Where Science Meets Muse

Innovation In Healthcare Requires Change In Culture

Posted by Plish on March 17, 2009


Innovative problem solving begins with a succinct and powerful problem statement. 

Poorly Phrased Problem= Ineffective Solutions

Problem statements are deficient when:

  • The wrong endpoints are chosen to define the problem
  • The variables in the situation are poorly understood

I was disturbed but not surprised by this articlethat highlights the fact that nurses, the front lines of healthcare, are reluctant about disclosing mistakes they and other clinicians make.  

In my experience, clinicians will often ‘blame’ medical devices, or send complaints to companies for perceived malfunctions in products or packaging (of which the company is required to determine if the complaints are serious enough to warrant changing the product or manufacturing processes), as opposed to accepting that products were used in the wrong way, or at the wrong time, or perhaps not used at all. 

I point this out not to condemn clinicians but to point out that it’s unfortunately, human nature, to shift blame to those outside the prevailing culture.  That does the following:

  • It gets the problem out of sight, which means it’s out of mind.
  • It self-justifies current behaviors and elevates the ego
  • Empowers the systems to continue functioning as they are which creates a facade of efficiency

And, by the way, NOT reporting a problem/mistake also has the same above effects.

It is clear then that cultures must change if innovation is to occur in the realm of patient care.

Some possible solutions:

  1. Decouple litigious ramifications for problem reporting. 
  2. Put systems in place which quickly address problems and put corrective actions in motion
  3. Free communication between all levels of healthcare hierarchy
  4. Encourage teams in which egos are left outside the realm of patient care
  5. Encourage checks and balances without fear of retribution
  6. Management needs to know where obstacles to care arise and then act to remove them
  7. Re-examine workflows to minimize opportunities for mistakes

Ultimately it comes down to changing cultures.  As Lillee Smith Gelinas, RN, BSN, MSN, FAAN, vice president and chief nursing officer at VHA Inc. says,

“The more we implement just cultures (where) nurses speak up more and feel more open, the more nurses will benefit and feel like they are not on the sharp edge of getting fired if they say anything. They will have the opposite view that if they speak up, they are honoring the portion of their license that says we are patient advocates.”

 What would you propose for improving and innovating healthcare cultures?


4 Responses to “Innovation In Healthcare Requires Change In Culture”

  1. lucychase said

    That’s beautiful. Keep speaking up and raising awareness.

    Did you catch that you just described how to adjust Wall Street’s and Congress’ best practices as well? This is a universal remedy. Honesty, refusing to take advantage of the less fortunate, and encouraging positive innovation.

    From the viewpoint of the patient, I’d like to see a greater amount of research in mental health. There are still medical frontiers where we don’t know enough to make intelligent diagnoses and I think that the brain is the big one. I know someone is being proactive on this somewhere, but just as an example, anti-depressants can really screw with you if the wrong one is prescribed. It’s not like some other meds, where it just doesn’t help if you take the wrong thing. It’s pretty scary when your mind has to go haywire for you to know that your current medication doesn’t work.

  2. Plish said

    Thanks for stopping by!

    You’re right on about positive innovation being a force for change on multiple fronts.

    I totally agree with your point on mental health. I am actually working on a project to improve a doctor’s diagnostic accuracy. Stay tuned.

    There is too much hit and miss in medicine and not enough constructive team collaboration. You, I and myriads of others have experienced this void. Like you say, when certain meds are wrong, they’re waaaaay wrong. Thigns will change, but it’s taking time and people suffer in the meantime.

    Thanks again for your observations!

  3. I don’t have much to say but I can tell you from working with over 150 clients and trying to lead business improvement initiatives that you can’t get anywhere when fear rules. So 25 years ago I started all of my productivity/business improvement initiatives with a firm endorsement of “No Blame”. If you want to change you have to accept the “NO Blame” mantra. Managers will counter with “No Excuses.” I trademarked the “NO BLAME” logo 15 years ago. Once that is all accepted, then you can proceed. If it isn’t in play, then fagetabowdit!

    There is a closely related issue to culture change and that is the presence of “Black Knights.” These are the people modeled after the Black Knight in Monty Python’s “The Search for the Holy Grail.” In that movie, the Black Knight is defending a bridge. He dispatches a “white knight” who tries to cross the bridge he is defending and so King Arthur comes up and offers the Knight a job in Camelot. Arthur and the Black Knight engage in battle and the Black KNight loses his arms and legs. He calls it a draw. So we play that vignette for all classes and tell everyone that we are looking to deal with Black Knights lurking in the company. The Black Knights are defending the bridge – or any change in the company. And when changes occur, the Black Knights are clever and obstruct the changes very cleverly. So part of the way that we deal with that is put a lot of ideas in play and smoke out the Black Knights. It has worked wonderfully over these past 25 years.

    Anyone want to read more about this go to our website: http://www.bertain.com or email me at: len@bertain.com or phone 510-520-8011.


    Len Bertain, Ph.D.

  4. Plish said

    Dr. Len, I love the idea of not blaming, and the flip side of no excuses. Great way to foster a growing culture where fear isn’t the dominating factor.

    Appreciate your thoughts and insights – thank you! Please feel free to stop by any time!

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