The Golden Hour

“There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later, but something has happened in your body that is irreparable.” – Dr. R Adams Cowley

The R Adams Cowley Shock Trauma Center is a free standing trauma hospital in Baltimore, MD and is part of the University of Maryland Medical Center.  Founded by R Adams Cowley, it was the first facility in the world to treat shock and now admits over 7,500 critically injured patients per year.  More amazingly, while many of the patients are near death when arriving at the center, more 97% of the 7,700 patients seen last year survived.

At the core of the center’s success is the shared belief that they can save every patient.  This almost obsessive pursuit of an “impossible” goal connects the team to a larger purpose and creates a never give up attitude in each member of the staff.  However, a never give up attitude alone is not enough to generate the trauma center’s impressive results.  Many organizations create inspiring visions and believe they are capable of accomplishing great things.  What they lack is a work environment structured to allow each individual to translate the vision into actionable daily events through simple, repeatable processes.

The mechanism the trauma center uses to create of this type of environment is the concept of the “Golden Hour.”  The golden hour refers to the sixty minute window after people are critically injured when what happens will determine whether they survive and what the quality of their lives will be.  This concept drives everything the center does and has guided each decision about how the center will manage the flow of patients and information, what equipment and technology will be used, and the make up and training of the staff.

So what does the concept of the golden hour have to do with continuous improvement?  Everything.  At the heart of continuous improvement is creating an environment where each individual identifies and solves problems.  Like a patient, what happens in the first 60 minutes after a problem has occurred dictates whether the problem is effectively solved as well as the quality of the new process going forward.  Unlike the trauma center however, few organizations create daily processes to ensure that each problem is identified, understood and solved during this critical window.

To effectively create an environment with daily problem solving at its core, management should take away three lessons from the trauma center.  First, it is critical to set expectations for each process so that there is a shared understanding of what constitutes a problem.  Second, we need to create systems which allow everyone to see problems in real time.  Finally, through a combination of an inspiring vision and effective training, we must provide the motivation and skills to solve problems in real time.


6 responses to “The Golden Hour

  1. Hi Michael,

    Great post!

    I stumbled upon your blog and 100% agree! Irrespective of the type of organization there is an opportunity to setup systems to identify problems, highlight work and ways to improve along the way.


    • Thanks Ron for your comment…ironically, I was just introduced to your company. How do you at Rypple organize your work to identify problems and engage people to solve them everyday? Would love to get your perspective. Mike

  2. Hi Michael,
    Thanks for the reply. I just got off the phone with Kristin and am excited that you’re giving us a try! We’re leveraging social behaviors to drive employee engagement and problem solve. Not rocket science by any stretch but better leverage existing tools and amplify their benefit at work. Would love to chat and can be reached at or 416 480 6493. Cheers, Ron.

  3. Hi Michael,
    Good question! I’m a community coach at Rypple and work our clients to: get them started, learn how to use Rypple in their environments, ensure they are successful and share tips/tricks about the service. Organizing against problems can be mitigated by having employees who are aligned, engaged, and motivated. Thoughts? (100% anonymous feedback)

    • The goal is not to organize against problems. Rather, our goal is to organize to expose problems in real time. Problems are merely gaps between what we expect to happen and what actually happens, which we create through aggressive goals, visual systems, and an engaged workforce. Thanks for your thoughts…

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