Healthcare cannot be a Ship in the Ocean

I again highly recommend the writings of Shane Parrish. His exploration of mental models and related topics are some of the best available anywhere. Go here to read for yourself.

Read this recent post on LinkedIn wherein Shane refers to passive stability and active stability.

Shane begins by mentioning:

A ship in the ocean is passively stable. The captain can take a nap, the power can go out, and the ship will still ride out the storm. Passive stability requires no intervention. Active stability is different.
Active stability requires constant intervention. A modern jet is actively stable. It has little inherent stability without constant intervention

For any Healthcare Professional (Nurse, Healthcare Security Officer, etc.), the subject of passive and active stability is significant.

Note this from Shane’s post: “Passive stability means you are default alive without an intervention. Active stability means you’re default dead unless there is an intervention.”

For the Healthcare Professional, replace “alive” and “dead” with “uninjured” and “injured.” For the benefit of helping us see how this applies to our healthcare discipline, I asked you to replace some words with others to reflect what is common in our healthcare environments (i.e., patient against staff assault). We all know, however, that, while “alive” and “dead” may not necessarily be probabilities, they are indeed possibilities. We should thus take this subject seriously. And we should take seriously the training we do to intervene in violent patient incidents.

Let us not get complacent with our crisis management and crisis intervention training, treating it like yet another box that must be checked every year or so. Let us also not get complacent with our current chosen crisis management and crisis intervention training programs. We should regularly be performing needs analyses to determine if the training meets the full needs of our Healthcare Professionals.

In today’s healthcare environment, we need to inculcate in all Team Members that the environment is not passively stable. Even if it is, it’s tactically wise to treat it as if it isn’t. Note: We CAN be tactically wise AND compassionate Care Givers simultaneously. Don’t ever let the amateur tell you that the two are mutually exclusive; they are not. If you believe they are, then your chosen training program is not sophisticated enough.

We ought to think (and act) more in terms of:

What we are constantly doing (proactively & upstream) to create a non-escalating environment (i.e., not simply waiting for escalation to occur at which point we pull out our de-escalation tools).

What we are constantly doing (proactively & upstream) to respond (i.e., intervene) with patients as early as possible so as to interrupt escalation before it unfurls to the point of impact (the point of impact being what most people view as the physical expression of violence).

What we are constantly doing (proactively & upstream) to combat the lazy and dangerous mindset that everything is passively stable.

It’s important to note the part about “constantly doing (proactively & upstream).” Way too many so-called professionals do way too little upstream work. They wrongly place almost all of their attention on responding to a crisis, with giving way too little attention and action to what they are already constantly doing (proactively & upstream), with conscious attention and outcome-driven intention, to create the environment, watch the environment, and monitor the environment. All of this proactive, conscious, upstream, non-escalatory, and situational awareness work should be hardwired into our training and reflected as expected competencies in our HR role descriptions.

We must train an ability to flip from a mindset of passively stable to one of actively stable, thus arming ourselves with more nimble and effective responses.

We must adopt (now) more of the principle of Universal Behavioral Precautions, an understanding and mindset with which we stay awake, aware, and alert in today’s healthcare environment.

We are not the Captain of a ship who can set the course and go to sleep.


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