How We Do this Work

The consistent delivery of safe, high quality care requires a clear and practical framework. At the clinical unit level, the following factors are assessed and specific actions taken for measurable improvement in each category:

Patient and Family Centered Care

Medical care is a profound social experience. Partnering with patients in a way that is clear, aligns with their needs and is respectfully inclusive is essential.


Patient care is an extremely complex process, and effective communication and teamwork is a fundamental requirement. Structuring communication through briefings (huddles, checklists, etc.), debriefings, SBAR and other standardized tools, and the use of critical language to maintain situational awareness and preclude problems from showing up at the bedside is important. Creating predictability in complex environments is a basic principle of high reliability, and allows skilled clinicians to use their expertise to manage uncertainty.


Effective leaders always set a positive, active tone, think out loud to share the plan and help create a common mental model, and continuously invite all team members into the conversation for their input and their concerns. This dynamic gets the team on the same page, creates psychological safety, and makes the leader approachable.

Reliable Processes of Care

The hallmark of excellence is the ability to consistently do the basics in a measurable, sustainable manner. Visible, reliable processes help reduce clinical variation; they also allow the people providing the care to see the work in a way that drives measurable improvement through testing and rapid cycle improvement.

A Culture of Safety

Culture is the social glue in an organization. High performing cultures have clearly agreed norms of behavior and structures that support behaviors that create value for the patient, caregivers and the organization. Two critical components of medical safety culture are psychological safety, the ability of anyone to voice a concern about a patient, and organizational fairness (just culture), the ability to learn from error.

Learning System

Every day our skilled caregivers deal with basic defects that make it difficult, if not impossible, to deliver the high quality care they are capable of. We call those defects the ‘pebbles in their shoes’. A learning system provides a methodical way to visibly capture those pebbles, act on them, and demonstrate a cycle of learning. This is an essential component of high performance cultures.