Speak Up for Safety Using ARCC

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By Dr. Tom Caven, Vice President Medical Affairs, Medical Director, UMC Brackenridge

As one of our HRO safety behaviors, "ARCC" is part of our commitment to 200 percent accountability – for the safety of our patients, peers and ourselves. Through ARCC, any associate or medical staff member can adopt a questioning attitude. That means you can speak up about any safety concern regardless of your position within Seton.

What Is ARCC?

  • Ask a question to gently prompt the other person of a potential safety issue.
  • Request a change to make the person fully aware of the risk.
  • Voice a concern if the person is resistant.
  • Finally, use the chain of command if the concern is disregarded.

Here’s an example from daily clinical life:

A physician is preparing to walk into a contact isolation patient’s room without protective equipment. A physician colleague is nearby and observes the situation:

  • First the physician might ask a question: “Do I need to remind you that room is an isolation room?”
  • If no response, next the physician might request a change: “This is an isolation room, please gown and glove.”
  • If still no response, the physician might voice a concern: “I am concerned that by entering the room without protective equipment you may spread infection.”
  • Finally, the physician might go up the chain of command and speak to the chief of staff or site VPMA.

As we move into the phase of actually using high-reliability organization tools such as ARCC, some new issues are becoming apparent. At some point, when one provider voices a concern or asks a question, the other provider may agree with the concern as raised, or may not agree with the concern. When this occurs, the clinician being questioned should ideally discuss the particular reasons for the decision in the first place. In this way, a questioning attitude tool such as ARCC increases communication both in clarity and detail among caregivers. This can only be a good thing for the safe care of our patients.

In short, ARCC and other tools like it depend on physicians, nurses and other personnel having a more questioning attitude than in the past. This creates not only the opportunity. but also the expectation that caregivers will question and speak up if they have misgivings about a plan of treatment. At the same time, physicians and other caregivers must be willing to accept a questioning attitude as a means to improving patient safety and not view it as an affront to their decision-making and authority.

Clearly, as we move beyond the first rudimentary stages of use of ARCC, we are encountering real-world examples of the way it actually plays out. This calls for changes in the actual role of caregivers at all levels of the organization. In final analysis, however, it will mean greater accountability and greater safety for the patients we serve.

Some Reminders

  • Start with the lightest touch. Ask a non-judgmental question.
  • Respond with “thank you” when someone draws your attention to a potential safety concern.