TRAVIS AIR FORCE BASE, Calif. -- In the Feb. 12 issue of the Tailwind, Col. Rawson Wood introduced the concept of high reliability and the Air Force medical service's journey toward Trusted Care, with David Grant USAF Medical Center at the lead.

To recap, high-reliability organizations operate in high-risk environments with a high potential for catastrophic outcomes, yet as Karl E. Weick and Kathleen M. Sutcliffe point out in "Managing the Unexpected: Resilient Performance in an Age of Uncertainty," HROs "manage to have fewer than their fair share of accidents." Examples include the United States airline industry and the Navy's nuclear aircraft carriers. 

Weick and Sutcliffe go on to codify the principles observed in HROs, and, in this article, I'd like to highlight some of the behaviors from the Trusted Care toolbox that you might find personally useful.

Most of us would benefit from clear communication. Closed-loop communication occurs when a sender sends information, the receiver reads or repeats it back and the sender verifies that the information was received correctly. This kind of three-way communication prevents miscommunication and misunderstandings. 

I recently asked one of my flight commanders to assist a group staff member with a travel voucher.  He sent an email to me a couple of weeks later stating that it was resolved - he closed the loop.  Communication clarifiers include the phonetic alphabet, differentiating sound-alike numbers and asking general clarifying questions.  Zero-point-five milligrams of medication versus five-point-zero milligrams could mean the difference between life and death. Finally, in the past few months, the Medical Group has adopted the practice of using the "SBAR" format to communicate service closures, drug shortages,system outages, etc.  In my squadron, we use SBAR on all staff summary sheets:

· Situation - What is the situation, problem or issue?

· Background - What information does the other person need to know?

· Assessment - What is your read of the situation?

· Request/Recommendation - What do you need the other individual to do or what is the recommended course of action?

This has standardized how we communicate and helps us be accurate and succinct.

DGMC began implementing Trusted Care in December and, to this day, we continue to receive training at all levels our organization.  We are committed to building a culture of reliability with a single-minded focus on safety and achieving zero harm, ultimately because we are committed to the mission and our patients.