Nursing Borrows a Trick from Manufacturing

(HealthLeadersMedia) It can take a lot of courage to do the right thing. To speak up when something’s wrong or to challenge a co-worker while on the job. But in the world of nursing, doing so might mean the difference between life and death for a patient. That’s why nurses need to have the courage—and encouragement—to stop the line when needed.

In recent years, the phrase “stop the line” has made the jump from assembly lines into hospitals. It comes from the manufacturing world, where Toyota is the famous example of a company with a stop-the-line policy: Every employee is encouraged to stop the production line if they see a problem. 

Now, the idea is being applied to healthcare, in an effort to improve patient safety.

Stop-the-line action starts with nursing, says AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, clinical director of transition unit and emergency nursing at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center in Philadelphia, Pennsylvania. But encouraging nurses to stop the line is about more than getting them to speak up. Leaders should also provide the correct language for them to do it effectively and provide support when it happens.

“Stopping the line is empowering any staff member to literally stop a procedure right in its tracks to prevent a mistake,” says Papa. But as soon as she says the word “mistake,” she corrects herself with this amendment: “It could be a mistake or to clarify the procedure or process.”

That’s because when it comes to stopping the line in a hospital, it’s all in how you frame it. Using neutral, non-threatening language to question a procedure makes stopping the line less intimidating for everyone involved.

According to Papa, there are ways to stop-the-line other than saying, “stop, you’re doing that wrong.” Instead, phrases like “can we stop for a minute, I need clarity,” or “I have a question, can we stop for a moment” are less threatening, and still get the job done. That’s where the word “clarity” replaces the word “mistake.”

“It’s just about somebody trying to gain clarity, get some understanding and then move forward,” Papa says. “Provide language and script it so that it’s minimally disruptive to the entire process but it still can have everybody save face.”

For the people on the receiving end of those questioning words, it’s important not to let egos get in the way. Nurses not only need to be willing to speak up, but physicians need to be receptive to the questioning, which is why stop the line must be a hospital-wide policy to be truly effective.

“You’ve got to sometimes eat a little bit of humble pie and recognize that it’s not about somebody questioning your skill, questioning that you don’t know what you’re doing,” Papa tells HealthLeaders.
Although many hospitals do encourage employees to stop the line, the practice isn’t as prevalent as it should be, Papa says. And nurses often have trouble questioning physicians.

“There’s often the belief that the nurse and the physician are not on a level playing field,” Papa says. “They’re afraid they’ll get in trouble because the physician got angry with them.”

Hospitals that prioritize patient safety and have a culture of respect and regard will be able to successfully make stop the line routine, says Papa.

Although most hospital leaders would say that their organizations fit that description, Papa says the truth soon becomes evident in hospitals where that’s not really the case.

“You’ll find out the underlying culture if you go in and just even question somebody,” she says.

Once a stop-the-line commitment is made in a hospital, nurse leaders must encourage staff to speak up whenever they have a concern, whether someone is about to hang the wrong blood type for a patient, or a physician is about to enter the trauma bay without being properly garbed.

Papa suggests practicing stop the line during mock codes and encouraging nurse leaders to debrief with their staff whenever a nurse stops the line, just to talk about how it went.

“They’re going to be afraid, they’re going to be hesitant, and they’re going to be nervous the first time that they have to do it,” Papa says. “It never hurts to stop for a minute. And it really doesn’t even take a minute; often it takes 30 seconds. And that 30 seconds can save a life and save a career.”

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