Joyful leadership

Every profession including healthcare has its great leaders; charismatic, high profile, some even adored. But they are not the only great leaders.  Some great leaders are humble, kind, respectful and quietly making the world a better place.

Most people, most of the time are neither saving the world nor exploiting it. [Badaracco]

The NHS is filled with leaders at all levels of the service making decisions every single moment of the day – the sum of which are a hundred times stronger than the acts of those that receive the public recognition.  These people are trying to solve important and sometimes what feels like impossible problems.  The every day problems that are messy and complicated; not having the time to do a good job, not having time to talk to patients, not having the time to reflect and think about what is working and what is not, and not enough time to sort out the staffing and resource issues everyone faces.

The every day problems are not solved by quick, decisive directives from the top, they take time in themselves.  They are addressed by leaders who build a shared purpose, engage with others and listen to their staff and patients.  Because the every day problems may not go away quickly then there is an imperative to make the day to day as joyful as it can be.  It calls for perhaps a kind of ‘joyful leadership’.

What does joyful leadership mean? 

These leaders pays attention to creating ‘joy at work’.  They also pay attention to the way they behave and how they want others to behave.  This includes being humble, kind, positive and respectful.  Many may assume that positive leadership is ‘nice’ and weak, rather than necessary and courageous.  That it might get in the way of getting the job done.

People had this lazy opinion that he’s too nice and they see kindness as weakness, but it’s the most unbelievable strength if you use it in the right way

This quote is about Gareth Southgate in a recent article in the Guardian found here. (I know I am picking up on the much talked about world cup here but its too good a quote to not share it).

Creating ‘joy at work’ is not just about having fun as the term suggests, although it doesn’t preclude having fun it is far more than that.  For me it is about really caring about your staff, taking the time to find out about them and helping them build on and make the best use of their strengths.  It is about helping people work well together and working things through together, respecting everyone’s views as equal.  Successful leaders do not just think they should be caring and kind they intuitively are.  It is crucially about how to help people find the precious resource of time.  To make dedicated time for people to work on things they enjoy together.  It is also about saying thank you and creating a culture of positivity in the workplace.

I have never felt the need to be an aggressive leader, never felt the need to be punitive or to bully people into doing their jobs.  I have concentrated on being me, its much easier being you than trying to be something or someone you are not.  And being me is to be kind, being me is recognising that I don’t know everything and that I need people around me who can talk to me, share their ideas and their concerns and who will know that I will listen to them.

Bringing ‘joy at work’ also fits with ‘Safety II’ which as you know is all about learning from when things go well.  Identifying what works also means that you can see how brilliant the people around you are – which then leads to a lot of saying thank you and celebrating what they are achieving every day.

Safety does not happen if you are negative, shout at people, blame people, keep telling people they must stop making mistakes.

I have come to believe that safety or as we prefer to call it ‘working safely’ is so much more that projects, QI, or safety improvement programmes or even necessarily new ideas, and innovations.  For all (patients and staff) when things go wrong – as Sidney Dekker says – it should be about finding out who was hurt, what they need and whose obligation it is to meet that need.  And as Eric Hollnagel says safety is about finding out what works as much as what doesn’t, replicating and optimising what is already working and removing blame from error.

For us in the Sign up to Safety team, working safely is about:

  • good leaders who listen, who care and who set the tone for their organisation
  • everyone wanting to learn, wanting to be curious about how things work
  • people who can expertly investigate when things go wrong using human factors, behavioural and safety science
  • all of us developing the kind of relationships that we all want to have where we are able to speak up, be heard and be listened to

Working safely is ultimately about the way we behave.  It helps if you are kind, respectful and supportive of people.  For me kindness, listening, empathy and creating joy at work will take you further than anything else.

References:

Joseph L Badaracco JR, (2002) Leading Quietly Harvard Business School Press

Healthcare Safety Investigation Branch – First Report

The Healthcare Safety Investigation Branch has published its first report .  The investigation was triggered by a failure to correctly check hip prostheses for a 62 year old man, Mr John Hampton.

The report is excellent and with this the Healthcare Safety Investigation Branch have set the bar high for the quality of their work.

