Applying the 3S in health care enhancing patient safety

From Kurt O’Brien
Seattle WA

Those of us who works in health care today can readily attest to the current (and oftentimes intense) focus on improving patient safety. Reducing errors, improving documentation of mistakes, and creating a culture where people feel free to speak up are just some of the specific areas that administrators and physician leaders are looking to improve.

While we have the most advanced health care technology in the world, mistakes still occur and conflicts still erupt in our clinics and operating rooms. A recent study conducted by VitalSmarts discovered that over 90% of the time health care practitioners don’t speak up after witnessing mistakes, observing instances of incompetence, or when disrespectful behavior is present. This figure is astonishing when one considers what’s at stake. This has caused hospital leaders to advocate for improving communication skills (notably, dialogue skills) which will help give practitioners the tools they need to surface and talk respectfully about difficult or sensitive subjects.

While teaching these skills to healthcare workers is vitally important, I also don’t believe it’s enough. In order to truly impact this culture of silence, people need to see their own responsibility and accountability to the larger whole, and I believe the Third Side can serve this purpose. The Third Side is about changing mindsets. It’s about helping individuals realize that they are inherently part of a larger system, and that their actions will always influence the broader community.

When I have presented on the Third Side at my own institution, people are immediately taken with it. They begin to understand that they can take an active role – that they have a responsibility to take an active role – in creating a culture where silence no longer dominates.

In the Surgical Services department at the University of Washington Medical Center, we are interested in applying the Third Side to a major improvement project the department has undertaken. We are in the process of meeting and planning what form this will take, and I would like to invite readers of this forum to contribute ideas or experiences that we can tap into – we have so much we can learn from each other.

Comments

[Katia]

I was really blown away by the study quoted and its implications. Often a sense of a lack of safety is what keep people silent; it makes me wonder if the surge in the recent decade of malpractice suits has created a culture of fear that is keeping people silent; or maybe a system of hierachy regarding decisions being made. I think a dialogue about why the silence would help reveal some of the potential areas where systems could be supported to provide individuals with the safety to speak up.

What is the belief sytem around conflict in your department? My sense is like most enviroments that the frame is a perspective of winner/loser. Maybe developing a frame of we all can win when conflict arises could be an interesting approach to project.

Just some initial thoughts - look forward to digging a bit deeper.

[Kurt]

Katia, thanks for your comments - you make some great insights here. Yes, the hierarchy is certainly alive and well, especially between physicians and nurses. The good news is that people are starting to surface the concerns around communication. The Silence Kills article is making its way around the hospital and some are using it as a starting point for a dialogue, but these are mostly pockets. Interestingly, tomorrow a few of us will try to make a case to an OR Manager group on the importance of learning dialogue skills so that the question you surfaced re: belief systems about conflict can be explored. By the way, the 3S would be part of this conversation. I'll let you know how it turns out!

[Katia]

This is great - In the 3/28 forum mailing about the nurses in a hospital system having an individual that they can go to support them as they manage issues and conflict I began to think about your work. Wondering if there is a new role needed to support individuals to find comfort in facing the silence and conflict