The Quest for Zero: Climbing the Mountain of Patient Safety

For my telluride post, I decided to reflect on the activity that impacted me the most, and I realized that a great lesson lies in the hike we all went on. On Wednesday we all went on a hike up a mountain range, which was a fun activity to do. While climbing, all my focus was to just keep going up, hoping not to fall amid the decreasing levels of Oxygen and the increasing snow. However, after we were done with the climb yesterday and went into one of the afternoon sessions. It just dawned on me that there was a clear parallel with what transpired during the climb, and what we have been talking about this week on patient safety.

While climbing we all encountered some slippery slopes and those ahead would always call back to warn those of us behind them about the slippery areas, making us aware of the impending danger. When I think of this, I remember how we talked about having an open culture where physicians can talk about their mistakes, educating other, so their colleagues become aware and do not repeat the mistake. As we kept going up, we encountered some difficulty with increasing snow and some people decided to turn back and not go past the point of difficulty/snow. This parallels the predominant situation where some people believe that medical errors are a normal part of medicine and we can’t go past them to a point where we can approach zero errors. A group of us on the hike decided to push on and to get to the end of the trails, and there were moments when each one of us was in front of the group but then we would slow down and lag behind a little, but we would still continue. This is like how we all assembled in Colorado this past week, to learn ways of becoming that group that pushes past what is thought to be possible in healthcare regarding patient safety. I believe in this journey, there may be time we will feel like we are lagging, but we must push on.

Many times on the hike, I almost slipped on the snowy trails but at everyone of these slips, those in front would always turn around and ask if I was okay. This is important because we are all in this together, which includes the patients too, and just as we talked about in Just culture and Care for the Caregiver, we should always endeavor to be there for our colleagues in every slip and every near miss.

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