This past month we have discussed learning culture and the five domains that make up the framework of a high reliability organization: leadership, psychological safety, accountability, negotiation, and teamwork. While at Harvard business school, Amy Edmondson wanted to study the relationship between error rates, teamwork, and the performance of teams in hospitals (Redford, 2019). To her surprise, Edmonson found that high reliability organizations actually had higher error rates. Do high reliability organizations make more mistakes? Not necessarily. HROs have higher error rates because they have created a company culture of “psychological safety” that empowered workers of all rank and seniority to speak up about mistakes without fear of negative consequences. Reporting errors and talking about what needs to change may initially inflate an organization’s error rate but overall leads to less adverse and never events in the workplace.

How can we create an environment of psychological safety even in organizations with a complex hierarchical structure of leadership? Edmonson argues that it is all about how those with higher status handle their status. By asking employees for their input, leaders can show that they are human and have made mistakes before. Leaders also come off as approachable and empathetic by doing so. One way this is done is through leadership rounding. A leader in an organization can engage with staff, asking “what did you see happen.” This empowers employees to speak up when they see an issue and feel that they have a seat at the table no matter how junior they are within the organization. 

A feedback-safe environment creates a workplace culture where employees are not afraid of being held accountable. High reliability organizations often have high standards. High standards does not mean fear of speaking up; instead the two should be applied together to create an environment where employees are more likely to recognize their mistakes and not fear reprimanding or looking incompentent by bringing attention to something that went wrong. In a high risk and complex industry like the healthcare industry “bad things will happen,” says Edmonson. How a leader reacts is what sets a lot of organizations apart. Adverse events won’t repeat when employees, that are on the front lines experiencing these events firsthand, are given the opportunity to speak about their experiences.

The same idea can be applied when providing patient care. All clinicians work toward a common goal of providing quality and highly reliable care to patients and patients are a central stakeholder to the mission. To that end goShadow asks patients the simple question of “What Matters to You?”. This one question empowers patients to be more involved in their care and have meaningful conversations with providers to what would improve their experience. Effectively, both personalizing the patients’ care while also uncovering details that might have gone unnoticed and gaps in care. Developing high reliability in healthcare has an extra layer compared to other industries, our customers are directly involved in the process and like staff must feel safe and encouraged to speak up about things that are going wrong.  

If you’re ready to start on the path to high reliability, goShadow offers free tools and data-driven methods to help you get started. Want to know more before you're ready? Contact us! We are responsive and always happy to answer any questions.

Source: Redford, Gabrielle. “Amy Edmondson: Psychological Safety Is Critically Important in Medicine.” AAMC, 12 Nov. 2019, https://www.aamc.org/news-insights/amy-edmondson-psychological-safety-critically-important-medicine.