Dr. Rochelle Low joins us to discuss resilience and recovery from patient safety events. On this episode of the _Cone of Shame_ Podcast, Dr. Andy Roark and Dr. Rochelle Low explore what patient safety events are and how they impact veterinary professionals. They discuss the critical role of psychological safety, strong leadership, and a culture of trust in helping teams learn, adapt, and heal when things go wrong. Dr. Low shares insights from her recent JAVMA study, breaking down the emotional and professional toll of medical errors, the importance of peer and leadership support, and how veterinary teams can create a safer, more open environment for learning from mistakes. This episode is packed with practical takeaways for veterinarians, technicians, and hospital leaders alike. Let’s get into it!
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ABOUT OUR GUEST
Dr. Rochelle Low, DVM, MaS, MHL, is the Global VP of Quality and Patient Safety for Mars Veterinary Health. Originally from Victoria, Canada, she earned her DVM from the Western College of Veterinary Medicine and completed a residency in Emergency and Critical Care at Angel Memorial in Boston. She later pursued a Master’s of Applied Science in Quality and Patient Safety at Johns Hopkins and a Master’s of Healthcare Leadership at Brown University.
Dr. Low spent 14 years as a medical leader for VCA Inc., focusing on quality, patient safety, and patient care, where she recognized the critical impact of hospital culture and nursing empowerment on patient outcomes. Currently, she is dedicated to building a culture of safety across MVH hospitals by implementing a global patient safety event reporting system and collaborating with Johns Hopkins to integrate team training and safety programs like TeamStepps.
She now lives on a small farm in Bend, Oregon, where she enjoys hiking, surfing, and skiing with her four pitties, two horses, two alpacas, four sheep, five mini-donkeys, and plenty of chickens.
EPISODE TRANSCRIPT
COS – 317 – Resilience and Recovery from Patient Safety Events
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with Dr. Rochelle Low and we are talking about patient safety events. This is a, oh man, this is a great episode. Rochelle is fascinating. She’s got good data that she’s going to present today, but also just really fascinating ideas about how do we support doctors and technicians in balancing back when things go wrong.
And things go wrong because we’re human beings and we get into that and the pressure that we put on ourselves to be perfect. But she’s a co author on this great study that’s come out in JAVMA. We talk about resilience. We talked about the impact of good leadership on the ability of people to recover and bounce back.
After patient safety events, we talk about the importance of a psychologically safe culture, the ability for people to say, I’m worried about this or I’m gonna speak up. It didn’t happen. But I almost made a mistake, and so maybe we should look at what we’re doing here so that a mistake doesn’t get made in the future.
You have to have trust to, to say that to the group or to say that to your medical director. And it’s just, anyway, it’s a great conversation about what do patient safety events, what do they actually look like? And then, what are the impacts that they have on our team? And then, what are the things that really make a difference in helping people to bounce back, to learn and get better and get stronger and not to be permanently kind of damaged.
So they’re like, I can’t, I’m not doing, I’m not, I’ll never do this procedure again. I don’t want to see this kind of patient again. Things like that. Anyway, very good conversation. I hope you guys will enjoy it. I got a ton out of it.
Let’s get into it.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast. Dr. Rochelle Low. Thank you for being here.
Dr. Rochelle Low: Oh, you’re welcome. It’s great to be here.
Dr. Andy Roark: I am so glad that I was able to get some time with you. For those who don’t know you, you are, you do a lot of things. Your background is in emergency and critical care, but you’ve done a lot of things in medical leadership.
Your main focus now is on medical quality and patient safety at Mars Veterinary Health. And so the reason I reached out to you, you have an article that came out that uh, very end is actually the beginning of 2025 in JAVMA is when I saw it and it’s called Personal Resilience Good Leadership and a Psychologically Safe Culture Play a Mitigating Role on the Impact of Patient Safety Events. There’s like five things in there that i’m interested in like around personal resilience good leadership psychological safety and patient safety events and so let me just sort of start for a second here because it’s that’s a lot It’s a lot to unpack start at a high level.
Talk to me just generally about patient safety events and how do you define that term? What is a patient safety event?
Dr. Rochelle Low: Yeah, so a patient safety event, if you look at a definition, is, anything that either happens or almost happened to a patient kind of during the delivery of care that actually has nothing to do with the reason that they’re there, you know, for medical care in the first place. So this would
be, just to give you an example, this is something like say we were giving a medication to a patient who was in hospital and we gave the wrong medication or it would also be an example that you often hear in human health care somebody goes in for knee surgery and inadvertently they do surgery
on the wrong knee. And so it’s kind of, it’s everything within healthcare, both in human healthcare and veterinary healthcare, that basically it, it’s considered a medical error or an adverse event. And so medical errors are things, obviously, that nobody wants to happen but, because we’re human they’re going to happen.
