One of the most successful aspects of the aviation safety model is that we, as a culture, have learned how to learn from our mistakes.  I was recently invited to speak to a couple of healthcare / patient safety audiences where I was warned by one of my hosts that when it came to learning from mistakes, the culture here was very much of a “blame, shame and punish” nature.  This was a culture that did not like to admit, much less discuss their shortcomings.

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Audience Polling Keypad

Inspired by Dr. Marty Makary, author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, I have recently started using an audience polling system as part of my “training arsenal”.

This device allows the user to gather data on how respondents truthfully feel about a subject without the encumbrances of – well, for lack of a better word – accountability.  Respondents have the cloak of anonymity, so they can truthfully answer a question without fear of their boss knowing how that particular individual might feel – unless of course, the answers are nearly unanimous, in which case, the boss has just been sent a very powerful message!

In the above-mentioned presentations, I incorporated this system and directed a number of questions toward audience perceptions of teamwork, communication and transparency.  The results were rather surprising to me: Perceptions of Communication and Teamwork indicated that at least half of the participants either disagreed or strongly disagreed with statements affirming the effectiveness of their own communication and teamwork culture.

Regarding transparency, in spite of what I had been told about the “blame, shame and punish” culture that existed, respondents appeared to feel “safe” in voicing their concerns.

However, when asked if they were confident that their safety concerns would actually be acted upon, 60% indicated that their concerns would not.  The actual audit question was:

Confidence that concerns will be acted upon
Confidence That My Concerns Will be Acted Upon

If I report a problem, I am confident that it will get acted upon:

  1. A.     Strongly Disagree
  2. B.     Disagree
  3. C.     Neutral
  4. D.    Agree
  5. E.     Strongly Agree

What this tells me is that the perception of the majority of respondents was that their concerns pretty much fall on deaf ears.  Only ¼ of respondents felt that their concerns would be acted upon.  That may not be the reality, but if 60% of your team feels that no action will actually result, might it be fair to assume that many may hesitate to bring up safety concerns because they are just wasting their time.

So to all you “Chiefs” out there – Chief of Medicine, Chief of Nursing, Chief of Surgery, etc –  the lesson here is that not only is it crucially important to seek input from those on the front lines, but to show those people that you are “listening” by providing feedback and taking appropriate action.