The Dynamics of Culture

In a westcoast hospital, and particular service line, basic and outpatient surgeries had a higher than normal error rate. A Crew Resource Management (CRM) company was brought in to help. After observing several surgeries and talking with several of the staff in this service line, it was decided that pre-op briefing procedures needed to be changed and communication training given to all of the staff. This process took about 2 months and initially appeared to help. But 3 months later, it was obvious that the error rate was still higher than normal. Eventually, a newer nurse spoke to the patient safety officer about a concern that illuminated the underlying problem:

   Several months ago, a few of the nurses were offended by a couple of the doctors. Over time, this grew into a low level of animosity among most of the nurses.

With this issue out in the open now, leaders from the two groups were directed to get together and work it out. It turns out that most of the offense was based on a misperception. Error rate and communication problems were just the symptoms. The underlying problem was a misperception that grew. With the problem solved, error rates dropped.

Lesson Learned:
In most cases, communication training will not solve underlying interpersonal problems. These issues must be illuminated and then resolved. Observation, interviews, surveys, and training do not tend to illuminate them. Two months of training and change implementation could have been averted in just one day of diagnosing culture! The remaining steps of ORM are then easily implemented with minimal cost and time to the hospital.