It is one of the best investigation reports I have ever read.  It is clear, detailed and easy to read and beautifully describes the multiple factors (human, system and cultural) that can lead to an error.  The following are a few things that really hit home for me.

The patient:

From what I can read it appears that the investigators developed a good relationship with the patient and that he was involved in the investigation.  There is a particularly moving point about the on-going effects for Mr Hampton on himself and his family.   Not only will they have a crucial piece of the jigsaw they should be involved , informed and supported throughout.  This should be the minimum.

All investigations should involve the patient and or their family  – they should never be a silent participant of their own story.

Standards, guidelines, policies and procedures:

The report shows that standards, guidelines and procedures are not full proof tools for error prevention.  As Jim Reason says ‘there are not enough trees in the rainforest to write a set of procedures that will guarantee freedom from harm’.  The issue is not that you have a standard but whether people know about it, whether it is easy to read and understand, whether it is short enough to help you make the correct steps but not long enough to drown you in detail.

Standards are worthless if they are not implementable.

Labelling and packaging:

We are reminded of the continuing problems with labelling and packaging (highlighted some time ago by the National Patient Safety Agency (NPSA) in its outstanding ‘design for patient safety’ series).   I urge you to read The Design of Everyday Things if you are interested in this subject.

This has been debated for far too long now and it is crucial that manufacturers use the support of human factors experts, designers and behavioural insight experts to design their products to minimise the errors that can be made with things like poor packaging and labelling.

Understanding human factors:

It is so heartening to see that the report has a wealth of human factors thinking and knowledge thread throughout. Crucially the investigation demonstrates the importance of understanding the environmental conditions, individual and team factors.  For example recognising the role that fatigue plays in performance.   There is a fascinating discourse on team work and relationships and the different error rates between familiar and unfamiliar teams.  There is also an insight to understanding more about our mind-set in relation to error; for example the consultant could recall being brought the wrong size before but not the wrong manufacturer so it ‘was not, therefore, an error experience had taught him to be alert to’.  There are so many things that are applicable for all healthcare, for example the issue of noise in section 5.3 and 5.7, and our cognitive biases in section 5.6.

We simply don’t pay enough attention to human factors in the way we design our systems, structures, and organisational processes.

Barriers to error:

The investigation clearly highlights the fallibility of human memory and the importance of the different types and effective use of memory aids and the importance of reading out loud all the details needed and/or independent checks.  Love the comment ‘what’s on the box may not be what’s in your head’ – which tells us all about the strange things our brain can do to convince us that we see things that are not there or don’t see things that are.

The ‘solution’ we are always searching for is the complete inability to make a mistake, ‘designing out the chances of error’ through effective barriers that get in the way of making an error (checklists, verification processes).  These are really rare and if we think we have found them we may have to think again.  Us humans are very clever at thinking of different ways we can get round things that don’t fit naturally with what we are trying to achieve.

As it says in the report ‘team checking processes already in place have not reduced the number of wrong prosthesis incidents, suggesting that more of the same is not the solution’ and ‘double checking requires that one fallible person monitors the work of another imperfect person’. 

Therefore if you are designing barriers, just as for manufacturers, involve human factors experts, designers and behavioural insight experts.

There may never be a neat answer:

There is also a key point that we don’t talk about often enough, ‘the nurse could not understand why she had gone to different cupboards that contained prostheses from different manufacturers’ – ‘the consultant…. could not recall the details of the prosthesis verification during the operation as there was nothing out of the ordinary about it’.  I can think of numerous incidents I investigated when the people involved had no idea why they did what they did.  They could not offer a nice neat explanation.  They could not recall even the steps they took.

There is still a particular pressure to desperately search for a root cause, to find an answer.  We seem to find it impossible to say ‘we simply don’t know’.  Not knowing too often is misinterpreted as ‘covering up’, or ‘hiding something’.

It is therefore great that in this report it clearly states ‘it cannot be known precisely what checks were undertaken or at what point the process failed’  Hopefully this will give other investigators the courage to say this too.  It does not mean that we cannot learn enough in order to make recommendations as this report has done so well.

