The statistics related to medical errors are staggering:
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.
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 situations emerged:
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 are outsiders.
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.
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 competence.
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.
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 reputations.
By David A. Hofmann, Hugh L. McColl Jr. Distinguished Professor of Leadership and organizational behavior