Learning vs Punishment & Accountability & alittle EBMgt

In hospital, Patient Safety, Resiliency on December 18, 2010 at 9:14 am

I cringe whenever I start hearing the words “employee accountability” for traditionally this refers to a way to blame individuals rather than have a management team or organization take responsibly for the conditions under which an employee has to do their job. Employees must have autonomy to have accountability..strict adherence to scripting or hospital polices is not the definition of accountability. In fact, when a union wants to slow down production in an organization, one tactic is to advise workers to “follow policy to the letter.”
I am constantly searching for blogs who say this in different ways to make the case for this concept as far reaching as possible. These are words from a blog by Jeffrey Pfeffer who an Evidenced Based Management Proponent. He makes… the case as does Col Casey Haskins from the military that standardization is important in that it simplifies processes. But to hold people accountable, they must be given outcomes, and guidelines in which to achieve those outcomes. Only then will you meet consistent outcomes that are personalized for work areas and have the potential for innovation. If you just employ a standard method that all employees throughout an organization use, all you will get is …the standard, not exception and therefore not exceptional performance. I will post more on the military’s Outcomes Based Training and Education program at another time. The gist of it comes from answering the question: do you want modern soldiers who have a bunch of protocols memorized or do you want modern soldiers who have internalized principles of behavior and critical thinking skills that allow them to be successful in unknown conditions? Wouldn’t the same approach assist healthcare professions as we charge into an unknown future? Clinical decisions and management decisions in healthcare should be evidence based. We can use other industries to gather that evidence when there is none in our own. But Evidence must guide who we look to for what especially when it is so easy to copy “best practices” from other institutions that may be truly limited in scope. There are always side effects to every intervention to the body and to the organization. Some of these are good, some are bad, some are obvious and some are not easily detected.

Here are Jeffrey Pfeffer’s top 5 Elements of EBM:
1.Face the hard facts, and build a culture in which people are encouraged to tell the truth, even if it is unpleasant.
2.Be committed to “fact based” decision making — which means being committed to getting the best evidence and using it to guide actions.
3.Treat your organization as an unfinished prototype — encourage experimentation and learning by doing.
4.Look for the risks and drawbacks in what people recommend — even the best medicine has side effects.
5.Avoid basing decisions on untested but strongly held beliefs, what you have done in the past, or on uncritical “benchmarking” of what winners do.

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