Carrying out investigations:

The report also recognises the complexities of carrying out investigations, for example noting how the interviews took place six weeks after the incident and that ‘memory recall at this timeframe may be affected by many factors and so have limited accuracy’.  It would be interesting to know whether most incident investigations involve interviews some time after the incident and how much of the truth we are actually finding out because of this.

The only way to truly understand what can be done differently is to study how work is normally done including the actions and habits that have become common place ( Steven Shorrock ).  I particularly like the way in which staff went to observe work in other operating theatres and in another country to see what normal practice was elsewhere.  We all know about the effect observation can have on behaviours but they were clever in that they stated they were observing ‘general theatre practice’.

What I like most about this is the way it demonstrates variation and that this incident was not the problem of one person, one team or even one organisation.

What’s missing:

The two things missing for me:

  1. The different slant that looking at all of this through a ‘safety II’ lens may bring.  I think it goes some way to try to explain the every day, what happens in the organisation of review but also what happens elsewhere.  It alludes to what works well elsewhere and what could be replicated but this could be a little stronger for me
  2. The cultural issues – was it an environment where people could speak up?  I appreciate that the fact the team were ‘like a family’ and its potential inhibitory factor was bought up but what about the issues of hierarchy or gender or status that may have inhibited people from challenging (even if this was not part of the factors that led up to the error)? Even if there wasn’t a problem it might have been worth discussing more

What to do with this report:

  • Read it! and then read it again – it has so many really great learning points throughout
  • Give it to your staff to read and use the report as a tool in itself to start the conversation for briefings and debriefings in theatres (it is applicable elsewhere too)
  • Use this to show the importance of accessing human factors experts where you can – not only in understanding how things work, how things could be safer and what you can do differently but also in your investigations
  • The way the report is written is a lovely ‘good practice’ example for all local investigators to learn from

Link to the report also found here: https://www.hsib.org.uk/investigations-cases/implantation-wrong-prostheses-during-joint-replacement-surgery/final-report/

Norman D (2013) The Design of Everyday Things. London: The MIT Press

 

Joy and happiness

There is a lot of talk these days about creating ‘joy at work’.

Why this growing interest in the study of joy ? What is the difference between joy and happiness? What does it have to do with helping people work safely (patient safety)?

We all talk about happiness and mostly know it when we experience it, but we lack a coherent definition.  Searching the definition of joy the dictionary states ‘a feeling of great pleasure and happiness‘ but when searching for the definition of happiness the dictionary states ‘the state of being happy’.  In fact, the source of the word happiness is the Icelandic word ‘happ‘ which means luck or chance.  What I do know is that during my career I have been very lucky.  Training to be a nurse and the subsequent years working in the NHS has offered me multiple opportunities to experience fulfilment, joy and happiness.

To help us understand more the Institute for Healthcare Improvement (IHI) have created a Framework for improving joy in work (Perlo 2017).  The framework provides four steps for leaders:

  1. Ask staff what matters to them
  2. Identify unique impediments to joy in work in the local context
  3. Commit to a systems approach to making joy in work a shared responsibility at all levels of the organisation
  4. Use improvement science to test approaches to improving joy in work in your organisation

Our friends at Kaleidoscope held a day focusing on joy in the NHS earlier in the year (see earlier blog) and have just published their paper which builds on that event together with the associated excellent webinars.  These can be found at:  http://www.kaleidoscope.healthcare/ .  The report is titled Beyond Burnout (Kaleidoscope 2018) and at the end it provides fives ways to bring joy right away:

  • Eat together – make dedicated time for colleagues even just five minutes to share a cup of tea or your lunch
  • Say thank you – create a culture of positivity at the workplace by normalising thank you and you will start to hear them back
  • Seek laughter – laughter brings joy, share jokes and allow yourself to have a laugh even during a tough day (it is ok to feel joy even when things are hard)
  • Learn new things – learn things about your work, your patients and each other, discovering something new is invigorating and joyful
  • Support flexibility – do your best not to micromanage your colleagues, let their creativity and joy flourish but be available for advice and direction if needed

Psychologists have found that happy people live secure in the knowledge that the activities that bring them enjoyment in the present will also lead to a fulfilling future, rather than enjoying something now that may make them unhappy later.  While we cant be happy all of the time, we can work on becoming happier.  For example, one of the exercises Emmons and McCullough suggest is to keep a ‘daily gratitude journal’, writing down at least five things for which you are grateful every day.  They suggest that doing this regularly can help you appreciate the positives in your life.

