How we need to take risk to reduce risk in hospitals

The show-stopping line from the Hans Christian Anderson’s 1837 fairytale is actually, “But he has nothing on!”

A brave, young, clear thinking boy in the crowd is the only person confident enough to say what he thinks and speak up. Perhaps even more simply, the young voice in the crowd has not had the life experience that often builds (and rewards) the filters of loyalty, flattery and only saying and thinking what we think others want to hear.

The story resonates so much that it has been re-told and re-written in as many different languages as cultures. In Denmark it was The Emperor’s New Clothes, in Sri Lanka it was crafted into The Invisible Silk Robe, in Turkey the story is told as The King’s New Turban, in India, as The King and the Clever Girl and in my homeland, England, we grew up with The Miller and The Golden Thumb.

The languages, settings and details differ; the moral remains the same and is well known, that we shouldn’t believe everything we’re told, especially if the evidence doesn’t support the claim.

Some will tell us that an additional lesson was about making a fool and mockery of the Emperor, but, in fact, he clearly does that to himself. He was a fool for not believing what he knew to be true, which can lead us to conclude that he took his position as Emperor for granted, especially in his belief that as Emperor no one would ever lie to him.

The analogies to our hospitals, departments and clinics are clear and prompt some important questions:

  • Have we created an environment that promotes or inhibits speaking up?
  • Have we become so confident and conceited due to our names and rank that we sometimes don’t acknowledge what we know is true?
  • Are we ignoring what the data is telling us for fear of embarrassment?
  • Are we doing something just because it’s the way the “crowd” does it, or the way we have always done it?
  • Are we willing, as leaders, to take the risks required to speak up and act differently? (to be that little voice in the crowd)
  • What are the risks associated with speaking and acting differently?

By any report, our hospitals, healthcare systems and practices are still unsafe and not as patient and family centered as they could be. As leaders of these organizations we must be willing to take, and reward, the risks associated with speaking up, with acting differently, with finding alternate solutions.

The risk of not doing this is too great – it’s more of the same.

Richard Corder is Assistant Vice President, Business Development, CRICO Strategies.  He can be reached on Twitter @cricoSTRATEGIES.

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  • Steven Reznick

    The JCAHO is the elephant in every room. Hospital boards and medical executive committees do not have the courage and wisdom to say NO when their recommendations make no sense, add to the bureucracy and are not particularly relevant to that local institution. There are fewer and fewer community participants as lay board members or as physicians representing the  community medical staffs in decision making positions as hospital systems look to employ and control everything and everyone. JCAHO continues to justify its own existence by increasing regulations that take care dollars away from the bed side and applied to administration for more people in white coats running around with clipboards checking on compliance rather than providing care. It has been over 30 years of JCAHO domination with the assistance of private insurers and government agencies. Hospitals are less patient friendly and less safe than ever

    • Suki Hoover

      Not all hospitals are going with JCAHO these days.  They can choose Magnet or DNV to be inspected by.  The way around any and all of them is hospitals can cover their weaknesses the days that the inspectors are coming. People in administration today are more ignorant of how a hospital needs to truly run than ever before in my 35+ year career.  Administrators really don’t want people that are knowledgeable in patient care today.  They only want “yes” men/women.  It is so true when people call healthcare today – sickcare.  Nurses and other professionals can do so much more to teach people how to be healthier.  If only we were allowed to function as such. 

      • CRICO Strategies

        Suki – thanks for weighing in. In cases where we have seen the front lines of the care team supported, resourced and celebrated are the times when you get the best outcomes for all.

    • CRICO Strategies

      Many thanks for the comment. I appreciate your position regarding the Joint Commission, although I don’t see them as the bad guys here – not perfect for sure, but not the driver of cultures that make it unsafe to speak up. Hospitals across the country, of all sizes and in various settings, have committed to not tolerating unsafe practices, have adopted safe protocols, have mandated the use of checklists and have implemented other proven mechanisms to reduce error, improve reporting and keep the patient and family at the center of what we do.

      You are on the money to point out that it is the collective responsibilities of boards, medical staff and leadership to drive this effort. In fact, those that are on the same page, have taken the personal accountability for safer care, and are in fact “speaking up”

  • drsharryn

    Couldn’t agree more! There is huge pressure to go with the status quo – and doctors can be own worst enemies here. We are bright innovators but somehow bow to peer pressure in not taking the steps we need to move forward.
    HAVE COURAGE – we need systems innovation in the everyday ‘mundane’ stuff if anything much more than the newest technological advances. These help the greatest numbers the most

    • CRICO Strategies

      Thanks for the comment, well said – certainly not an easy path but courage helps you rest a little easier too. 

  • petromccrum

    Absolutely agree.  As an “outsider” (patient) I can not understand why medical professionals do not do more to protect and help their patients.  Sad, sad comentary on the state of entire health care system is this country. 

    • Suki Hoover

      Why they don’t speak up?  Because they know they are putting their jobs on the line.  I cannot tell you how many times I and other healthcare professionals have spoken up with regards to patient safety in hospital settings.  Many many times the person reporting unsafe acts or potentially unsafe issues will become a target.  It seems to be getting worse. The person speaking up is often written up.  Because you are upsetting the system.You are talking about their facility, their system, their employees.  Administration does not want to hear it.

  • dsblanchard

    The risk is when someone “goes along” with what one knows is detrimental to patient care and, out of fear of reprisal, stays silent. Each time a risk is taken and there is no immediate consequence the “crowd” is emboldened to remain silent when the next risk is taken. Each time the risk gets riskier. In his book, “What the Red Dog Saw,” Malcolm Gladwell coins the phrase “risk homeostasis.” Famous for his classic work, “Blink” and “The Tipping Point” this newer book is a collection of writings he did for the New Yorker.

    Gladwell says that organizations try to balance risk to stay solvent economically. The balancing act necessitates payment of another kind, like with forfeiture of people’s lives. Those who won’t play the economic “game” in favor of compassionate patient care and decreased morbidity and mortality rates cease to remain employed. These people are a risk to the financial survival of the institution! I think we have reached a “tipping point” in our society. We are not able to take care of patients and remain financially solvent. I think  our society has chosen which she thinks is more important and I see no way to make an “about face” within the present system. 

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