“There is no power for change greater than a community discovering what it cares about.” Margaret Wheatley
Patient safety may look to be the current fad or focus for the next accreditation cycle but it is more than a new manual or a report to boost our competitive position. It is the heart of what we do. It is the duty we have to those who are in need of our help. It is the minimum we can provide and the optimum we can achieve. Patient safety represents nothing less than our integrity- our bond of trust with each patient and family member who arrives through our doors. To truly achieve a safe environment, we must take the time to have conversations that matter.
Creating a culture of safety will require that we follow four principles. We will need to incorporate these four principles into all of our activities both as individuals and collectively in our health care organizations. The first task we must undertake is to be present. We need to find a way to be present in the moment and be aware of our environment. We cannot recognize system deficiencies if we are no longer looking at the space in which we are working. To be present means that we have to get outside of our heads and pay attention to where we are. We have to look and listen and feel the space we are in and become aware of the others who share that space. We must find ways to quiet the noise in our heads so that we can hear our intuitive voice and act on the gut feelings that drive us in the right direction.
The second principle is to listen. We must learn to listen with an open mind. We need to create a space where there is respect for each other’s story. We cannot create a safe environment for patients until we create a safe environment for sharing our stories. We must listen fully- not just to the information but to the context it is delivered in. We must listen without judgment and encourage disclosure. We must spend time assessing situations before diagnosing what is wrong or who is to blame. We will need to find ways for stories to be told without fear of retribution or retaliation. We will need to look for the theme of each story rather than bicker about the truth of the facts or deflect the message in an effort to diminish the storyteller.
Our third task is to solve the problem together. We must find ways to collaborate and foster consensus. We will need to provide the staff and clinicians with skills for negotiating their environments. We will need to encourage them to look for ways to communicate their concerns, to share their ideas, to collaborate and not compete. We will need to remove barriers that keep them from collaborating. These barriers include conflicting policies, unnecessary hierarchies, perpetual rivalries, and misuse of resources. We will need to give them skills in listening, openness, mutuality, and acceptance. We will need to give them a safe space to be creative and to take risks that can lead to transformation of ineffective processes. We will need to be there with them when there are errors or unanticipated outcomes and model integrity and forgiveness.
To solve the problems together, we will need to implement processes that enable collaboration and consensus. We must have alternatives to power-based models that rely on a small group or a single authority to determine all outcomes. We must encourage appreciative inquiry, and dialogue, and mediation, and facilitation to find out what works and to encourage and propagate the positive things we do rather than debate over who is liable for what went wrong. We will need to move away from use of policies for explaining our actions and toward the use of processes for understanding each others’ needs. We will need to have conversations that matter, conversations that reveal what we care about as a health care community. Conversations that are meaningful, that address difficult issues, and that incorporate civility and respect.
The fourth principle is to find ways to make the other person look good. We need ways to encourage support of each other and not enable those who would tear down others for personal gain. We will have to demonstrate the benefits of making the other clinician, the other department, and the other division look good. We will have to find ways to help others save face when they are embarrassed, to feel supported when they have made a mistake, to feel acknowledged when they have a great idea.
In order for us to create this safe environment for healing, we are going to have to make some difficult choices. We are going to have to choose to put the welfare of our patients and their families above our need to be right. We have to choose to share information and understand causes over our desire to manipulate data and place blame. We will need a culture that understands that reflection is the opposite of blame and encourage reflective practice. We will need to choose to listen to those who come forward regardless of the message they bring. We will need to choose to listen to the tone of our environment and recognize that silence is more dangerous than dissent. We will need to listen to the voice inside of each of us that says we should do what is right, not what we have a right to do.
Through the incorporation of these four principles, we can create healing environments that keep our patients safe and allow our clinicians to excel. If we choose to be present, to listen with an open mind, to solve the problems together, and to make the other person look good then we choose to return hope to the health care environment. It is through that hope that we will find the resources for solving the difficult problems that arrive at our doors each day. It is through hope that we can create safer healing environments and restore the joy that comes from working together to care for each other.
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