by Candy Campbell, DNP
She set up the chest tube insertion tray per protocol, and assisted the physician to gown and glove for the procedure. In so doing, the doc asked the nurse to move the tray to the opposite side of the patient bed. Her response: “Oh? Okay.”
Unfortunately, the patient was a 26-week gestation preemie who weighed about a pound. When the physician punctured the unaffected lung with the chest tube, it did not bode well for the baby.
During the root cause analysis, this nurse, who had nearly 10 years of experience, was asked why she didn’t speak up. She stated:Why did this experienced nurse with critical insight stay silent? Click To Tweet
1) She was unsure of her ability to read the Xray,
2) She had never had a conversation with the in-house physician, and
3) She ‘had heard via the grapevine’ he wasn’t very friendly to nurses.
Together, she felt uncomfortable risking being wrong or being intimidated, so that’s why she didn’t question the doctor’s request.
How many of us would have reacted similarly? When do you feel speechless?
It was bad enough that in 1999, the IOM report, To Err Is Human, noted that annually in the US, approximately 98,000 people died in hospital related sentinel events. Worse yet, in 2013, an updated report documented that up to 440,000 people per year, who enter a hospital for a non-threatening health diagnosis, exit —dead!
How could this be?
Research as far back as the beginning of the 21st century pointed to interprofessional miscommunication as the greatest contributor to sentinel events in healthcare. Upon further study, nurses’ cultural indoctrination was tagged as a major impact on miscommunication. In short, nurses often don’t feel safe to disagree with teammates, especially those who are perceived as higher up in the hierarchy. Qualitative research found that the intimidation stems from a fear-based culture, where perfection is the goal and recrimination is a possibility. Whether clinic or acute care environment, the result was clear: In a fear-based culture, anyone on the lower end of the pecking order may feel it’s unsafe to voice a differing opinion. The predictable outcomes? Disgruntled employees, inefficient teams, medical errors, sentinel events, and (of course) patient dissatisfaction.
What’s the problem?
The healthcare hierarchy is known for being averse to risk and CHANGE.
For decades, thought leaders in our literature have cried out for “new ideas!” and “Innovation!” Nevertheless, in many a microcosm, “change” is the five-letter, four-letter word…unless it comes from the top down. In that case, change looks less like innovation or management and more like manipulation.
What can be done?
Many teambuilding and consciousness-raising programs have been tried, but according to the data, none have made a difference so far. Neuroscientists and cognitive behaviorists, who study how we learn and why we do what we do, agree: in order to learn, grow, and implement real change, we must be engaged in more than mere intellectual stimulation.
Researchers have made comparisons to the concept of play and the effect on memory and learning. For example, watch how children learn best: provide a safe environment, add tools for engagement, and see imagination flourish! (This is the idea behind the interactive museum movement. )
As adults, we can learn a lot from child’s play.
If our goal is to promote teamwork, creativity, and spontaneous solutions to problems, we can set up an environment and assist adults to play while learning.
Happily, there is a method, known for centuries to artists of all sorts, called improvisation, which utilizes the gentle and fun-loving humanness inside each one of the participants to learn relatablity, emotional intelligence, and reap the byproducts of spontaneous creativity and adaptability to change. This movement in healthcare is growing, as applied improvisational facilitators across the country have been trained to hold workshops for healthcare clinicians.Improvisational facilitators across the country have been trained to hold workshops for healthcare clinicians Click To Tweet
In our complex adaptive systems, the most comprehensive learning that will lead to change, our minds, bodies, and emotions must be engaged.
- Here’s some feedback from health professionals who have embraced this kind of training:
- “I’d love to share this class with everyone!”
- “ …[facilitator] motivated us to speak, interact, and take chances. In so doing, she revitalized our group.”
- “This class is so much fun and such good learning!”
Dr. Candy Campbell is an award winning actor, author, and filmmaker. She co-founded the improv company, The Barely Insane Players and has taught improv since 1995 to students of all ages. Her latest book, to be released in 2018, is Improv to Improve Healthcare: A System for Creative Problem Solving. Click here for info on the next healthcare communication conference using improv: