Changing of the Guard

I was thinking today of how people who find quality improvement and patient safety as cornerstones of medical care can convince others to work towards “zero.” Many people think that medical errors are an inevitable part of the system and (to some degree) are either unavoidable or the result of professional incompetence.

I was also reading some materials about the history of Telluride and San Miguel County, which (interestingly, enough) houses the two oldest hydroelectric plants in the entire world. Telluride was at the forefront of mining technology as companies extracted zinc, silver, lead, and other minerals from the area.

Telluride has seen, in my opinion, two major shifts throughout its nearly 140-year history. The first was part of the Colorado Labor Wars in the early 1900s that saw the unionization of the mines and fierce–and often violent–battles between miners and mining companies. At certain points, even the national guard was brought in. Secondly, the transition from mining town to “hippy” ski town in the 1950s through the 1980s was a significant culture shift met by much resistance from locals. Though many followed the uranium boom to Moab, UT, several locals remained and were concerned about the new influx of hippies, drugs, and skiers.

If Telluride was able to ride through economic situations using innovation and compromise, medicine should be able to do the same. It took visionaries like L.L. Nunn and Joseph T. Zoline to lead Telluride into new eras of technology and a new foundation for the economy. In medicine, it will take similar leaders and probably a significant amount of time to induce a paradigm shift in the culture, but we can hope that soon all providers can recognize the importance of “getting to zero.”

For more information on Colorado history, visit or one of the many state and regional museums.