I had the privilege recently of attending a symposium about “surplus safety,” put together by the Erickson School at the University of Maryland at Baltimore and funded by the Maurice Rothschild Foundation. Many thanks to these organizations for convening a group of more than 30 of the best and brightest minds in the world of long-term care for two days of rich and deep discussions. Our discussions reflected a lot of diversity in terms of background, experience, knowledge and opinion, adding a lot to the value of the experience.
We came together to wrestle with this concept of surplus safety. This is a concept coined by Dr. Bill Thomas and Dr. Judah Ronch to describe the practices that follow when the only risk that is considered is the risk that something worse than expected will occur (downside risk) and that the likelihood that the outcome will be better than expected (upside risk) is close to zero. One of the main premises is that a person will be harmed by a bad choice, so we limit choice to ensure a safe outcome.
I have heard Bill Thomas speak about surplus safety several times. But this time, it was different. While I was familiar with the concept, I heard so many new and different ideas and issues raised by this group that it took on a much greater depth and meaning for me. Surplus safety suddenly went from being an interesting concept to a harsh reality that the people in the long-term care system have to deal with every day.
We talked about a long list of F-tags and how they conspire to create a system that imprisons those who live and work within it, including Elders, staff, regulators, and families. At The Eden Alternative, we are fond of saying that culture change is all about changing a system that is broken, and freeing those living and working within it to create a life worth living. Well, I now see surplus safety in that same context. There is a system of safety in long-term care that produces this phenomenon we call surplus safety, literally trapping the people who live and work within the system. While well-intended, the rules and regulations created to promote safety can suck the life and meaning out of any environment for those who live and work there.
Our discussions offered new ways of thinking about this issue and how we can work to change the system. We did not talk about creating anarchy and chaos, with safety issues completely ignored. Rather, we talked about striking a proper balance between safety and a life worth living. We talked about focusing on growth, rather than decline, and creating opportunities for growth by unshackling Elders and staff from the maze of rules and regulations they have to contend with on a daily basis.
This symposium was the beginning of a serious discussion about making things better for everyone by looking at the broken system that fosters this smothering environment of surplus safety and identifying opportunities for positive change. I believe our goal should be to liberate our Elders and their care partners along with the regulators to focus on growth and living, rather than decline and risk avoidance.
I am excited about the possibilities as this group continues its work over the coming months. I am hopeful that this diverse group of people can harness its collective wisdom and translate it into a set of actionable ideas that will help us transform “surplus safety” into a life worth living.
What do you think about this idea of “surplus safety”? Can you share examples of surplus safety that you have experienced or observed? Is there hope to change “the system”? Please share your thoughts.