Tuesday, May 14, 2013

Tip 20: Leaders think small to improve safety

Leaders think small to improve safety

Bobby KnightIn our overly complex world of Healthcare there is something to be said for thinking small when searching for the right solution to a complex problem like safety. Don't underestimate the genius of small ideas and actions. These little things often surprise us by generating subtle but substantial change that leads to amazing results. From time to time I'm reminded of the light hearted side of the theme: the famous "Think Small" Volkswagen Beetle ad campaign that came out in the 1950's, Steve Martin's album "Let's get small" in 1977...certainly worth listening to if you haven't heard it in awhile. The reality is that there is true value in "thinking small" if you're a leader and/or physician looking to help your staff have a greater impact on improving patient safety.

I was reminded of the concept in a recent article in the New Yorker that tracked the origin of Earth Day. Today, we all know Earth Day as a global movement that led to the Clean Air Act of 1970, the Clean Water Act of 1972, the Endangered Species Act of 1973, and just eight months after the inaugural event, the establishment of the Environmental Protection Agency. Throughout the seventies, Congress passed one environmental bill after another, establishing national controls on air and water pollution. Most of the powerful environmental groups we know today are by-products of the Earth Day movement. Many of colleges and universities instituted environmental studies programs, and many news agencies became dedicated to regular reporting on environmental issues. Earth Day is just one of many examples of how movements that led to great change didn't require highly coordinated efforts. Quite the opposite really, and in the case of Earth Day, those closest to the movement will tell you that it was largely uncoordinated. The rapid success of the movement took it's champions by storm, captured the hearts and minds of millions, and has contributed to small changes in behavior across the globe that made a substantial difference.

So how can the Earth Day movement help inform healthcare leaders on how to have a greater impact at improving patient safety?

It helps us to realize that as leaders a handful of small actions can lead to big results. Improving safety doesn't always require a well coordinated movement or major organizational initiative. We don't need to wait for the board or medical staff consensus to authorize new initiatives to achieve the patient safety outcomes we keep talking about. Many of the organizations we work with have done an outstanding job improving safety, but often discover that all the checklists and initiatives in the world only get you so far. Your future gains in reducing harm and improving safety will need to come from a different place. As the coach of your team who understands that small insights and actions will contribute greatly to safer conditions can also lead to a movement that even surprises you.

CL Tip 20: The Power of Small

Recently, I've been asked to do several interviews to discuss my upcoming book Heroes Need Not Apply: How to build a patient accountable culture without adding more to your plate. I am asked regularly why a doctor would be anti-hero? I keep reminding people that I'm not anti-hero....just anti-heroic effort. Heroic effort certainly did not make the Earth Day movement a great success and it's certainly not going to be the driving force for making patients safer. The hero mindset in healthcare has minimized teamwork and has led to cultures that generate episodic excellence. That sounds a bit unpredictable if you're the patient. The only way to achieve systematic excellence is through small behaviors and actions that reinforce collaboration, matter most to our patients, and create safer conditions.

I've been listening to your feedback, I understand that most leaders in healthcare realize the value in coaching their staff. The concern is where to start and how to find the time?

As we've pointed out in prior issues, introducing coaching into your leadership practice doesn't require more to do, but often provides leaders tools that result in time saved. One of the benefits of incorporating coaching into your leadership practice is that it offers more frequent opportunities to guide staff, build team trust and strengthen relationships. More frequent interactions with staff doesn't translate into more time leading... as the leaders I work with report significant time saved due to less upward delegation and more effective/shorter meetings. Coaching isn't something you do every 6 months at a performance review and it doesn't need to take place in a private room with comfortable seats and subtle lighting, nor does it need to take hours like some leadership approaches we know.  Keeping with our theme of small actions - big results, this tip might be one of the most effective and underutilized skill leaders practice:

Use silence effectively to allow others to think.

While the idea of using silence as a coaching tool could be perceived by some as a whole lot of nothing, the most effective leaders we know in and out of healthcare apply it to every conversation. Just the word "silence" suggests passive behavior, but we've found it to be anything but. As a physician, I discovered the benefits of using silence or what I often refer to as "creating space" so that my patients have the opportunity to tell their story. As providers we have grown fearful that if we offer space in the conversation for our patients to ask a question or share a thought, they'll ask for more than we can give...simply not the case. The opposite is true. When you offer patients and/or staff the opportunity to think by creating space, you create an opportunity for listening to occur and an insight to be made. When your staff/patient is aware that you listened to them, they feel safer, they are more likely to trust in your leadership, and engage in the change you're advocating.

Creating space might look and feel like a small thing, but the safe exchanges it creates have a remarkable impact on improving care. Effective coaches know that every conversation they engage in can offer perspective and insight... all you have to do is pause from time to time.

Email me or share your thoughts on our Facebook page.

Brian WongDr. Brian Wong's highly anticipated book,'HEROES NEED NOT APPLY' releases this spring.

Listen to Dr. Wong as he discusses Heroes Need Not Apply: A Unique View on Accountable Culture Click here to listen>>

Brian WongCheck out the new video interview with Brian Wong, M.D.
to access Dr. Wong's Q&A as he discusses "Heroes Need Not Apply," Click here>>

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