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Volume 4, No. 12, December 2006/January 2007
Abstract of the Month
Organizational silence threatens patient safety
Organizational silence refers to the tendency for people to do or say very little when confronted with significant problems or issues in their organization or industry.
The paper focuses on some of the less obvious factors contributing to organizational silence that can serve as threats to patient safety. Converging areas of research from the cognitive, social, and organizational sciences and the study of socio-technical systems help to identify some of the underlying factors that serve to shape and sustain organizational silence. These factors have been organized under three levels of analysis:
(1) individual factors, including the availability heuristic, self-serving bias, and the status quo trap;
(2) social factors, including conformity, diffusion of responsibility, and microclimates of distrust;
(3) organizational factors, including unchallenged beliefs, the good provider fallacy, and neglect of the interdependencies. Finally, a new role for health care leaders and managers is envisioned. It is one that places high value on understanding system complexity and does not take comfort in organizational silence.
Henriksen K, Dayton E. Organizational silence and hidden threats to patient safety Health Serv Res. 2006 Aug;41(4 Pt 2):1539-54 (reprints available below*)
OB/GYN CCC Editorial comment:
Value dissent and multiple perspectives as signs of organizational health
Henriksen and Dayton, M.S., of the Agency for Healthcare Research and Quality (AHRQ), describe the individual, social, and organizational factors that contribute to organizational silence and can threaten patient safety. They cite several individual factors that contribute to clinician silence. For example, the availability heuristic suggests that if relatively infrequent events that harm patients go unreported and are not openly discussed, clinicians don't believe these events are a problem at their hospital. A second factor is self-serving bias. People tend to view themselves as "above average" in their chosen field of work and so "why do things differently?" Successes are attributable to their own abilities but failures are blamed on situational factors. Finally, members of all organizations display a strong tendency to perpetuate the status quo and not speak up or rock the boat.
Several social factors also underlie clinician silence. There is great pressure to conform in order to gain acceptance and work harmoniously with coworkers. Diffusion of responsibility is also a problem. In clinical settings, individual roles and responsibilities are often assumed rather than clearly spelled out. Under these conditions of diffused responsibility, components of care that should be attended to are often missed. Also, managers who seek blame and attribute error to the individual failings of careless or incompetent staff create a microclimate of distrust.
Finally, three areas of organizational vulnerability that warrant closer attention are unchallenged beliefs, the perceived qualities of the good worker who "works around" problems rather than focusing on the contributory factors to the problem, and lack of understanding of the interdependence of complex clinical systems.
The authors recommend that health care leaders and managers value dissent and multiple perspectives as signs of organizational health, and question agreement, consensus, and unity when they are too readily achieved.
Another successful example is the 100,000 Lives Campaign, which is an initiative to engage US hospitals in a commitment to implement changes in care proven to improve patient care and prevent avoidable deaths. The Institute for Healthcare Improvement estimates that the lives saved as of June 14, 2006 was 122,300.
To that end, the National Indian Health MCH and Women’s Health meeting , August 15-17, 2007 in Albuquerque will highlight speakers from the Institute for Healthcare Improvement and others that have evaluated and treated various health care systems. The meeting has individual facility program review as well as many hours of CME/CEUs.
Your facility should send a team of staff to the above meeting, e. g., you and 2-3 other colleagues from different disciplines should start planning now.
National Indian Health MCH and Women’s Health meeting
http://www.ihs.gov/MedicalPrograms/MCH/F/CN01.cfm#Aug07
*Reprints (AHRQ Publication No. 06-R060) are available from the AHRQ Publications Clearinghouse http://www.ahrq.gov/research/order.htm#clear
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OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
