SAfety MAtters

From their website

Brigham and Women’s Hospital is dedicated to providing the safest, highest quality care to every patient we serve. Part of our commitment to safety includes telling our stories about mistakes we have made, what we have learned from them and the improvements we are making as a result.

Our goal is simple: By telling these stories, we hope to show everyone that, while improving care is not easy, we are absolutely committed to transparency, to learning from our mistakes and to continuous improvement.

Each story that we share is accompanied by a Just Culture corner. To achieve our goal of learning from mistakes, we know that staff must feel safe and supported in speaking up about making a mistake. Just Culture ensures that we treat staff fairly, that we support each other and take the opportunity to provide education and fix our systems when a mistake occurs.

Let’s make their blog super popular!!

Great list of simple tools to use to make improvements

http://www.institute.nhs.uk/option,com_quality_and_service_improvement_tools/Itemid,5015.html

There are some interesting leadership behaviors that can occur in an unsupportive workplace environment. When a leader gets frustrated with lack of progress on an initiative or overall group day to day performance they can attempt to regain control by exerting power (kind of like parenting?  “because I am your mother thats why!”).

There is a theory of how employees repond to this (Sims, 2010):

1. Leader Display of Power
2. Employee becomes frustrated… might product feelings of threats to autonomy/social identity and feelings of injustice
3. Two options:

1) Employee accepts this

2) Employee rejects the display of power by:

1. a) displaying exit behaviors which can be physical or emotional (eg. leave the group or physically stay but become disengaged).
2. b) using the employee voice: which is productive if its internal and listened to and used to find a better solution or non-productive if the voice is ignored or used outside of the group to bad mouth the leader or the group in general

A group who perceives this cycle to be repeating over and over(even if its not true), eventually may adopt a deviant culture where negative organizational behaviors become the norm.  When this happens even internally motivated, self-regulated individuals can conform to socialization.  In general, people need to feel a sense of equity: that the reward they get from work matches the effort they put out (Henle, 2005). Rewards are more than just money. They can be respect, acknowledgement, educational opportunities, a good schedule, gratitude from patients/customers, etc…In times of budget restriction, the rewards for employees are usually reduced and the work demands are increased, thus creating a potentially harmful mismatch.

One of the mediators of workplace deviance is interactional justice.  In a leader this would mean treating all with sensitivity, dignity and respect and giving adequate explanations for decisions made AND taking ownership for decisions made. Staff experience more frustration if they feel their leader does not agree with an organizational decision but is powerless to fix it. Senior leadership has an obligation to give their middle managers adequate explanations and a list of talking points to help disseminate the information. If the decision does not have a valid explanation maybe it is not the right decision!  There are many psychological biases inherent in leadership decision-making that can compromise effective operational strategy.

Another mediator of workplace deviance is to have leader and employee goals that match.  It is important to understand employee workplace goals. A good leader will help the employee discover how their goals can align with the organizational goals or in a case where there might be a poor fit and the goals do not align, coach the employee to seek an alternate environment.

Those employees whose goals do align can be used to create positive deviance within the group.  Involve them in projects that fit with their goals. Eventually the norms of the group will change and become more aligned with the organizational goals creating benefit for the organization and engagement in the employees.