Health care has learned a lot about safety from the aviation industry.
But what about zoos?
Each year before the IHI Forum in Orlando, IHI faculty member, Kathy Duncan, and I take health care professionals on an excursion to the Central Florida Zoo, where they learn about how reptile keepers protect themselves when they handle venomous snakes — rattlesnakes, mambas, cobras, pythons, and vipers. In addition to the snake house, we visit with their vet to learn about medical procedures, and education staff, who talk to us about how they staff the zoo, manage volunteers, and design the grounds for safety and flow.
Last year, we interviewed Michelle Hoffman, a reptile keeper at the zoo, which has one of the Southeast’s largest collections of venomous snakes. The keepers have to handle the snakes on a regular basis to clean their enclosures, update the exhibits, and give them veterinary care, and the zoo has a great system for protecting keepers and snakes from injury when they do. The reptile team has clear protocols to protect staff from bites and to reduce the harm to them if a snake does bite a keeper, which hasn’t happened in 20 years.
Here are four tips for designing systems to prevent injury, whether in health care or in a zoo:
- Use simple, clear visual cues to help prevent errors. Behind the scenes of the snake exhibit, the openings to snake enclosures have red or green labels to indicate whether the snake inside is venomous or not. This intuitive visual system helps prevent keepers from mistakenly handling a snake that is venomous as if it were not.
- Have a plan for what to do if the worst happens. In the context of the zoo, a failure is a venomous snake bite. In health care, it could be a medication error, a misdiagnosis, or a wrong-side surgery. Obviously, safety systems try to prevent these bad outcomes, but if they do occur, effective organizations can still do a lot to mitigate the harm. The zoo has a venomous snake alarm, which triggers an alert for all staff and a call to 911. The herpetarium staff also only work with venomous snakes in pairs, so that trained personnel are available to help if a snake bites a keeper. In addition, anyone working with a snake wears a belt clip with information about the snake they’re handling — including the type of snake and the antivenin that works against its bite. That allows response teams to know exactly what to do, even if the handler is incapacitated from the venom.
- Learn from failures and near misses. The zoo hasn’t had a venomous snake bite in more than two decades, and part of the reason for that is that the team is continuously improving. They don’t wait for a snake bite to address the weaknesses in their processes and systems. For example, they used to use lanyards to hold the cards with the essential information about the snakes, instead of belt clips — until they realized that a snake could wrap around the lanyard. They also take advantage of new hires to learn about processes at other zoos and apply fresh eyes to notice any gaps in their system.
- Promote a culture of openness, trust, and teamwork. Just as in health care, establishing a culture of safety means flattening the hierarchy. If a reptile keeper is having a bad day, feeling sick, or upset about a personal issue, the team managers want to know about it. Staff know that they can count on their managers not to punish them if they speak up about a safety concern, and they also know that other handlers will have their back if they think they’re not feeling up to handling venomous snakes that day.
I love helping people realize they can learn improvement ideas from any setting. Once the switch has been flipped, there’s no going back. After an excursion, participants often go home to find themselves noticing new things about reliability or flow principles from Starbucks or the car wash. The zoo excursion is particularly interesting because zoo keepers have to care for animals that can’t communicate their pain or problems.
Sometimes, it’s easier to learn concepts about safety and improvement in a different setting because learners don’t focus so much on the barriers to change in their organization. Instead of thinking, “but we don’t have that staffing” or “our rooms aren’t designed that way,” they can just learn about snakes and then think about how to apply the concept in practice when they return home.