Recognizing the ‘Art of Safety’ in a Complexity Science World!

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BB closer Headshot 1-13 CherationsI am going to make a bold statement.

We will not be as effective in patient safety efforts as we can be unless and until we pay attention to the ‘Art of Safety’!  

Evidence-based? If you look at our track record of inconsistent and slow progress, it certainly suggests we are missing something.  Some of the most consistent data for causes of sentinel events according to the Joint Commission persistently points to underlying problems that involve human factors, leadership, and communication.  All of these have roots in communication and behavior that are gray, messy, changeable, varied, and intuitive.  Is this enough evidence?  I think so.

We are not drones or robots

Human beings are adaptable, flexible, creative, and mysterious creatures.  We are influenced by all sorts of intrinsic and extrinsic variables that contribute to our physical, emotional, and spiritual survival and desires in life.  The weather, hormones, family of origin, how rested we are, personality type, stress levels, ethnic culture, education, mood, status, are just a few of the things that affect our thinking and behavior.  They are part of our expression of who we are and what is important to us in any given moment.  And we don’t exist in a vacuum! Our expressions shift and flow as we respond to others and others respond to us.

We are part of a fluid, learning and changeable composite of life!  We are imperfect, have insecurities (at least most of us do), and our expression is our voice, our power, and to some extent, our very existence. An assertive mindset recognizes and values the expression of one’s self and others.

Our expression or voice is an art that interfaces with others’ expressions and informs collaboration. Click To Tweet

We humans will have a voice in our own destiny

Our expression or voice is an art that interfaces with others’ expressions and informs collaboration.  If we have opportunities to develop respectful communication skills and channels exist that invite us to express our voice and use our power in healthy ways, i.e. assertively, we will (at least most of the time). We’ll speak up when we need or want things, share our knowledge and experience with others, contribute ideas and voice concerns when we see problems in a give and take world where others are doing the same. And we’ll do this with a sense of faith, trust, and patience that we’ll be ok.  It is a more joyful way of being than simply surviving.

But, when we don’t have opportunities and channels for respectful expressions, as with Theory X management strategies, we will find other ways to have a voice in our own destiny! We will be just as creative, but more self-serving.  And it occurs to me that whether we are aligning for or against something, we  are always collaborating! We have to in order to survive.  This helps explain the two seemingly paradoxical definitions of collaboration!

In Complexity Science Our Expression and Relationships are Keyevolution human

Many of the elements of Complex Adaptive Systems (aka complexity science) include these human variables in the context of relationships.  Adaptability, flexibility, the butterfly effect,  learning, emergent behavior, diversity, and self-organizing are some of the elements of CASs that could just as easily be described as how we are existing in relationship with each other in the systems we are living and working in.  Complex for sure!  Investing in the people skills necessary to form healthy relationships is an investment in the system itself.  Whether healthy or toxic these inter-professional connections will ripple out into every aspect of the system.  The healthier the relationships the healthier the system.

What is the ‘Art of Safety’?

The Art of Safety is the promotion and support of healthy channels to develop and practice respectful communication and assertive behavior along with organizational cultures that support them.  (Not only assertive behavior for patients but for our selves and each other.  Remember that assertiveness inherently involves respect for self and others.)

The ‘Art of Safety’ is listening and speaking up.  It is emotional and team intelligence.  It is situational awareness and embracing of diversity. It is intuitive and hard to measure. It is knowing when to invoke hierarchal authority and when to invite input from others and to be able to dance with both at the same time.

Learning the skills and practicing the behaviors is not easy especially under the high stakes high stress world of healthcare.  Coaching, interactive workshops, leadership development, and ‘medical improv‘ are process oriented strategies that help.  One of the reasons ‘medical improv’ can be so effective is that it takes the learning outside of the clinical environment and builds skills and relationships that will be stronger, healthier, and more respectful when working together under pressure later on.

In closing, if we want to provide the safest, highest quality, and most cost-effective care possible we should focus on both the science  and art of safety.


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4 Responses to Recognizing the ‘Art of Safety’ in a Complexity Science World!

  1. Pingback: Creating the Ideal Healthcare Organization: The Importance of Involvement

  2. Your article highlights what many hospitals and organizations are implementing around the country. Research indicates simulation learning improves both the quality and safety of healthcare delivery. Human patient simulators, simulated clinical environments, and virtual procedure stations foster the core elements that are frequently the cause of poor outcomes, particularly in emergent crises – communication.

    Literature has also indicated team members are less likely to speak up to voice safety concerns when the professional culture places a hierarchy on healthcare delivery with the healthcare provider (MD, NP, or PA) at the top. Simulation also contributes to all members understanding the important role they each have as a team. This includes simulated activities with communicating established key words used as clues to alert everyone to a team member’s causes of concern in order to prevent poor outcomes, and improve both the quality and safety of care delivered.

  3. Mark Seton says:

    Yes, I certainly concur with your observations that human beings are ‘adaptable, flexible, creative, and mysterious creatures.” Encouraging us to consider/imagine an ‘art’ of safety as well as valuing the science of safety, is particularly valuable in also taking into account the psycho-social aspects of health and safety in any workplace. I have
    found especially helpful the research and writings of Ralph D. Stacey and his colleagues at the Complexity and Management Centre, University of Hertfordshire, and their close examination of health care contexts (Hospitals, etc.) and how supposedly logical, strategic and transparent
    activities and processes to ensure safety can be subtly undone and undermine by the reality of human beings attempting to make meanings together and ensure their own status and power in such work contexts. We often take honest and respectful communication for granted when it is
    actually a conscious learned skill that takes time and compassion and forgiveness when we, and others, don’t always ‘get it right’.

    • Beth Boynton, RN, MS says:

      Thanks, Mark. I appreciate your frame of ‘…the reality of human beings attempting to make meanings together and ensure their own status and power in such work context”. Old hierarchy, gender differences, and egos. in a world of sickness and vulnerability make quite a mix for challenging yet important human learning. Sometimes I think that healthcare is a big mess and yet other times I am inspired by possibilities of generally kind-hearted and smart people collaborating, co-creating, and role-modeling healthier ways of being and caring. Thank you very much for mentioning Stacey and colleagues work. I’m not familiar with the Complexity and Management Centre and look forward to checking it out.

What are your thoughts?