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     The Elephants, the Prophets, and the MIAs

    
     The Elephants are the excuses that defeat quality and safety initiatives. Sometimes they are voiced; more often they are the "elephants in the room" that no one wants to acknowledge, yet they are ever present. The Prophets are the safety leaders who are energized by national meetings and the evidence for impact, yet when they return home they meet a huge wall of resistance. They are "prophets who have no honor in their own country" who need actionable concepts, tools, and resources to drive change. The MIAs are the "missing in action" – those people and hospitals who are missing at national safety meetings and not participating in national performance improvement programs. They need to see the reality that demands action. They need clear opportunities to join the quality movement before they are left behind.     


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