Graded Escalation

I had a chat with Rob Tomlinson the other day. It was 1 degree in Blackburn and 36 degrees in northern New South Wales, which explained why I was sitting beside the pool. 

He asked me about how we call 'Below Ten Thousand'. 

It is as simple as saying the words, and yet not so simple that that is all there is to it. 

The utterance of "Below Ten Thousand" initiates a safety cascade. 

The first step is the most important: the realisation for the need for quiet in order to better focus, think and communicate. 

The second step is having the ethical courage to call it. 

The call is simply the intital step in the graded escalation of assertiveness. 

"Below Ten Thousand;"

It calls the team to a single purpose:

Quality and safety teamwork in order to best serve the patient. 

Compliance is the third step. 

If people don't comply to someone's request for safer operating conditions, graded assertiveness will escalate to a more assertive call. 

Lack of compliance identifies a behavioural safety issue. 

The fourth step is follow-up

If the 'Below Ten Thousand' call was successful, thank the team for their cooperation. 

If it wasn't?


Behavioural safety issues are dealt with by performance management through their line manager. 

Not because you want to avoid conflict but because if one behavioural red flag exists for a team member, there may be other red flags to performance you don't know about that their manager surely will. 

And it is the manager's job, and right, to be the person to guide that process. 

At the end of the day it is about being professional and providing the best environment within which to treat the patient. 

An operating theatre is just another day at work for us. 

For others it may well be the end of their world as they know it. 


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