A culture of fear worsens the nursing shortage and medical errors

There has been a lot talk about changing how we reimburse providers for healthcare from one that pays for services performed, to another that reimburses providers depending on what happens to the patient.

I think we must take a couple of steps back and first tackle the public health crises we are facing that is putting our healthcare in danger, namely, medical errors and the growing nursing shortage. Despite identifying work place conflict as the root cause, the number of medical errors and shortages of nurses has continued to rise over the past decade.

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 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.

Although errors and hostility are the proximate cause of conflict, the root cause is in the system: failure in the design of processes, tasks, training, and working conditions that make errors more likely. However, if we want to significantly reduce the number of medical errors and retain our best nurses, working conditions must change; the culture of fear that permeates healthcare must be replaced with one of trust.

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 this 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.


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