You’ve have probably heard stories about wrong-side
surgeries, where patients wake up and wonder why the bandage is on the wrong
side ;) I was very interested in how
Beth Israel Deaconess handled this 5 years ago, when then-CEO Paul Levy wrote
about it in his blog, Running
a Hospital. Now I’m enjoying his new
book, Goal Play, in which he connects leadership to lessons from the
soccer field! Levy talks about creating organizational
cultures that “learn from mistakes”, which I think was a highlight of his
tenure at Beth Israel. There was a
highly-publicized surgery mistake in his hospital, and the administration was
very open about what happened. They did
not fire or punish the surgeon. When
challenged about that, Levy maintained that if you want people to disclose
errors in the future, you can’t respond in a punitive manner. Hence a learning organization – they were
creating the conditions for people to be able to disclose and learn from their
errors. There were also other measures
and tools that they implemented to improve the way people worked together.
One popular tool is a checklist, which was highlighted in Atul
Gawande’s book, Checklist Manifesto.
I’ve
been a fan of his since before he became famous. :) He urges OR doctors to go over checklist of
questions before every surgery in order to reduce errors. Health care borrowed this from the aviation
industry, which also uses checklists. The characteristics that both industries
share is a hierarchy with a chief at the top – the pilot or the doctor, wherein
the rest of the team defers to the chief, who may lead them down the wrong path
– to a wrong-side surgery or to fly into a mountain. The airline industry created CRM, crew resource management, to help crews
have conversations that will help them prevent errors. CRM includes 3 steps: state the facts; verbally challenge the
captain; take an action that impedes the ability of the captain to make a fatal
error.
The problem with CRM is that staff who are used to deferring
to the chief, who is seen to have the ultimate power, are reluctant to raise
questions or to provide negative information that would question a leader’s
decision. What teams need is time to
practice the skills of speaking up, to break their habit of keeping silent, and
to get over their fear, well in advance of stepping into an Operating room or a
cockpit. There is an important role here for us to play: to coach leaders on the need to be open to
receiving this feedback and to not punish people for giving feedback – as well
as coaching the team and the leader on how to give feedback to one another, in
a respectful way that isn’t blaming or humiliating. The ideal would be for us to help leaders
create working cultures where people invite feedback. As facilitators we are used to asking for
feedback when we facilitate groups, and hopefully it’s a skill we practice with
our clients. When we ask for feedback we
are modeling that which we’re asking leaders to do – which makes our ability to
ask for feedback a real gift to our clients!
Do you have a story of helping a team to give one another
feedback? How did it go?
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