After a disaterous delivery that resulted in the death of the baby and almost the death of the mother, the Labor and Delivery unit at Boston’s Beth Israel Deaconess Medical Center went about making some serious changes. In his 1-20-2007 blog post, BIDMC CEO Paul Levy discussed how the department went about changing how they did things. (see my 3-2-2007 post on Paul Levy and his blog).
Levy made a passing reference to the studies of cockpit communication that have documented aircraft accidents that would have been avoided if the culture and communication was different, i.e. the captain would listen to the co-pilot who spotted a problem. In his post, Levy wrote,
This was not a simple seminar or two. It was a process that took many months. After all, it had to break down barriers and behaviors that had taken years to develop. Nurses had to feel comfortable offering suggestions to doctors, and doctors had to learn how to hear the nurses’ comments.
Our OB staff would tell you that it has changed their view of practicing medicine. They would also tell you that it has created unusual bonds of collaboration and friendship in their department, even for a group that had always had a strong group ethic. Most important, the program has actually had a measurable difference in clinical results.
The journal article can be accessed here.
The lessons from this experience applies not only to hospitals, but to how practices work day to day, and how we manage the organization. Your staff sees and hears things that you never will. Sometimes their experience has been with other physicians where they were to be seen but not heard from. You may inadvertantly have created this impression as well. Regardless, you want to break that culture.
Start by asking them, “did Mr. so and so say what was bothering him?” Follow up with another question if it fits, such as “is he worried that it might be a reoccurance” and so on. Your staff will quickly come to learn that you really want to hear what they know, and they’ll be more open to sharing with you. Changing culture and behavior may not happen overnight, but it can happen pretty quickly.