About me, Dave

Walking through the emergency department (ED) at the end of my second year of medical school I saw a trauma resuscitation going on. Because of my experience working on the Rescue Ambulance for the Los Angeles Fire Department (LAFD) I was interested in how it was done in the hospital. What I saw, I simply could not understand. We would have been disciplined had we acted on the streets like what I saw. Yet, here they were not only acting in that manner, they were proud of it and happily criticizing others after the resuscitation ended.

 I did not know at that time the problems my Rescue Ambulance past would cause me. I was one of the first career fire paramedics to enter medical school. Witnessing these behaviors started my pursuit to understand the science that made the beliefs and behaviors of 1970s ambulance men and firefighters correct, what made the beliefs and behaviors of certain physicians wrong, and what was it that made them believe they were right 

When I became a physician in the Pediatric Intensive Care Unit (PICU) I had a chance to apply my mountaineering and LAFD Rescue Ambulance experiences to medical care and teaching. Ron Perkin, M.D., a former U.S. Navy aviator with aerial combat experience from the Vietnam War, and I used our experiences to create a new PICU. Within three years we were the second largest PICU in the state and had the second largest pediatric critical care transport program. We also had half the expected mortality for a unit of our size and for an academic center. We used this approach in in our regional EMS program and an investigative reporter spent three months looking for problems in our pediatric EMS program. He found none.

These results gained the notice of Karlene Roberts, PhD, from the University of California, Berkeley, who told me that we were performing in a manner she called High Reliability and that we had created a High Reliability Organization (HRO). This started our collaboration with the Berkeley group of HRO academics and our series of HRO articles. To share this information and our experience I started the series of International HRO Conferences and the website. 

Early on I was taught that people are our best assets, particularly when a problem must be solved immediately because of high risk. This philosophy worked well in the PICU and we could see change in the performance of the PICU staff, or any of the programs where I worked, within months. The interventions are generally straightforward and we worked from middle management downward to the line worker. As Dr. Roberts pointed out, the executives and organization must allow this to happen.



I started this blog to focus on what the individual can do. My experiences, and what I learned from other practitioners, will be my guide here. What I write has been used by me or taught to me by people I work with

Please read this material and see what you can use immediately. Tell me what works or if you had a problem with it. Let us continue the discussion of how HRO is a normal behavior we can implement immediately.