Thought Leadership

Speaking up: It don’t come easy

January 8, 2010

Workers are encouraged to speak up, stand up, when they know of OSHA recordkeeping abuses. When they are pressured to hide minor injuries so company safety goals can be met, and incentive rewards doled out. But it takes a lot of guts.

A similar “speak up” campaign is being waged in health care, where patients and healthcare staff, nurses, etc., are told to report what they see when it comes to medical errors or at-risk behavior on the part of docs or others delivering care.

A month or two ago I was in the position of being a patient, lying on a bed surrounded by those flimsy curtains, in an outpatient center specializing in certain types of medical screening procedures. As I waited for my doc to arrive and explain the procedure to me, I thought about things I had read on the emergence of the newly empowered patients. No longer is the doc the unapproachable, unassailable all-knowing power. Patients today are supposed to be part of the health care team, a partner with a say in care and treatment.

It’s similar to supposedly empowered line employees who are engaged in enlightened corporate cultures to participate in decision-making, are part of the team, and have the right, nay, the duty, to report on cultural flaws, such as bogus recordkeeping or unenforced policies.

Well, lying on the stiff bed waiting for the doc it hit me how everything in my immediate environment put me in the vulnerable position of victim, not empowered patient. The waiting room is cold, sparse and sterile. Intimidating. As a patient you’re stripped down, lying down, and pretty much ignored. Your anxiety is high, probably reflected in a higher than normal blood pressure reading. And you’re waiting, waiting, uncertain about what’s happening next.

Then the doc finally shows up. I’ve never met the man before. He seems busy, with many procedures scheduled for this morning. And I am supposed to break the ice by asking him, “Excuse doc, but have you washed your hands before coming in?”

It takes a certain kind of moxy to do that, one that doesn’t come by me naturally, and not to many patients I imagine. Everything in the doc’s manner is direct, to the point: this is what I’m going to do, this is what you’ll feel, then we’ll discuss the results. Boom On to the next patient, same explanation, same script.

Perhaps if something was drastically off course, like the doc was prepping me for the wrong procedure, it would be easy to interrupt and say wait a minute, something’s wrong here. But most minor slights, breaches of patient safety like did you wash your hands or not, I’m going to let slip by. I just want to get this thing over with.

I have the feeling the same thing occurs often in the workplace. Report near-misses. Confront or coach employees you seeing performing at-risk behavior. Report that light bulb missing in the stairwell, that pothole on the loading dock. Yes, of course we should. But human nature being what it is, we just want to get on with our business and not go out of our way, or beyond the call of duty for safety, as the motivational speakers say.

It’s takes a supportive environment or culture, one that continually encourages reporting, rewards reporting, publicizes reporting, and has easy-to-use systems for reporting or speaking up, to overcome human nature. I haven’t found those cultures or environments to be very common.
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