Open cultures
A couple of weeks ago I wrote about the sound of silence. I claimed that in the best run workplaces bosses are open to discussions about problems. They have a “no blame culture“.
Fact or theory?
Is there any data to support my claim? Or was I just running my mouth off? — Heaven forbid.
Without data your just another person with an opinion ~ W. Edwards Deming
In the 1990’s Amy C Edmondson started to measure “openness” in hospitals. She did this quantitatively, making a number of observations:
- If there was a medication error what was the management response to blame or learn?
- How did the senior nurses spend their time? Managing or Nursing?
- Was the senior nurse hands off or hands on, approachable or controlling?
- How did the senior nurse dress? Suit or Scrubs?
- What did the senior nurse think of her staff? Were they hard on themselves, or did they need discipline?
- What did the staff think of the senior nurses? That they were a super leaders or overbearing?
- How did the staff feel about mistakes? They were natural and should be reported. Or that the environment was unforgiving and that heads would roll?
Using this quantitative scale Dr Edmondson scored the culture in eight different departments. Not all hospitals were equal; here are the results:
Does culture drive performance?
If my hypothesis is correct — management openness creates better performance — then I would expect the more open hospital wards would be safer. This is what Amy Edmondson expected as well.
To test the hypothesis she collected data on reported error rates in each ward. She measured how often mistakes were made that were potentially dangerous for patients.
Now the data looked like this:
Openness correlates with mistakes
The results blow my theory out of the water. They are completely counterintuitive. The more open the culture of the ward the more accidents there were. To put it another way open cultures perform badly.
Another take
There is of course another explanation.
The statistics were for reported errors, not total errors. It is easy to believe that staff report errors in open cultures but in blame cultures they do not.
Unfortunately the numbers don’t show the number of critical mistakes. The number of times patients were actually injured. But it is worth considering the swiss cheese safety model. The surest way to reduce dangerous accidents is to report and act on all minor incidents.
Covering errors up and hoping nobody notices is a recipe for disaster.
The acid test
Having read this what do you think? Does a culture of openness improves performance?
Which hospital would you choose be treated in?
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Read Dr Edmundson’s full report
Image by Topher McCulloch
Hi James,
Fascinating results. I wonder if these results would translate across to other industries? I can see the rationale where ‘chain of command’ might be critical but wonder how that would work in other situations.
Adrian
I agree, Adrian. That was my question, too, as I was reading this… would it translate to other industries?
Adrian, I think it translates really nicely to a story on your own blog:
Erin Pepper is the Director of Customer Experience at Le Pain Quotidien. When she started the role around 3 years ago she counter-intuitively stated her goal was ‘to triple the number of complaints that we get’. She then proceeded to put in all sorts of new policies to gather feedback at a number of different touchpoints.
http://www.adrianswinscoe.com/why-every-business-should-be-hugging-their-haters-interview-with-jay-baer-of-convince-convert/
Indeed, James. Thanks for the HT and the link :)