"But, if you don't know how this goes...!" "What are you in for?" "Shut up, you're better!" Expressions like these are common. They modulate the culture of our organizations and, although we do not give them excessive significance, they condition our behaviour. I don't know if it has happened to you, but sometimes we have the feeling that it is better to remain silent than to speak. Sometimes, the fear of being disliked, receiving a bad response, or receiving a reprimand causes us to keep quiet. In the workplace, there are hierarchies, unwritten rules, customs, and group dynamics that determine when and how things are done and what should and should not be said. But this way, the quality of care will never improve and patients will have a higher risk of suffering an adverse event. The culture of the organization contributes to speaking up or shutting up. Individual differences do the rest.
We have been emphasizing for some time the importance of the work environment and the culture of the organization to achieve better results in patient safety. That is why we look for formulas that promote a proactive safety culture, convinced that this is an essential step to tackle system failures and to contain the most frequently repeated errors in time.
The safety culture of institutions is key to tackling letdowns and reducing errors
Due to this situation, in health care organizations, we have recovered the concept of "psychological safety", introduced in 1999 by Amy Edmondson, which is based on the belief that we are better able to face complex challenges when we do so in an environment of mutual respect and trust. Psychological safety is related to how:
- Clinical errors and system failures are addressed.
- Clinical decisions are made in environments of complexity and uncertainty.
- Feelings and worries derived from overload and seeing that "things are not going the way we thought they should be" are managed.
The feeling of psychological safety is key to reducing adverse events
The feeling of psychological security expresses to what extent we feel confident that we can raise and discuss with colleagues how we do things, what we can improve and what we have to change to achieve a better result without fear of rejection, criticism, or sanctions. In short, better care is provided when the members of a team feel integrated, interact freely, share achievements, shortcomings, and problems and talk about all of this "without cutting each other".
One of the essential components of psychological safety is "speaking up," which is defined as the assertive communication of quality and safety concerns to patients to prevent harm and to ensure patients receive the best care possible. It might be expected that this would be the most common among members of care teams, but some data suggest otherwise.
Talking about everything without fear reduces errors and improves the work environment
In a recent study conducted in Austria, 32.3% of the doctors and nurses surveyed said that they usually kept their concerns about patient safety to themselves, and 41.6% that they preferred not to share their ideas for improving quality assistance. A similar study that we are carrying out with students of health disciplines suggests that 59% do not feel capable of speaking out in a critical situation and prefer to remain silent due to the consequences that "sharing their views" may have on their future.
Half of the professionals choose to keep quiet
Since it is obvious that clinical practice has its risks, it is absurd to act as if everything were perfect and that therefore nothing bad, unexpected, or negative could happen. It is still too common that when "things don't go well" we resolve the situation by looking for who is to blame (normally, the last one to "be with the patient"). But this way we don't improve anything and, on the contrary, the rest of the team learns that it is best to hide the problems and look the other way. The proactive safety culture we aspire to suggests that when an error occurs, the team should first repair the damage if it exists, then analyse its causes and look for ways to prevent similar incidents in the future. That is, go from the red traffic light area to the green traffic light area in the attached diagram. This, which seems simple, is complicated in the reality of everyday life.
Identifying and overcoming the barriers that prevent sharing concerns and proposals to achieve optimal quality must be a commitment of managers, middle managers, and all professionals. The available data do not allow us to doubt this.
In this health crisis caused by the new coronavirus, there has been a growing concern since its inception about how to support the teams so that they would be able to cope with the workload that caring for COVID-19 patients was assuming. And in this case, we have been able to observe that the response to the challenges posed by the pandemic has been more efficient in institutions where the organizational culture and managers have facilitated working in multidisciplinary teams and an environment open to debate before making organizational and clinical decisions. Leadership, multidisciplinary and psychological safety (with its key component of speaking out and without fear) have been fundamental during the pandemic and are daily to achieve a safer environment for patients.
Lessons from the pandemic: leadership, team and finding solutions together
There are no easy solutions, but we have learned some lessons and it may be a good time to apply them. Formulas are being sought to motivate professionals again after the pandemic hit, and for this, some simple recipes could be put into practice: listen to what professionals have to say, share information with them, involve them in decisions and create a suitable atmosphere to talk about how to deal with problems and improve what we do, because professionals continue to be key elements to achieve it.
No comments:
Post a Comment