And then adverse events are things like an adverse reaction, say to a blood transfusion or a vaccine. And so, so anything that sort of impacts patients and it really is this area that it’s interesting, but other industries, say, like the airline industry or automobile industry that are also trying to keep people safe, they very much dive into these, you know, these kinds of safety errors and they dissect them and they learn from them to try to prevent them.
Healthcare lags a little bit behind, and so that was why it became a fascinating area for me, because when I was in leadership roles, I handled a lot of these kinds of situations and cases, and I think I think that not only did I notice that the way you handle them, the way you. Very transparently communicate with the client or, you know, the way you talk to your team about an event has such a huge impact.
But I also noticed that there’s actually things that we could do to prevent future events if we learn from those events. And so there’s just kind of this whole area that I feel I would still say it’s very much an emerging field and that med and we’re getting there. People are starting to get interested in it and that, but hopefully we’ll be able to continue to move it forward.
Dr. Andy Roark: It’s a fascinating area now because we’re reaching an a level of connectivity that lets us really work with some significant data sets that just, wasn’t, available 10 years ago. I don’t know, there’s a lot more opportunity. So in this research, you, put together, it’s, it seems like from my readings through, it seems like put together a survey tool and you had over 2000 veterinarians take the survey.
Talk to me about that sort of your objectives for this sort of survey tool and where you’re trying to go.
Dr. Rochelle Low: Yeah, so the survey what we really wanted to do was get a large veterinary population of veterinary professionals. So I actually reached out to veterinarians to nurses to every position honestly within a hospital team because in this area they’re all really critical. And where the surveys were sent so three we have three large teams in North America with Mars veterinary health But also we partnered with AAHA and sent it to the AAHA membership database.
We also partnered with ACVIM and so we also surveyed ACVIM diplomats and what we really wanted was to be able to spend all different levels of different types of care and then all different positions within a hospital. And so we got some really good input from that.
Dr. Andy Roark: Yeah. And so you were really sort of looking at their experience of their response around you know, around patient safety events, you know, so looking at, kind of what you found here and, and sort of starting to get into this a little bit, you found that majority of people who took the survey had reported experience at least one patient safety event in the last 12 months.
That seems amazing to me. did that track for you? Were you surprised by that? Because I think, yes, one in a career, of course, I mean, maybe one every three or four or five years,
Dr. Rochelle Low: No, it’s interesting. Yeah. So actually it’s, interesting. So many people did ask, could it be longer than a year? So, you know, if it’s not just within a year, but to be honest, when you look at human healthcare, there’s sort of an estimated amount of patient safety events to expect per say number of people in a hospital.
And essentially what you expect is one to three events per associate per year. So if you think of it, you have a hundred people in a hospital, you should be seen at least 300 events. And what they know from the numbers in human healthcare is that probably, even though this is a. You know, it’s actually a huge source of, you know, the way people die actually in human health care.
There is actually probably only about 40 percent of all patient safety events are reported in human health care. So there’s a huge room from a culture perspective to really increase that. And so that’s, yeah, it’s a, it’s a really interesting statistic, but it is, I think what happens though, if you think about it, there’s several different kinds of patient safety events.
And this is, what I, think it’s interesting when people start to learn we always remember the sort of the tougher events the ones that impacted a patient and those do tend to stand out. But there is a whole category called near misses in this patient safety science field where what that means is say I’m in a busy environment.
I pull up a medication for a patient I pull up a huge dose and I’m not thinking and I walk towards the patient’s cage and I’m like, you know what? This is this dose is way too big for a cat and I go back And I basically am like, okay, you know, and then I figure out the right dose. Well, no event actually happened.
That’s called a near miss. And that’s a hugely critical category because what we actually find is that the near miss category that they have the same, very similar root cause analysis to, you know, basically patients hit the events that are in more serious category. So we can learn a lot from this near miss category that actually never impacted a patient or happened.
You know, and the idea is to learn kind of the nuances of what caused it to happen so that we can prevent future events. So,
Dr. Andy Roark: Rochelle, unpack these categories for me a little bit more. you’ve got your, so your near misses. How else do you look at patient safety events? How do you break those apart in your mind?
Dr. Rochelle Low: Yeah, so the way I break it apart is so you have a near miss category sort of, you know, and then the next one is a minor event. So something that, you know, maybe that is maybe we give the wrong medication, but the medication is harmless that we give. So we give Cerenia maybe as an example instead of Convenia.
