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Quality Improvement: “Escape Fire”

The following article is about principles of quality improvement.

Please do not hesitate to contact us with comments, questions, or requests for additional information.
 
Sincerely,
 
Elizabeth
 
Elizabeth E. Hogue, Esq.
(877) 871-4062
On December 9, 1999, Dr. Donald M. Berwick; the founder, President and CEO of the Institute for Healthcare Improvement; gave an important address to the 11th Annual National Forum on Quality Improvement in Health Care. The wisdom of Dr. Berwick's words still rings true today and is important for all providers who are committed to improving the quality of patient care on a continuous basis.
 
Dr. Berwick began his speech with a description of the Mann Gulch fire in Montana on August 5, 1949. Thirteen young men lost their lives in this fire that did not develop as expected. At first, the fire appeared to be routine. The firefighters called it a “ten o'clock fire,” which means that they expected to have the fire beaten by 10 o'clock in the morning. But they were wrong. The fire flanked them and cut off their escape route to the river. 
 
The firefighters immediately changed course, and hoped to get up a steep hill and over a ridge before the fire reached them. Their leader, Wag Dodge, recognized that his team would not make it over the ridge before the fire engulfed them. Here is Berwick's description of what Dodge did:
 
“With the fire barely 200 yards behind him, he did a strange and marvelous thing. He invented a solution. On the spot. His crew must be thought he had gone crazy as he took some matches out of his pocket, bent down, lit a match and set fire to the grass directly in front of him. The new fire spread quickly uphill ahead of him, and he stepped into the middle of the newly burnt area. He called to his crew to join him as he lay down in the middle of the burnt ground…”
 
Dodge's team either did not hear him or ignored his calls and ran right past him. Only two of them, in addition to Dodge, survived. Dodge invented what is called an “escape fire,” which soon became a standard part of training for firefighters.
 
Berwick goes on to point out that a key role of organizations is what he calls “sensemaking,” a concept developed by Professor Karl E. Weick. Sensemaking is the process by which the fluid, multilayered world is given order within which people can orient themselves, find purpose ad take effective action. According to Weick, organizations don't discover sense, they create it.
 
Here are some of Berwick's principles of sensemaking in healthcare organizations:
 
  • With regard to patients, the guiding principle must be “Nothing about me without me.”
  • From Dr. James Reinertsen, “All and only. We will promise to deliver, reliably and without error, all the care that will help, and only the care that will help.”
  • “Every patient is the only patient.”
  • “The patient is the source of all control.”
  • “By what right does a nurse, doctor, or manager make a decision that violates basic principles of human decency and caring?”
 
If providers follow the above guiding principles, just imagine how the quality of care provided to patients will improve. Let's go!
 
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©2021 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.
 

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