Refuse to Settle: The Journey From

Ordinary to ExtraordinaryBruce Spurlock, M.D.

Cynosure Health

1.It is natural to settle for less than the best – why?

1.What happens if we refuse to settle?

1.How do we move from ordinary to extraordinary?

Stage 1 - Becoming aware that

you are settling

Normalization of Deviance

violations

acceptable risk

migration

normalization of deviance

intentional non-compliance

I can handle it.

I can get away with it.

I can’t help it.

Everyone does it.

Its what they really want.

They’ll turn a blind eye.

Delay in feedback

Examples• Hand Hygiene• Readmissions• VTE prophylaxis

• Poor surveillance• Inadequate or no data collection• Overlooking the hard stop

Misinterpretation of results

Examples

• “I never have these types of complications”

• “The data are wrong”• “The problem is with X department”• Good catch – we don’t need to worry

about it

Stage 2 – Seeing what is possible

Shock Alert Outcomes

From Sebat, et al. Chest 2005

Mercy Hospital, Oklahoma City

Already Low Rates

This is excellence!

Northern New England Cardiovascular Group

Benewah Community Hospital

Stage 3 – Launching an Effective

Action Plan

Have you ever performed an RCA which resulted in the following

conclusion:

1. Policy is correct.2. Policy not followed.

Step 1 - Find one patient story a month

Step 2 – Get great ideas from each other

www.hret-hen.org

Step 3 – Use a system for improvement

Direct the Rider

Motivate the Elephant

Shape the Path

1.It is natural to settle for less than the best – why?

1.What happens if we refuse to settle?

1.How do we move from ordinary to extraordinary?