TCOM and Systems Safety: My Journey

By: Tiffany Lindsey, Policy Analyst

Chapin Hall at the University of Chicago

My journey towards Safety Culture began in a group home.

I was 24-years-old and had just started a new job as program manager—my first supervisory role. I was the only clinician on-site. All but one of my staff were older than I was, and the group home appeared on the verge of closure. Per state auditors, no new admissions were allowed in the facility until we had things “cleaned up.” From what I could tell, it was going to be a very long Performance Improvement Plan.

I worked there constantly, sometimes just sleeping a few hours on the couch in my office rather than drive home. The group home housed 8 adolescent females. Every night it seemed one or more of the girls were self-harming, fighting, sneaking in contraband, or running away. It wasn’t uncommon to find staff crying in the office. I honestly wanted to cry several times myself but was too overwhelmed for the tears to come out.

My boss, Kim, was new to supervising both me and the group home. She was compassionate, assertive, calm, and smart. She was in charge of several programs and did not work at my location, but I remember calling her several times in the middle of the night:

Kim: Hey Tiffany.

Me: It’s crazy here, Kim. I don’t know what to do… [insert rambling, hurried, nearly nonsensical story]

Kim would always help me solve the crisis quickly, even if it meant she traveled out to help me in the middle of the night. She was never mad at me or my staff, even if we had made mistakes (which we often did). She always wanted to talk through it and help us plan ahead for the next time. After all the residents were in bed, Kim and I would finish up documentation at 3-4am. During one of those times, she said:

“I want you to learn to think beyond these crises, Tiffany. Get upstream. Take a problem and ask yourself why it occurs. Then, whatever that is, ask yourself why it occurs. Keep doing that until you think you’ve found a systems issue we can reasonably tackle.”

Kim was an amazing mentor to me and my teammates. At the time, neither she nor I knew anything about the Safety Sciences or Safety Culture. Without knowing it, she was instilling in us the habits consistent with a Safety Culture. Those team-based habits are:

1. Candor and respect are preconditions to teamwork.
2. Spend time identifying what could go wrong.
3. Talk about mistakes and ways to learn from them.
4. Discuss alternatives to everyday work activities (i.e., finding efficiencies, testing out small iterative changes).
5. Develop an understanding of “who knows what” by communicating clearly.
6. Appreciate colleagues and their unique skills.

Those habits became the basis for all our improvements at the group home. Rather than blame the residents or fire a bunch of staff, we solved all the underlying systemic issues we could. We changed our staffing pattern, hired more PRN staff and targeted our employee recruitment at MSSW programs, created a new treatment process and positive reinforcement-based behavioral program for residents, and reallocated some resources to foster more safety in community outings. We did far more than that, but those changes alone made a huge difference. Our group home held a sense of community and pride.

I intend for this blog to be the start of a new featured series on System Safety and Safety Culture. There are several core values (e.g., psychological safety), quality improvement tools (e.g., driver diagrams, TCOM’s Safe Systems Improvement Tool), and team-based strategies (e.g., huddles, debriefs) useful in the interdependent, high-risk work of human services. In every way, the TCOM values of shared language, honest and respectful communication, and collaboration are parallel to the values of Safety Culture.

I’m going to make a bold claim: Safety Cultures are the best cultures to support TCOM. Where there is one, there needs to be the other. With that in mind, I trust I’ll find some kindred spirits among TCOM’s thriving community. I’m the “new girl on the block” with the TCOM Team, but you already feel like home. 

Thanks for welcoming me into the TCOM community!

Tiffany