Thursday, February 11, 2010

The Right Words

I've read some fascinating material recently on communicating effectively...which is especially relevant to me at this time: the hospital where I work kicked off 2010 with an organization-wide training on patient safety and medical error reduction. My colleague is directly involved in the committee developing the training, and she has a role in the didactic sessions. "Safety" has become the word she mentions in every meeting, every communication.

By virtue of her involvement, she's become invested in this project. It's the way she now thinks. It's her culture.

Which was the goal of this project at the outset: the organization doesn't just want to discuss safety as a theoretical construct, or a set of routines. They want safety to be the "culture." This is the way we ALL think about our work. The hospital wants everyone, at every level, including patients and their families, to call "time out!" if they think an error may happen. Did you wash your hands? Is that the right pill? Why are you doing another x-ray?

Naturally, there's some push-back. Physicians, especially, have been schooled to be leaders, to take responsibility for the team and make the tough decisions. I know what I'm doing; why do I need to invite another person to give me feedback?

And to expect patients and families to point out errors is another challenge. Hey, these people are physicians and nurses, experts in their field, much more knowledgeable about my illness and treatment than I'll ever be. Plus I'm sitting in bed wearing nothing but a flimsy hospital gown that doesn't even cover me, and you want me to feel empowered?

Since I haven't yet gone through the training, I can't judge its effectiveness, but I wonder: have the trainers really look at what it would take to "change a culture"?

Malcolm Gladwell, in a chapter on airline safety in "Outliers," talks about hierarchy in cultures and how it impacts the ability of one person to give feedback to another. In Asian cultures, where status and experience (and age) are highly respected, it is nearly impossible for a subordinate to give direct constructive criticism to a superior. That would be considered extremely offensive. However, in Australia--remember, this is a former penal colony!--there is hardly any hierarchy. Everyone's a "mate" and it is culturally acceptable to give direct advice to another. So in the cockpit, the first officer in a low hierarchy culture will be more likely to speak up if he or she perceives the pilot is in error...thereby increasing the chance that a mistake can be avoided.

Now to take that to the bedside: hospitals are famous for their hierarchy. Just among physicians there are ranks (watch out for those people with the short white coats), and the MDs are at the top of the food chain relative to the other professional staff. And patients, by virtue of feeling ill and all the emotional vulnerability that accompanies a diagnosis (not to mention the embarrassing wardrobe)feel overwhelmingly inferior. And we want these folks to feel comfortable questioning a fully-dressed professional wielding an icy stethoscope?

Although I love the place that I work, it has its flaws, and among them is the communications it provides to its customers. It's a teaching hospital, it's an academic center, and it wears those robes proudly: why say something in 5 words when a paragraph of explanation is so much more scholarly?

I think my cohort is supposed to be trained in safety culture in the next few months. I'm curious to experience the training. I'll wonder if the messages are short and effective. And what tools we can give families--and staff--to perceive each other as equals, as partners. To be able to ask, "Are you sure you want to do that?" To say "stop" before an error occurs.

Maybe we need a wizard. Because for this to work best, we have to act as if we're in Oz.

G'night, mate!

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