Quality & Patient Safety

Zero-Tolerance Rules: Can they work?

Patient Safety Quality Monthly, October 16, 2009

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This month there was an interesting article in The New York Times about a 6-year-old boy who was suspended from first grade because he took his Cub Scout combination knife, fork, and spoon to school. I personally remember those days well and can see myself wanting to show off this cool thing to my classmates. Unfortunately, the student ran afoul of the school's "zero-tolerance" rule about bringing a weapon to school. He is now subject to 45 days' suspension at the district's reform school. In my day, the threat of reform school was about as dire a consequence as I could imagine.

Completely independent of the rights or wrongs of this specific case, it provides a great conversation starter in your organization about zero-tolerance rules. When we work to build a culture of safety, we often need to focus on improving compliance, and a valuable tool to do this is to establish a limited number of "critical rules" or "red rules", of which we have zero-tolerance for violation. But if we use critical rules or red rules, how do we keep from falling into the same trap as the school district did with the 6-year-old?

Although actual zero-tolerance may not be ideal, if we want to use rules that approach this, we should consider the following:

  1. There should be a limited number, and they should reflect our highest risks or most important values.
  2. Everyone should know them. They should be clearly communicated, even to the point of being over-communicated.
  3. We should make them as easy as possible to comply with.
  4. They should be drilled into our behaviors.
  5. They should be uniformly enforced.

Let's step through these criteria for zero-tolerance rules and look at how two organizations apply basically the same rule. We will compare this school district to the TSA airport screening process.

  1. A knife in either world is not acceptable; however, the risk in grades one through five, although not marginal, is probably not the largest risk or most important value in those situations.
  2. You can't get close to the TSA checkpoint without seeing posters or videos or even hearing the TSA officers explaining the dos and don'ts. I doubt if that level of communication was done at the school door.
  3. At the TSA checkpoint, compliance with the zero-tolerance rule is supported by an inspection process, scanners, and a team of people who are 'helping' us comply. I have forgotten to remove things from my luggage, and the process has helped me comply. I doubt if there were metal scanners, inspectors, etc., at the school door. (Although by the time you get to junior high, metal scanners are not that uncommon!)
  4. I travel every week and get lots of practice in TSA compliance. I wonder whether there was ever a knife drill or simulation for the first graders?

Independent of the value of the zero-tolerance rule, as patient safety or human performance folks, we probably could have predicted that there would be more problems with the zero-tolerance rule at the first-grade level than at airport security. But in this case, well-meaning people set up a potentially faulty rule system and have had to deal with a huge public outcry. When you think about the outcry, it probably isn't focused on fighting the rule—which isn't a bad rule. I doubt if anyone is encouraging first graders to take knives to school. I would contend that the outcry is because people recognize there is a failure in the rule process, rather than a problem with the rule itself.

Think about your red rules, critical rules, or zero-tolerance rules—have you made these most important rules the easiest to comply with, understand, and defend? If not, you may be setting your organization up for a similar failure in the rule process.

Ken Rohde 10/15/09



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