Those are two drugs that are commonly mixed up. Probably not a huge impact on a patient. So that’s a minor event. A more serious event would be that we actually, you know, say we’re doing a dental procedure and we inadvertently fracture the jaw of a pet because there’s multiple reasons. It could be patient factors.
It could be technique factors. And then the larger category is sort of, or not a larger category, but the top category is kind of unexpected deaths. We did not, this is not a critical patient. We, Did not expect to lose that patient say under anesthesia and then really trying to unpack why that happened.
So that’s sort of the way that are we’ve just created this global patient safety event reporting system. And that’s the way our system is set up. And we’ve been collecting data now for a couple of years in that system.
Dr. Andy Roark: Talk to me a bit about reporting. So that was something that you, you sort of dug into in the research a little bit was, you know, you looked at different roles and sort of said how likely was this person to report up the chain if they experienced an event things like that.
What’s your general impression of how good a job we do in the vet field? You talked a little bit about human medicine. What’s your impression of how good a job of we, of reporting we do?
Dr. Rochelle Low: I guess I think we have a lot of room to improve in that area. And really, honestly, the reason is, so when I, when I speak about this area and I start sharing data the audience is really engaged, so they. People want to do this, but what we don’t have within vet med is actually typically formal systems or expectations even that we’re openly kind of talking about this.
So this is kind of the first big step I think for veterinary medicine is to get to that point where we realize that hey we have a team of people in a very complex environment because health care is considered kind of a high risk field just like the airline industry, the automobile industry, getting that point where our mindset is realizing that and really encouraging people to that
when those things happen, there actually are things because we can learn from them. We really need you to report these things. And so this is actually where that whole concept of psychological safety, which you mentioned in that paper comes out is that. People have to know that they, if they are voluntarily reporting these events, which it is a voluntary system, they have to know that we’re going to get their back when they do report, that they’re not going to be blamed for this, that these things, like what you see, what’s interesting is as you start really looking into the patient safety events.
field, what we see is very similar events continually happening, meaning that they’re repeated by multiple people, meaning that those events not only should be able to be prevented, but that if we just focused on individual blame with a particular event, we’re not going to solve it, you know, make a situation safer for the next person to prevent it.
So that’s really why I think that if Okay. If we talk about it more as a profession, it becomes a standard part of the ways of working within a team. Now we’re going to see our teams really respond. So I don’t think it’s that we’re reluctant at all to do it. I just don’t think the infrastructure is there right now.
Dr. Andy Roark: Yeah. So imagine that, we as a profession continue to lean into this, right? let’s say that good things happen. I’m a perpetual optimist. Ten years from now, Rochelle, like, what is it, what do you think that looks like in private practice? You know, we witness a patient safety event.
we’ve advanced a long way towards building a good, healthy system across our profession to work with things that sort of continue to improve what we do. What would the experience be like interfacing with that system?
Dr. Rochelle Low: I think Yeah, I guess my vision when I think about it, I would love all, you know, when we think of that, it starts at our learning institutions. So all colleges, veterinary schools, veterinary technique, technician schools across the U. S. are actively teaching the sort of nuances of patient safety science of why it’s so important.
And I think really instilling in people that it’s okay to be human, like really instilling that, you know what, you can never, I think sometimes in healthcare, we really strive towards perfection. And that’s not reasonable because we’re human. But what we can strive towards is excellence, and we can learn from those things that aren’t perfect, and that, once we actually grasp that, it’s so much easier for students to come in and, be involved in a healthcare team, you know, I think of myself as an intern or resident, like how somewhat terrifying some of those situations can be, and it really, this is why I think the culture that you’re working in, and leadership, which is sort of mentioned in that paper as well, are so critically important at that time, because if you go, if you experienced your first patient safety event, I, when I lecture, I talk about one particular event that really landed with me because it, it happened to be a patient that it was a serious hit by car patient.
It really was critical. It probably shouldn’t have made it to be honest, but the team did this incredible job to stabilize this patient. And a few days down the road, I made a mistake with the calculation of insulin for that dog and it really impacted him. We did get him through it. So it went really in the end, went really well.
But what I noticed at the time when that happened, I was sort of. I mean, I really was. I was stunned. I didn’t know what to do because nobody had ever talked about this with me. I was right out of my residency program. I started thinking really quickly, like, what can I do to reverse the impacts on the patient?
