leveraging compliance in the field when things are not quite perfect, and I (almost) invariably ask them back the question: how do you escalate the issue to a level in which greater traction can be achieved? It is possible that escalate isn’t necessarily the most correct term; it may have more to do with enlisting the right mix of resources, but for the purposes of this discussion, I’m going to define “escalation” as reaching out beyond the core group of physical environment overseers.

Of course, there’s always the dilemma of picking your battles. Clearly, if this becomes a standard response to barrier management, then it might be time to look at the structure/membership of that core group. But I don’t know that it needs to be a strategy/tactic that is reserved “only in case of emergency.” I guess there’s the notion that a committee or other stewardship entity (after all, stewardship is the primary directive) has whatever it has for membership, but maybe there’s a need to reach out. My suggestion is something akin to the “time out” that has become the standard of practice in the surgical world—hardwire an “escalation time out” into your committee activities. At first, I was thinking that could be something for every meeting agenda, but that might be so frequent that the group becomes desensitized to the notion of really thinking about “asking for help” (and maybe even accepting it). I think it’s definitely a question that should be part of the annual evaluation process and probably part of any reporting on the physical environment that reaches organizational leadership.

It doesn’t have to be crazy complex, just a simple “stop” in the analysis of compliance performance in the physical environment. “Committee X has determined that the following issues would benefit from additional resources,” or “Committee X has determined that there are no compliance issues for which additional resources are requested.”

It seems more than likely that, as a function of accreditation surveys of the physical environment, survey findings are going to be escalated into findings under leadership and governance standards. And if you haven’t done a good job of identifying your organization’s vulnerabilities, I can foresee any number of awkward (at best) conversations in the survey aftermath. You can’t do it all, but you do have to recognize those issues that require a helping hand and make it a practice to ask for that help.

About the Author: Steve MacArthur is a safety consultant with The Chartis Group. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is an advisory board member for Accreditation and Quality Compliance Center. Contact Steve at stevemacsafetyspace@gmail.com.