When the Elf Becomes a Reminder

It’s that magical (and slightly chaotic) time of year again, when the Gopalakrishnan household is deep in the throes of Elf on the Shelf season.

For us, this isn’t a one-elf operation anymore. We now have a full entourage: two elves, a pair of reindeer, two Saint Bernards, four elf babies, and even a miniature gumball machine. Each morning, they’re supposed to appear somewhere new and exciting. And each night, my wife and I are supposed to remember to make that happen.

When we first started this tradition with our oldest kids, it was exciting. A joyful little challenge. But years later (across a kid age range that now spans from college to elementary school), I’ll admit, it’s become a bit… routine. Some nights, I forget. Some mornings, I scramble. (And yes, I’ve wished more than once for a timeout to remember the elves!)

It struck me recently that this is exactly what can happen in healthcare, too.

At the start of our careers, the small details (the ones that keep patients safe) are drilled into us and feel urgent. Check the ID band. Label the specimen. Pause for the timeout. These steps are new, meaningful, and deeply important. But over time, they can feel mundane. Routine. Easy to overlook when we're moving fast.

That’s why the concept of “preoccupation with failure” in high-reliability organizations is so powerful. It’s not about being fearful. It’s about being vigilant on purpose. It’s why we have timeouts in the OR, checklists in the ED, and safety rounds throughout the hospital. These practices catch what memory alone can’t. Because in healthcare, missing a small step can have big consequences.  

Our goal of zero harm isn’t about chasing perfection. It’s about committing to the process, even when it feels routine. Especially when it feels routine.

So yes, I’ll keep scrambling for elf placements and hoping for a little seasonal magic. But more importantly, I’ll keep appreciating the magic that happens here at GBMC every day... when teams slow down, speak up, and stay committed to the small steps that make a big difference.

Here’s to the elves, to checklists, to timeouts, and to every moment of intention that brings us closer to zero harm.

COMMENTS

**Jenn Anderson commented on 12/12/25 at 07:08:**
I absolutely love this write up! It's so relatable! Well done :)

    **Dr. Gopalakrishnan replied:**
    Thank you Jenn. Happy Holidays!

**Melissa Graczyk commented on 12/9/25 at 18:10:**
I love the reminder! Thank you. I also love the term about being "vigilant on purpose."

If you ever need an idea for el(ves) on the shel(ves)... we love urinals and bed pans. Its always a good laugh!

Happy Holidays!

    **Dr. Gopalakrishnan replied:**
    Thanks Melissa. Happy Holidays!

**Savannah Dunivant commented on 12/9/25 at 07:44:**
Hi Dr. G! Your blogs have sincerely become something I look forward to reading each week. Thank you so much for taking the time to share your thoughts and connect with us. Happy Holidays!

    **Dr. Gopalakrishnan replied:**
     Thank you Savannah. Happy Holidays to you and your family!