No one in healthcare harms patients. If one were to ask anyone, they would say, "It is not me.” Everyone is right. It is not about blaming oneself, but it is about us! It is not singular. It is plural. We are harming patients.
One in 4 patients are harmed (Auraaen, Slawomirski & Klazinga). Everyone in healthcare knows the number. Everyone knows that it is a lottery no patient wants to win. However, patients are buying a ticket every time they are admitted into a hospital. It is up to everyone to change the odds.
Culture plays a big part in that change. In 2010, a study out of the journal of Nursing Scholarship outlined the subcultures of safety. The two subcultures were 1) being just and 2) teamwork (Sammer et al.). Teamwork was outlined as safe, respectful, open, and flexible relationships. It was about being a team; knowing others were there and willing to help. Being 'just' was about looking at failures as part of a system and not the fault of one person. It was about being accountable.
'Being just' is a significant barrier to a culture of safety. Failures, fault, and accountability often go hand in hand with judgment. Judgment is something no one wants, as it usually comes with punishments. Studies show that judgment and punishment can even hurt the psychological safety of staff. In a study on team performance, Google found that the best performing teams were teams not punished for mistakes (2019). Not punishing mistakes flies in the face of traditional management practices.
Traditional management practices are simple: encourage employees not to make mistakes, and employees who do make mistakes should be corrected. It is simple, but people are complicated. Management practices in healthcare are not meant to solve complex problems.
Most management practices are based on principles developed during the 1950s. These management practices focus on positive and negative reinforcement. Think B.F. Skinner and his rodents. Despite the similarity in DNA, people are more complex than rodents.
Administrators and leaders in healthcare need to acknowledge the human complexity of healthcare. Accepting human complexity is a paradigm shift. In the book Drive, Daniel Pink outlines a new paradigm for management practices. The model defines it as motivation 3.0. Pink diverges from traditional management practices of positive and negative reinforcement (Pink). Pink’s model proposes empowering employees and accepting the complex nature of humans.
Accepting human complexity also means the deferral of judgment. Deferral of judgment is part of Being just and allows teams to improve from mistakes, not fear them. The emerging problem-solving processes of agile and design thinking list the deferral of judgment as being a critical aspect of creating solutions (Roschelle & Teasley). When leaders defer judgment, staff become collaborators in the problem-solving process. The collaboration develops group problem-solving, where everyone is a part of the solution.
No one harms patients, but everyone prevents them from being harmed. Everyone needs to give patients better odds.
Auraaen, A., Slawomirski, L., & Klazinga, N. (2018). The economics of patient safety in primary and ambulatory care. http://www.oecd.org/health/health-systems/The-Economics-of-Patient-Safety-in-Primary-and-Ambulatory-Care-April2018.pdf
Pink, D. H. (2011). Drive: The surprising truth about what motivates us. Penguin.
Roschelle, J., & Teasley, S. D. (1995). The construction of shared knowledge in collaborative problem-solving. In Computer-supported collaborative learning (pp. 69-97). Springer, Berlin, Heidelberg.
Sammer, C. E., Lykens, K., Singh, K. P., Mains, D. A., & Lackan, N. A. (2010). What is patient safety culture? A review of the literature. Journal of Nursing Scholarship, 42(2), 156-165.
Google (2019). Re: work Identify dynamics of effective teams, https://rework.withgoogle.com/guides/understanding-team-effectiveness/steps/identify-dynamics-of-effective-teams/