The statistics related to medical errors are staggering:
- On average, Americans are treated correctly only 54 percent of the time. (New England Journal
of Medicine study, 2003)
- Approximately 1.16 million patient safety incidents occurred in over 40 million hospitalizations
in the Medicare population alone. (HealthGrades Patient Safety in American Hospitals Study,
- 1 of every 10 patients who died within 90 days of surgery did so because of a preventable
error. (Department of Health & Human Services' Agency for Healthcare Research and Quality
The vast majority of medical errors that are uncovered are preventable. As a result, medical
centers around the country are trying to understand what causes errors and how they can prevent
them. One way to reduce the negative impact of errors is to make sure that help and expertise is
available to frontline employees when they encounter complex patient reactions that are not fully
understood. In addition to being available, however, frontline employees must also perceive that
asking for help is valued and encouraged.
Seeking The Advice Of Others
When individuals are confronted with complex situations, they often prefer to turn to other people
for information and input. Why? It’s only through this interpersonal give-and-take that a more
complete understanding of the situation can emerge. Given this, the question in complex and
dynamic situations is not so much whether individuals will seek others out, but instead, who
individuals will seek out.
Obviously, the organization would want individuals to seek out the person with the greatest
amount of expertise relevant to the situation at hand. But, unfortunately, the reality is that this
often isn’t how it works. Sometimes resident experts are unavailable. Sometimes they don’t
possess adequate interpersonal skills. And sometimes they make individuals asking for their input
feel incompetent. For these and many other reasons, individuals may be reluctant to seek advice
and input from the most knowledgeable source.
Our research focused on these interpersonal relationships and how they contribute to nurses’
decisions regarding whom to seek out for advice and input. We found that two different types of
- Strong Relationships Create Easy Access. If individuals have strong interpersonal
relationships with experts on the unit, then these relationships enable them to confidently
approach these individuals for input and advice – even if they perceived the experts to be very
busy and somewhat inaccessible. In other words, the interpersonal relationship provides the
nurse entrée into the experts’ inner circle.
- Availability and Willingness Encourage Interaction. If individuals do not have strong
interpersonal relationships with experts on the unit, then they needed a strong signal regarding
the experts’ availability. In other words, if nurses do not know the expert well, then they need a
strong message communicating to them that the expert is both available and willing to help.
Understanding the Impact On Strategic Staffing
This second situation has significant implications for staffing decisions currently being made within
numerous hospitals. Many hospitals have moved to strategic staffing models that increase the
number of contract and float nurses. Because these contract and float nurses are frequently
moving across units (and hospitals), it is difficult for them to develop strong interpersonal
relationships within any given unit. Said differently, they are almost always likely to feel as if they
To help contract and float nurses effectively deal with complex situations and reduce the negative
impact of errors, our research suggests that the organization must send a strong signal that help is
available and that seeking out this help is encouraged. One way that some hospitals have chosen
to do this is by designating a formal consulting role within the unit. Individuals are chosen for this
role based on their experience and expertise. Essentially, these professionals spend part of each
shift as on-unit consultants and answer questions.
By defining helping and mentoring as part of an individual’s role, the organization signals to others
that this person has relevant knowledge and expertise, and that they are available to provide
advice and input. It becomes their job to help others and this is communicated clearly on the unit –
particularly to the contract and float nurses. This signal, in turn, opens up the communication and
increases the likelihood that nurses will seek out the advice and input they need to help diagnose
and understand complex situations.
A Climate of Help Seeking
In addition to signaling that help is available, organizations must also ensure that the broader
cultural norms communicate that seeking this help is valued and that individuals can seek out this
help without fear of retribution, getting in trouble, or being made to feel as though they lack
Creating a culture that enables people to feel free to admit, “I just did something and I’m not sure
what to do now” without fear of retribution is key. From a managerial standpoint, organizational
leaders need to ask, “Do people in this organization feel safe bringing negative situations or
problems up the chain of command?”
Our research suggests that organizations can undertake several specific and concrete actions to
better manage complex situations and reduce the negative impact of errors.
- Signal that help is available. Organizations must first send strong signals that help is
available, accessible and that it is safe to seek out this help. One way to do this is to
formally designate several individuals on the unit as consultants. These individuals should
be selected based on both their interpersonal skills and their expertise. Several of their
other job demands would need to be reduced in order to provide them the time to help
- Perform a cultural audit. Organizations need to evaluate the culture of the organization
periodically. Can people raise questions and concerns to managers and supervisors and get
the help they need? What is happening that signals it’s not acceptable or allowed to ask for
help? If managers find themselves often asking their subordinates, “Why didn’t I know
about this sooner”, then the first place they need to look for an answer is in the mirror.
Because for some reason, the managers have created a culture that discourages the upward
communication of negative information.
- Ensure fairness of decision making. Transparent decisions that are based on good data,
provide opportunities for input, and that are consistently applied across individuals are likely
to be perceived as more fair. Similarly, organizations must investigate errors in a fair and
just way. If it’s an honest mistake, then it’s honest mistake, but intentionally violating a
policy is a different matter altogether and is a punishable offense.
- Showcase successes. When a nurse is confronted with a complex situation, seeks out
help, and successfully resolves the issue; make an example of this successful behavior. Post
write-ups of successful responses, those who sought out help and made the situation
correct. This is a way to implicitly communicate the behaviors that are expected, valued,
rewarded and supported.
Beyond the Bedside
Healthcare isn’t the only industry in which errors can garner catastrophic results. Error
management is critical to any organization that’s dealing with complex technologies coupled with negative outcomes and not a lot of time to recover. Healthcare is also not the only industry to
utilize an increasing number of contract workers to manage fluctuations in demand.
We need look no further than NASA, which experienced significant errors on the Challenger, Hubble
and Columbia missions. There were engineers on the front line who knew things weren’t right, but
their concerns fell on deaf ears. After Columbia, the agency performed a cultural audit and found
that lower-level employees believed that upper management didn’t care about them raising safety
Trying to manage in the small space between a complex event and negative consequence requires
that people find help to resolve problems. By creating a culture of help-seeking, managers can
save a lot of operational time and money, and avoid damage to individual and organizational
David A. Hofmann is associate dean for the MBA Program, academic director of the Leadership
Initiative, and professor of organizational behavior/strategy at UNC’s Kenan-Flagler Business
School, firstname.lastname@example.org or 919-962-7731.