The Value of Understanding Unit-By-Unit Data on Safety, Teamwork, and Resilience

Posted on Jan 10th, 2013 at 9:14am.

Bryan Sexton and others have made us all aware that hospitals don’t have one culture of safety—they have dozens of microcultures of safety, unit by unit. One of my most important insights from 2012 comes from what Bryan can teach leaders about how to deal with poorly functioning units. Most hospitals have one or more units that fit this description: staff are burned out, safety outcomes are poor, and new initiatives such as checklists simply don’t gain any traction. Staff in these units report that they don’t take time to eat properly, don’t sleep enough, work through breaks, and even avoid drinking fluids so that they don’t have to take time to urinate.These units are simply incapable of dealing with any changes, including new safety initiatives. The key insight for leaders? If you want to improve safety outcomes in these units, you must first make sure that the basic needs of staff are being met, by addressing the causes of poor resilience in the unit. Often the root cause can be traced to the quality of local leadership, but other issues such as proper staffing, protected time for breaks, and distrust of distant management must also be dealt with. Some of you recognize this phenomenon from Maslow’s Hierarchy, which I’ve always summarized this way: If you’re gasping for air and panting for water, it’s hard to sing opera.

So, take a good look at your culture of safety and other staff surveys. Units with low scores need a fundamentally different leadership approach to implementing change, compared to units with good scores.