A near miss is not a failure — it is proof the system worked. But that reframe only holds if leadership backs it up. Staff who report and see nothing change learn quickly that the culture doesn’t match the message.
The ASC administrators who have built the strongest safety cultures know that the hard part isn’t getting staff to report the first time. It’s earning the second report, and the tenth.
Four leaders shared how they have made near-miss reporting a point of pride rather than a source of fear at Becker’s 32nd Annual: The Business and Operations of ASCs conference in Chicago.
Note: Responses have been lightly edited for clarity and length.
Question: How do you encourage your staff to report near misses?
Trina Cole, MSN, RN. Administrator of Saint Luke’s Surgicenter-Lee’s Summit (Lee’s Summit, Mo.): I think the staff need to know that you’re listening to them when they come to you. There’s some staff that want to talk about everything that happened in the last 20 years they’ve worked there, so you have to kind of reel them into the actual incident. But they want to be listened to. They want to know that you’re doing something about it. You can listen all day, but if they don’t ever see you following up or having some kind of outcome with what they’ve talked to you about, then you might as well not even ask, because they’re going to stop coming to you at that point.
We recently had a survey with a credentialing issue, and our credentialing lines are so tiny. One of our orthopedic physicians who does total joints marked an “X” on an elbow instead of the hip. Thank goodness the surveyor found it. I would much rather that have happened than an incident down the road, and there’s no defense for that. So that changed the whole process for us. Prior to this, the staff in the office was filling those out. The physicians didn’t even know what they were checking. So now we have initiated a form where they have to check off and sign off on their credentialing packet before it comes to us.
Gloria Gardner, RN. Senior Administrator of Physician Partners of America (Tampa, Fla.): Staff don’t want incidents to repeat. If you address it in a positive manner, a near miss is something good. Somebody caught it before it happened. As long as the staff knows that everybody is going to learn from that instance, then they come forward. I’ve been a nurse for 50 years, and when we first started with near misses, that didn’t happen. You shoved them under the table. Now you do have to report, and it’s our duty to report. It’s made a positive impact on everybody. When something like that happens, they will come to me or to my charge nurse and say, “Look, this happened in my room. What can we do so that it doesn’t happen again?”
Amanda Nunkovich, BSN, RN. Administrator of CenterPoint Surgical (Palos Heights, Ill.): Not to turn it into a fun event, but we have an initiative called the Great Catch program. We have cards around our center, and we even included our business office for things like the wrong date of birth or the wrong name. They fill it out and turn it in to their charge nurse or whoever they feel comfortable going to. And then we celebrate them. We recognize them. We teach about what happened and how this could have been avoided. And then they’re comfortable: “I’m not going to get in trouble. This is not a problem. I’m actually getting highlighted and recognized.”
Jason Raidbard. Executive Administrator of the Ophthalmology and Visual Sciences Department at UChicago Medicine (Chicago): At a previous organization I worked at, I remember walking in the door my first day, and it just suffered from a lack of a good culture, period. I didn’t realize that going in. So I started from the beginning, just trying to understand the people that work there: what’s important to them, their personalities, their quirks.
I think it helped to have a champion. My nurses were really strong, and I picked up on that. So I allowed them to speak their mind and share their knowledge, because they had wonderful knowledge. What that did over time is that people saw that the culture, at least within our bubble, was changing: that you could exchange ideas, and you could bring things up when there were safety events. I also worked with the doctors, and they were just exhausted from no one listening to them. So collectively, between my medical director and nurses, that permeated the rest of the staff. When we did have safety events, people would come forward and talk about it, and they were not shamed.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
