Rogues of Safety Hi Menna. You are correct. John and I developed and marketed the ‘Below Ten Thousand’ concept to our own colleagues at University Hospital Geelong. From there it has spread like the rabbits at Winchelsea. We tried to include our managers at every step of our concept development but they refused to engage and as we progressed, they became resentful of our work. It’s not unusual for new ideas to meet a hostile reception in their formative location, but we were surprised to be labeled ‘rogues’ by our own leadership team when we did so much to try to include them from the very outset, as per our ethic of open collaboration. In the end, despite 90 percent of the clinical staff educated, enthusiastically using the tool and clamouring for its official stamp of approval from the bosses, that stamp of approval never eventuated and with our educator too scared to promote it at orientation, perpetuation of the tool to successive generations of new staff became problematic. John and I were told emphatically “all you have is three words and when you leave they will die” But we continued our cause because we considered it unethical not to. Patients (and staff) were still being compromised because of noise and distraction, and even though we continued to invest time, energy and money into keeping the clinician-led cultural change at the forefront of clinicians working knowledge, we figured that Barwon Health would never be a primary ‘customer’. We had our first big break when Liverpool Hospital in Sydney gave us an overwhelming thumbs up and their Director of Nursing labelled ‘Below Ten Thousand’ as “a very patient centric Model of Care” Our second big break came from the Pennsylvania Patient Safety Advisory acknowledging our work, and later the arrival on the scene of both Rob Tomlinson (UK) and Ash Kirk (NZ) Rob’s advocacy got a boost, first from the AfPP who labelled BTT “the missing link in the Surgical Safety Checklist” and more recently from the Care Quality Commission who included it as a safety strategy in their 2019 Prevention of Never Events Report. Ash’s outcome was awesome too. At Dunedin Mercy, BTT is approved for use right throughout the hospital in clinical and non-clinical settings and has the vocal backing of the CEO. John and I knew we would have to sell the concept to the world in order to sell it to our own operating theatre management team, and that’s what we still vow to do. To illustrate, a year ago a junior nurse in the day stay unit spoke at a meeting about something she had read about in the Journal of Perioperative Nursing, and how she thought it would be a great idea to introduce into her work setting. The operating services manager and the educator shut her down, and it was only later that the nurse learned that the project she was talking about, ‘Below Ten Thousand’, had its birthplace 150 metres away and three floors up in the main operating theatre of her own hospital. When Rob’s award win was mentioned by a nurse at a theatre staff meeting, the clinical staff went wild with applause. The management team, however, merely scowled and remained mute. One of the reasons I left was because of the strain of the oppositional management culture and their relentless hostility towards clinicians. I felt I could no longer effectively advocate for my friends (conflict resolution) and patients (safety). I could no longer function in that deeply absurd environment and it is only two and a half years later that I feel ‘healed’ in some way and have stoped dreaming about it. This is an off the cuff response after a day working hard on the farm, and so I don’t expect  eloquence will be a feature of my reply. Thanks so much for making a great text box feature out of ‘Below Ten Thousand’ for the next edition of your text book.  I hope my story doesn’t diminish your respect, for which I am forever grateful, for that carefully deliberated idea that John Gibbs innovated and that I, naturally, plunged headlong into making a reality irrespective of the consequences. Some might say I am an idiot. Some might say I was brave. But in the end, Ethics is simply a call to do the right thing, and the cost means nothing when what is at stake is a matter of heart. If you ever need a presenter for a conference, I’m happy to talk about my experience. Especially now that I am a Rogue of Safety, and, as it seems in the UK, an International Man of Mystery. Pete! 0404014338 

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