And then I reached out to our medical director at the time and he came right down. I told him what happened and, you know, he put his arm around me. He said, Rochelle, you know what? These things happen to the best of us. Let’s just go fix it. And right there, I knew, I didn’t know what it was called, I didn’t know that that was a culture of safety or psychological safety, but I knew that it was okay, like I knew that, hey, this isn’t the end of the world, even though this was a dog that everybody adored in the hospital, and the family was amazing, and you know, we’ve all been in those situations but what that leader did that day for me, was basically, not only did he help with the case and made sure that You know, us just getting this dog back on track, but he also gave me guidance and how to completely transparently talk to the dog’s owner.
He, he also honestly checked in on me to see how I was doing. Because you know, these things can take an emotional toll. And so I think when I think of the future and I think about, yes, an element of it, of it is reporting these events. That’s a really important piece. But when I think about that team that I was lucky enough to work within.
The really cool thing is that that environment not only lended itself to you feeling part of a team and supported by that team, but it was hugely a learning environment. I mean, psychological safety has to be there for people to say, Hey, can you help me with this? I’ve only done this procedure once, or, you know, can you look over my shoulder?
And people won’t, if they speak up, if they don’t have a voice and they don’t feel like they can speak up maybe that happened because somebody sort of. You know, didn’t respond well the first time. Well, then people will stay quiet and what that means is that actually now leads to sort of unsafer situations for our patients.
And even sometimes for ourselves. So it’s, yeah, it’s just this area that the more that I get into it. I’m, sort of fascinated by it. But I think that what I really feel is that patient safety event reporting will help our profession, but the bigger thing that will help our profession is developing a culture of safety across the profession.
And so I’m really excited kind of about that opportunity because we haven’t, honestly, we’ve done a lot of looking into health and wellbeing, but we haven’t actually looked into that pressure that medical professionals have on their shoulders to be perfect. And I think that this is the area that is starting to do that.
Dr. Andy Roark: I love that point. I, I’m so, I so agree with that. And also, I really love the story of, of sort of, of your sort of mentor and, and how they responded to that. And, you know, and I think it illustrates so much that’s good about good leadership. And so talk to me here. I think using maybe that story as an illustration. How does your experience there, how does that line up with what you’re finding in the research around, you know, personal resilience and good leadership and sort of what you were getting back in the survey, put those things together for me.
Cause they’re to compare and contrast.
Dr. Rochelle Low: yeah, I think, you know what we’ve been able to do through the survey is what we really wanted to find out is do these events impact people like do they have an unimportant impact because we know they do in human health care, but we don’t have this is one of the first studies in this area in vet med and.
I sort of knew they did because of my history as a leader, but I, I wanted to see it. Right? And so that’s really, that was the first big step is it was very clear that these have kind of a, both a psychological impact, even sometimes a physical impact where when you think about, if you think about a patient safety event, you’ve been through you know, you start to,
it depends on the situation, but you might start to question your abilities as, you know, as a veterinarian, you might not want, what we do see is if something happens during a certain, say procedure, you might want to avoid that procedure in the future. So it’s all these things that actually can lead you to question your, abilities and your skills.
But also those feelings of, you know, we as veterinarians, I think so many people, are so incredibly empathetic that are in this field and so it really impacts you when something negatively might have impacted a patient and it’s the last thing that anyone wants to have happen but you think of feelings of guilt feelings of sort of not being adequate as a provider like there’s so many different things and just the level of stress that these things can cause so that was the first part that in this study that we found like we definitely found that yes so veterinary medicine is impacted by these events as well.
The second piece that we wanted to ask was how, what kinds of support do you think could help you get through these events? And as we just with the specific tools that we use to kind of, to interview people we found that basically the number one type of support is very similar to what they found in human healthcare.
And it is peer support. When you think, you know, we often think that it might be leadership that people immediately go to, but if you think about it When something like this happens, oftentimes we’ll talk to, you know, maybe it’s an intern, maybe it’s a good friend, that’s a veterinarian or a nurse.
And it’s somebody that understands you, somebody that understands what that feeling’s like when something like this happens. And so that was by far the main thing that people thought support wise. But the interesting thing is, and I think this is a difference from, human health care and veterinary health care is the second thing was actually support of a hospital administrator and so I actually think that position in veterinary hospitals is extremely important and it could be you know It could be another leader but just that I described a medical director in a role that came and supported me during this that case somebody that’s, I think, important sort of in, in the leadership infrastructure in a hospital was another, another important level of support.
And as we started to kind of dive into the data, we really found that the kinds of things that helped mitigate the you know, the impact of these events were things like being in a psychologically safe culture. Like you could imagine if in that story, I mentioned if that medical director had said, how, how did you possibly do this?
