Chapter 14 An evolving concept

Chapter 14 builds on our theory and experiences that at the heart of a safety culture is the ability to talk to each other.

A good conversation is where the person is given the time to speak, someone listens, and importantly hears so that they can respond.

Helping people talk to each other could shift the direction of patient safety forever.

There are so many examples (that are described throughout the book) that show how badly things can go wrong if we don’t talk to each other more effectively and what happens when we are not listened to, or we fail to listen or we fail to learn.

This chapter describes the different methodologies:

  • the world café approach
  • huddles
  • briefing and debriefing

It also talks about what gets in the way of a good conversation such as status, gender, hierarchy, grandstanding, personal culture, bullying, incivility and a lack of respect.  For this blog I will focus on two of these:

Hierarchy is a significant issue in healthcare. There are rules and boundaries that exist in relation to conversations; we are not supposed to interrupt the boss, we are not supposed to question the expert surgeon or the senior nurse.  But for the safety of patients this can be extremely damaging.  While, a concerted effort has been made in healthcare to remove this risky behaviour we still hear of cases where someone failed to point out a particular risk that sadly led to the patient being harmed as a result.

Gender is another important aspect to focus on. We think we have an increasing equality of gender but it still falls short of ideal. This can have a profound effect on safety. Across the many cultures worldwide women find it really hard to speak out, often only giving an opinion if asked.  Gender and the impact on patient safety should be openly acknowledged rather than lurking beneath the surface. Women need encouragement and respect from both men and other women.

There is so much fear that speaking up will make the situation worse or be inappropriate or go unheard. All of us have a role to play.  We need to act as a cohesive group, working together for a common purpose.


The World Café; shaping our futures through conversations written by Brown and Isaacs in 2005.