A culture of fear permeates the healthcare system

The culture of fear that led to dozens of fatal plane crashes in Korea, the molestation of young boys at Penn State University, and the tens of thousands of deaths of patients in our health care system are all a consequence of unresolved organizational conflict arising from a culture a fear. Unless, we replace fear with trust, conflict won’t be resolved.

In Korean culture, questioning authority is unacceptable and led to a culture of fear in the airline industry. We’re talking about fear of humiliation and retaliation. This culture of fear led to tragic airline mishaps due to pilot error; the co-pilot could never question the pilot. Finally, early this century the system has changed to one of trust and there has not been any further incidents. Building team work and collaboration instead of retaliation.

We all know what happened last week at Penn State. A culture of fear over upsetting Joe Paterno and his football kingdom ruined the lives of who knows how many children and may financially ruin the university.

The same culture of fear infects our healthcare system. The CEO could do no wrong at Parkland Hospital in Dallas until an investigation published by the Dallas Morning News exposed the hospitals’ callous disregard for patient safety. However, attitudes didn’t change until Medicare took over the daily operations at the hospital and threatened to relieve Parkland from its Medicare privileges. The arrogance displayed by Parkland leadership nearly took down this major hospital. It is still not certain how this will turn out.

Until the role of organizational culture in conflict is fully addressed, we will continue to have nurses abandon the profession and unacceptable levels of medical errors. The culture of fear that permeates the healthcare system effectively blocks open communication and collaboration that is necessary to resolve conflict and provide the safe working environment necessary for quality healthcare. Rather than learning from medical mistakes and resolving conflict, healthcare managers and leaders, like those at Parkland, place blame for errors squarely on doctors’ and nurses’ shoulders. Fear of litigation, blame, accusations of incompetence, and retaliation creates unresolved conflict throughout the organization. With unresolved conflict, mistrust persists, anxiety grows, conflict escalates and mistakes escalate, creating an unsafe, hostile environment.

Change must start at the top. Healthcare managers and leaders must be willing to change their behavior and work collaboratively with all healthcare workers to minimize the effect conflict has in the workplace. In a new environment of trust, employees will be empowered to openly communicate and collaborate and to learn from mistakes, which will result in a spiral of trust and, as a consequence, better patient care. Without change from the top of the organization, mistrust will persist no matter how many systems designs are implemented.

Jeffrey I. Kreisberg served on the faculty the University of Texas Health Science Center at San Antonio where he was a Professor of Pathology, Medicine, Surgery, Urology, and Molecular Medicine.  He is the author of Taking Control of Your Healthcare. He blogs at Taking Control of Your Healthcare and can be reached on Twitter @kreisberg.

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