Rochelle? I was so stupid. Like, what are you rethinking? You can’t do that. That’s just not, well, that’s a very different response than what he actually did. And so feeling that people are, are going to get your back even during those really stressful things is. Makes a huge difference to that impact of that event on you personally.
And so to me, the thing that we found that probably most significant is that is the fact that how can we and I actually think that the two things are very related is strong leadership, transformational leadership and the ability to develop a psychological safety culture within your team. Really were the main things that had an impact on, you know, on the kinds of situations that we asked people.
Dr. Andy Roark: You know, I have always believed that the doctors, experienced doctors telling stories about their mistakes or the hard lessons they learn to younger doctors is just a beautifully healthy, helpful thing. The number of times that doctors who I looked up to said to me, Oh, you know, Oh, I’ve seen this go badly.
This, this happened to me, or, you know, if I’m having a hard day and struggling and they just say, Oh man. I’ve had some, I’ve had days like that. That, that means a lot. There was an internist named Dr. Mikey Share at University of Florida. Everybody called him Uncle Mikey, but he would talk about his pile of bones.
And I remember as a student being so impacted by that. I was like, this guy is a, you know, he’s an icon. he’s written a textbook and he talks about his pile of bones. And I always, I said that to him after I graduated. I was like, Hey, look, that really. I really appreciate that you did that. Looking back now and going, even as a young vet, I was like, boy, the absolute best people make mistakes and have problems.
And that was just illustrated for me. So I really love that. Rochelle, I think, one of the things I want to ask you about here is, you know, when we say the support of the hospital administrator means a lot, and I think you really illustrated this in almost the best possible aspects in your story, but if I’m a hospital administrator, if I’m a medical director, if I’m, you know, a hospital manager independent practice owner, something like that.
I want to be that supportive person, you know, for my vets. what kind of advice would you give to someone in that role to, to help them maybe to start to plan a little bit, or just to be prepared to support a doctor or a technician that’s, responding to sort of a patient safety event?
Dr. Rochelle Low: Yeah, I think, you know, it’s interesting, but I think the number one thing you really want to try to do is put yourself in their shoes as opposed to kind of getting too quickly forward to try to start just fixing the event. So you really want to think about like it’s easy for me to come in if somebody calls me and says hey Can you look at this patient safety event and tell me what you think the root causes were and things like that and I can Start to give my opinion, but I wasn’t there I wasn’t there on that overnight with lots of cases lined up at the door or you know minimally staffed or we had somebody call out all the different sort of things that actually create the environment that lead to these things, not the only thing that leads to them.
But I think really the best thing, honestly, that any leader can do, and it doesn’t even have to be a person that’s in a formal leadership role. We all know of people that don’t have a leadership role, but everybody follows them. And those are critical people in this kind of a trying to develop this kind of a culture.
And really, when you think about those people, they tend to, be really good listeners and they just tend to be really genuine. Like they just treat people really well regardless of the situation. So even if it’s a, very stressful situation with a client or a very stressful situation with a patient safety event they are still going to be even keeled and supportive.
And that is kind of the way that I would, for any leader, I would suggest listening to the last thing you really want. If you’re telling somebody that, hey, this patient safety event happened is kind of like a huge sense of urgency and kind of stress and really trying to, have that kind of approach where people realize that, hey, you’re listening you care about them and you’re going to support them to get through this.
That is sort of the way that I would look at it.
Dr. Andy Roark: That’s fantastic. That’s really beautiful. Dr. Rochelle Low, thank you so much for being here. Thanks for talking through this with me. If people are, are, if they’re interested in this, I mean, I think this is fascinating. Where can people find you online? Where can they kind of keep up with what you’re doing?
Dr. Rochelle Low: Yeah, so I think probably the best place is just to look on LinkedIn. So I recently gave a lecture somewhere and had a few people reach out via LinkedIn and yeah, happy to chat, happy to share any data or I’d love to listen to people actually as well.
Dr. Andy Roark: Thank you so much. Guys, I’ll put a link in the in the show notes. Rochelle, thank you for being here. Gang, thanks for tuning in to listen, everybody. Take care of yourselves.
And that’s what I got. Guys, I hope you enjoyed it. Thanks to Dr. Rochelle Low for being here. Thanks to you for being here. This gave me just a ton to think about. Guys, be kind to each other. Let’s just, let’s empathize. Let’s, let’s see each other as humans. let’s address the human first and then figure out how we’re going to fix the problem.
We can do both of those things in pretty short order. But I think putting the human first, I think it matters. Anyway, team, take care. I’ll talk to you guys later. Bye.
