HEALTHCARE teams are currently facing unprecedented levels of challenge, change and uncertainty. Some days I’m sure your immediate environment can appear so chaotic that negative feelings, such as loss of control and elevated anxiety, may seem unavoidable.
If you have a formal leadership role, you will be working – visibly or in the background – to understand and assess the nature of risk, make decisions and take action so that appropriate conditions are created within which safety is supported. Setting up safe systems, creating policies and procedures (including to raise concerns and report/respond to incidents), ensuring safety of equipment and other environmental factors are massively important.
However, certain behaviours are required at all levels in the healthcare team to ensure safety on the front line on a day-to-day basis. So no matter if you have a formal leadership role in risk management or not, learning, practising and encouraging the following behaviours will strongly act to influence ongoing risk reduction.
1. Step back and take an overview
Many adverse events arise when situational awareness is diminished. Situational awareness is basically knowing what is going on around us: understanding how this information is impacting on the situation now and predicting how it is likely to evolve. Sometimes it is referred to as taking a “helicopter view”. Given that in the delivery of patient care there are often many complex variables at play, missing or misinterpreting one important element can lead to a patient safety incident.
We also know that senior team members tend to become ‘doers’ in high-risk situations, and the focus of attention can become performing the task to the best standard rather than challenging whether the current course of action is still appropriate. Activity reduces the capacity to evaluate the situation and so sometimes we need to be challenged to “step back” and where possible check with others.
2. Take a deeper look when things go wrong
When things go wrong, you almost always have an opportunity to learn something that will allow risk to be reduced in future practice – but often we fail to ask ‘why’ enough times to get at the underlying factors. Just deciding that you will act differently “next time” may not be enough. Perhaps you need to take time to improve a working relationship, or perhaps you need to champion change in a system or protocol. If you avoided or delayed doing something, analyse why and take action to fix it rather than expecting to do better next time. If an incident involves a colleague, consider how you can support them to do the same.
3. Ask for help
Asking for help can feel risky and many doctors find it difficult to demonstrate perceived vulnerability. However, taking the first steps can encourage others to do the same. Teams that are confident enough to engage in more help-seeking behaviours are likely to provide safer care. Communication style is important when there is a direct risk to patient safety, and providing relevant and succinct information will ensure you get the help required. Use introductory phrases such as: “I need you to come in on this….” or “I need your advice…” or “You need to know, I have a deteriorating patient…”. Taking time to understand exactly what the issue is (e.g. your capacity or knowledge of patient-specific factors) before seeking help can ensure that your request is not “woolly” – causing additional delay in patient care.
4. Ask for feedback
Asking for feedback (hard as that may be sometimes) is a key component of building a supportive team culture. Listening and providing positive responses and then demonstrating how feedback has impacted your practice will send strong signals about your approachability and in turn reinforce that you can be challenged if necessary to support safety.
5. Give feedback
Letting colleagues know where they could do better is obviously key to improving quality and reducing risk, but it’s important to assess the current “comfort level” within your team before jumping straight in. Regular praise (or encouragement when colleagues are engaging in new activities/roles) has been shown to make it easier for an individual to hear and absorb critical feedback. To ensure trust you must deliver feedback in a sensitive and considered way. People need to believe the good intentions behind your feedback. In an atmosphere of open feedback people are less fearful and more likely to disclose problems, ask for help and challenge you when necessary. For more on delivering feedback and creating feedback cultures check out this webinar on our website.
6. Challenge colleagues’ behaviour
I appreciate that this can be difficult (and some will find it more difficult than others), particularly so when the individual you need to challenge is perceived as an expert or “in charge”. An ‘authority gradient’ might not be the single cause of a patient safety incident but it is very often a contributing factor, leading often to delayed action. Trust is crucial in staff feeling comfortable challenging each other and in influencing how that challenge is received. Placing the patient’s safety at the centre of your response is key, and certain situations will require a more assertive approach, even if there is risk of a negative response from colleagues. Low-risk scenarios allow more time for a considered approach.
7. Choose how to approach situations with care
How we respond to situations, particularly when under pressure, can vary significantly from person to person. Perhaps you become a little more directive? Perhaps you experience anger? Perhaps you are more likely to stay silent until able to acquire more information? All of these internal responses result in external signals or behaviours which have an effect on how others engage with you. By understanding and working to moderate your own responses, along with monitoring how others respond when faced with similar situations, you should be able to select the best approach to maximise the impact of your communication.
Most healthcare professionals work in multidisciplinary teams and how we interact with others is obviously important. We are all working towards the same goal but examining patients and situations through differing lenses. Taking a moment to explore the perspectives of others can allow collaboration to improve the outcome of the encounter – both for you and the patient. This has been recognised via multidisciplinary approaches to training which can identify and create solutions to natural, and sometimes ‘historically manufactured’, tensions within and between teams.
8. Follow through on commitments
Internal and external accountability for your own actions is important in managing risk. Taking personal responsibility for your own actions – both successes and failures – and following through on commitments you have made to yourself and others will reassure colleagues that you can be relied upon, building respect and increasing your credibility.
9. Be consistent
Your own values and ethical standards should be aligned to those of your colleagues and the organisation, and these should be at the forefront of your mind in any interaction or decision taken. Ensuring this is always the case means colleagues understand the “rules by which you play”. Demonstrating consistency across values such as openness, safety and fairness should mean that colleagues are more likely to trust your motivations and feel able to challenge things that “don’t feel quite right”, which are often the conditions within which patient safety incidents arise.
10. Take time out to reflect and create a plan of action
It is important to take time to understand yourself. Recognise how you respond emotionally and behaviourally to certain people or situations and how your communication and working preferences align or misalign with your colleagues. Consider how much capacity you have to engage proactively with colleagues across the areas above and what drains your capacity.
By understanding and practising some of the behaviours above (perhaps the ones you find less comfortable) you should be able to see a direct impact on the behaviour of others and strongly influence risk reduction across your teams’ activities.
Liz Price is senior risk adviser at MDDUS