In the 1960s my Uncle was a scientific officer at the Radar Research Establishment in Malvern. There were a number of divisions within the establishment who had a tendency to stick together in their different groups. My uncle decided that every day the different groups should be invited to come together for coffee and conversation. They had one main rule which was to ban any conversation which concerned things beginning with C. This was to rule out computing, which was their main work related activity and therefore encourage people to broaden the conversations to help learn more from and about each other.
He would pose questions that may have been triggered by the latest New Scientist or the latest news but more often than not they were stimulated by some obscure question or fact. For example one time they talked about Puccini’s opera Turandot. The opera was unfinished at the time of Puccini’s death in 1924, and was completed by Franco Alfano in 1926. The question posed was; ‘should an opera lover walk out at the point that Puccini stopped and before Alfano started or stay to the end?’ This to my uncle was a bit of fun but he was fascinated in how it stimulated conversation and improved the conversational skills between divisions.
My uncle is not the only person to think about helping people talk to each other.
For example, a lot of people have used conversational methods such as ‘The World Café’. One such example is that of Bob Veazie, a senior engineer at Hewlett-Packard. Bob’s role was to improve organisational performance. He experienced a World Café event where he realised that the boxes in his traditional hierarchical organisation chart would be better depicted as webs of conversations. That managing these conversations might not be the best way to achieve results. He described how every day his teams were engaged in conversations about different questions. He sensed the power and potential for networks of conversations and how the connections among them could produce real value. He wondered if conversations and personal relationships are at the heart of our work. He questioned his role as the leader and whether he was contributing to or taking energy away from this natural process. He questioned why we are using the intelligence of just a few people when we could gain the intelligence of hundreds or thousands of people.
When Bob became the safety leader for Hewlett-Packard’s inkjet operations he was eventually responsible for fifty thousand employees at five sites around the world. When he started there was a high accident rate. This varied from country to country; in Oregon US 6.2% of the workforce was being harmed each year, 4.1% in Puerto Rico and 2.5% in Ireland. The initial attempt to address this was to implement a programme called STOP, which is where people give each other feedback about how they are doing against a list of predetermined risks. Feedback from the test group was that the discussions related to someone else’s list, not their own ideas about what their own risks really were. He says ‘we started with someone else’s answer rather than a question that should have evoked people’s own curiosity and creativity’. The second attempt was to pull together a small group of full time internal safety experts, called safety change agents. The safety change agents defined the set of risks for the whole organisation. As Bob says this was the second mistake. He felt that by doing the work internally, they were consistent with the principles of the World Café; that the wisdom lies with the people themselves. In reality they had created a small group that functioned like outside experts, removing the responsibility from others.
The third attempt was to ask, what are the few key questions that would improve safety results if we were to ask them to people already in conversations about their daily work? What they chose to do was pose key safety questions to the people in the already existing but invisible ‘café’ – the web of relationships – so that they could integrate the questions into conversations they were already having. Bob and his team began by meeting with people where they normally gathered, in staff meetings, worker assemblies and on the shop floor. First they shared the local facilities safety record with them. They showed these people the visual from the world café which shows how one person can then influence a small group, who can then influence a number of groups which can lead to large scale impact. This shows the powerful pattern of the world café in action. It helped employees realise that to make a shift, rather than use predetermined training programmes that focused only on solutions. It demonstrated that they were trusted to hold conversations, develop relationships and mutual intelligence as a way of dealing with critical safety questions.
The first question Bob and his team explored was; if you were to get hurt, how would that happen?’ People began answering the question with risks that they identified from their own work situations. The second question was; do you want to manage these risks before people get hurt or after?’ Of course they all said, ‘before’. The final question was; ‘what do you want to do about it?’ Bob’s team had invited them into a meaningful conversation called ‘I don’t want to get hurt at work’. They talked together about different methodologies, and their own ideas for managing risk. Then they were asked to try out the answers, keep asking the questions and revisit the answers as they learnt more.
Bob used the World Café as a guide to help his safety effort and articulated this as an on-going ‘Safety Café’, a network of conversations across the company connected by key questions. The internal safety experts he had employed were used as the hosts. Bob and his team travelled across the world sharing the stories, bringing together people from across the product lines to learn with and from each other. Bob says that as they were leading the safety effort, they were simultaneously learning about how conversations are a core method that really works to enhance performance. The results of these efforts; the accident rate reduced in Oregon from 6.2% to 1.2%, Puerto Rico went from 4.1% to 0.2%. The company as a whole was able to reduce the overall accident rate by approximately 33%.
So, thanks to my uncle we have one example of an informal get together to help create relationships with people you wouldn’t necessarily meet or spend time with and thanks to Bob we have another example which is a more structured approach to build knowledge through conversations.
The Sign up to Safety campaign is encouraging conversations to help people work safely and combining these two approaches; bringing people together from different groups to talk to one another but also to focus around what we can all do to help people work safely.
We have called it a ‘kitchen table’ because we wanted to evoke the times when you sit round a table with your family or friends and tell them about your day. We imagine different people from across the organisation or practice coming together to have a conversation about safety. We don’t want people to over-think it so we suggest that it is not planned like a meeting, doesn’t need an agenda or minutes taken. The host could stimulate the conversation with questions and some key insights could be captured as single words or key messages on a scribble sheet in the middle of the table.
It doesn’t have to be as obscure as Puccini’s opera but if that is what it takes to create relationships then why not?! What would be even more wonderful is if the kitchen table then stimulated a network of conversations in the same way Bob achieved for Hewlett-Packard. Imagine that network not only across an organisation but across the country simulated by key questions about how we can help people work safely. This is what we are trying to achieve by our second national kitchen table week starting on 19 March 2018.
We would love it if the conversations were linked to three key topics;
- Firstly about how everyone across the NHS could implement ‘safety II’ i.e. a way of looking at what works as well as what doesn’t
- Secondly about how we can instil ‘joy at work’ by building on the initiatives such as ‘learning from excellence’, #kind2018 and saying thank you to the people you work with
- Thirdly how we can keep building this way of developing relationships and having conversations so that they become part of the everyday fabric of the NHS
If you want to know more about the kitchen table week all you have to do is head to our website or twitter account @signuptosafety. You will see what people did last year and you can see what people are planning for this year. Any questions can be asked via team@signuptosafety.org.uk
In memory of Dr Philip Woodward DSc – 6.10.1919 to 30.01.2018
Patient Safety Now 