How to Shift Our Thinking to Improve Patient Safety

By Beth Boynton

Doctors, nurses, patient advocates, and administrators want to prevent medical errors! Yet communication, collaboration, and workplace culture pose ongoing problems. Problems with ‘soft’ skills that make patient safety a stubborn challenge.

“Everyone agrees we haven’t made as much progress as we’d like to make [with reducing medical errors], and the improvements have been uneven,”  -Linda Aiken, PhD, RN – Healthcare Still Misses the Mark on Patient Safety.

Our approaches so far

To date, we have focused on safety engineering ideas and new communication strategies. They come from a scientific and intellectual mindset.  Science of safety interventions and structured communication techniques arise from this way of thinking.

Safety Science

For instance, the science of safety recognizes that humans are imperfect. Researchers that look at patient safety from this perspective design solutions that attempt to make it impossible to make a mistake.  They force or try to force patient safe behavior.  Pre-op checklists and color-coded IV tubing are examples.

Structured communication 

Standardized communication protocols like SBAR and the two challenge rule have been implemented and assertiveness training programs such as Vital Smarts have been administered to thousands of nurses and doctors.  They are trying to regulate human behavior.

While these efforts are valuable, they missing important elements of communication and behavior. Communication is gray and messy and human beings want to have choices in how they think and what they do.

Communication and Behavior are complex

If we are going to make healthcare safe, we need to take a deeper dive into understanding communication and behavior.  Listening and speaking up require ‘soft’ skills like trust, courage, and confidence. The ability to work in teams, honor other points of view,  manage conflict, and lead collaboratively and authoritatively are also part of this skill set.

While not easy in general, these ‘soft’ skills are almost impossible to develop and practice when bullying, blaming or a code of silence permeates the culture. What’s more, the way we behave influences the culture and the culture influences the way we behave.

Forcing behavior will keep a nurse from using the wrong IV tubing in a rush, but it won’t help her address a conflict with bullying peer or eliminate worries about her student loans. The consequences of using the wrong tubing may be obvious.  Whereas, the bullying behavior or late payments may not be so clear.  For instance, will the bullied nurse ask for advice from the bullying person? Will she remind this person to wash their hands? Will she pass along a message from a patient’s brother about a concern in a timely manner?  And what about worries about paying back loans?  Will they be a distraction?  Will an important detail be missed?

If we are going to move the needle on patient safety, we have to address the roots of communication and behavior that influence relationships.

So what do we do?

We need a radical shift in thinking! In addition to structuring patient safe communication and behavior, we must also engage, inspire, and empower others to be their best!  In other words, we need to help motivate nurses, doctors, and others to communicate effectively and behave respectfully. It is an intrinsic approach to behavior change that is aligned with complexity leadership.

This analogy will help explain what I mean: Let’s say our goal is to get our children to eat  healthy lunches at school.  Our first tendency might be to look for ways to control their eating options.  We could:

• Put carrots and protein cookies in their lunchbox.
• Advocate for nutritional food policies with the school system.
• Make sure the vending machines at school only sell healthy foods.
• Create a parent action committee to ban sugary desserts from classroom parties.

These solutions will probably have some positive impact, yet there is more we can do. We could:

• Plan lunches and cook together.
• Enjoy a healthy snack with them.
• Be curious about and listen to their food ideas.
• Offer small bites of nutritional information and give choices.

These ideas will probably have a positive impact too.

What we're not doing is engaging, inspiring, & empowering healthcare professionals to be more effective communicators!

An intrinsic approach

Improv activities offer playful opportunities for nurses, doctors, and other healthcare professionals to feel heard, practice listening, share ideas, and develop trusting relationships.  When facilitated properly, the emotional risk in listening and assertiveness is minimized.  Think about how powerful it might be for a nurse to experience what it is like to be heard in the course of teaching him or her how to listen.  Or how memorable a lesson it might be for a surgeon to accept an idea from a nurse and build on it. And how healing it might be for a nurse who tends to be aggressive and one who tends to be passive to share power in a playful way. 

The principle of “Yes, and…”

Many of you are familiar with the principle of “Yes, and”.  Maybe you’ve been to an improv comedy show? Or maybe you’ve been to a workshop where improv techniques were used for team-building? Well, the same concept can be adapted for nurses, doctors, and other healthcare professionals.

To do this we take the focus off of performance, use facilitation skills to create a safe environment, and frame the learning in goals that involve patient safety and ‘soft’ skill development.

“Yes and…” Improves Communication

The “Yes” part of improv activities nudges nurses and doctors to accept what others are saying.  Translated into communication learning, it is about listening.  And listening will improve patient safety.

The “…and” part of improv nudges healthcare professionals to share ideas.  In terms of communication, it is about speaking up! And speaking up will prevent medical errors.

And there are hundreds of activities that naturally engage participants in practicing communication! It is like a fitness program for ‘soft’ skill development.

Moving the needle on patient safety requires a radical shift in thinking!

Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!