Joy comes from so many places; enjoying what you do, liking the team you work with, having pride in your job and your organisation, and your own health and wellbeing. Often joy comes from small moments in the day.  As with so many things at the heart of this are relationships.  Healthcare employees who experience joy in their work and other positive emotion such as contentment may well thrive and build better relationships.  These relationships can be enhanced by the way we talk to each other in a positive and respectful way, our own joy, even the way we smile and show kindness.

Things that get in the way of joy include bullying, racism, sexism, the blame culture and incivility.  There is a need to acknowledge the current problem with incivility, when people are short or rude, which is sadly common in healthcare.   Incivility impacts on people’s cognition, their happiness and quality of work (Riskin et al 2015, Porath et al 2013).  It takes its toll on productivity, morale and relationships. See – https://www.civilitysaveslives.com/.  To shift from incivility to a kinder culture everyone needs to counter the rudeness by role modelling the right behaviour, reward good behaviour and deal with bad behaviour (Porath et al 2013).

In order for a more positive approach to safety to flourish we have studied the psychology of positive emotions, drawing from Barbara Fredrickson’s Broaden and Build theory (Fredrickson 2013). The Broaden and Build theory of positive emotions suggests that positive emotions i.e. enjoyment, happiness and joy, all broaden one’s awareness and encourage new insights, thoughts and actions.

Over time, this broadened behavioural range builds personal skills and resources. This is in contrast to negative emotions, which prompt narrow, immediate survival ‘fight or flight’ behaviours (Fredrickson 2004). Frederickson stresses the importance of positive and authentic feedback to instil pride in the workforce, and the benefits to both the person giving and receiving of saying a simple thank you.

Positive emotions are therefore considered a key component in happiness and wellbeing and perhaps even prevent burnout.  It could also help to promote both a positive safety culture and improved patient safety which are both dependent upon good relationships and the ability for people to speak up, listen to each other and learn from each other.

In a positive safety culture workers are seen as the solution rather than the problem. If we change our approach in patient safety, to draw explicit attention to the positive rather than simply look for the negative or even at the absence of the negative, we may in turn help people feel happiness and joy and also develop new insights and ideas.

It is a joyful time that these emerging concepts and theories; positive emotions, positive deviance, appreciative inquiry, safety II, joy at work and learning from excellence are all starting to gain serious traction within the safety world.

References:

Bushe, G R (2013) The appreciative inquiry model. In E.H. Kessler, (ed.) Encyclopedia of Management Theory, (Volume 1, pp. 41-44), Sage Publications, 2013

Cawsey, M.J, Ross, M, Ghafoor, A, Plunkett, A, Singh (2017) Implementation of Learning from Excellence initiative in a neonatal intensive care unit ADC Fetal & Neonatal http://dx.doi.org/10.1136/archdischild-2017-314737

Emmons RA and McCullough ME (2004) The Psychology of Gratitude, Oxford University Press

Fredrickson, B (2013) Positive Emotions Broaden and Build. In Advances in Experimental Social Psychology, Vol 47 Elsevier

Hollnagel, E, Braithwaite, J, Wears, R L (2013) Resilient Health Care. Ashgate Publishing Limited

Kaleidoscope Healthcare (2018) Beyond Burnout found at: http://www.kaleidoscope.healthcare/uploads/8/0/2/1/80213224/beyond_burnout.pdf

Perlo, J, Balik B, Swensen S, Kabcenell A, Landsman J FD (2017) IHI Framework for Improving Joy in Work. Cambridge Massachusetts found at www.ihi.org/resources/pages/IHIWhitePapers/Framework-Improving-Joy-inWork.aspx.

Porath, C, Pearson, C (2013) The price of incivility. Harvard Business Review, Jan-Feb; 91 (1-2): 114-21, 146

Riskin, A, Erez A, Foulk, T A, Kugelman, A, Gover, A, Shoris, I, Riskin, K S, Bamberger, P A (2015) The impact of rudeness on medical team performance: a randomized trial. Pediatrics, Vol 136; issue 3

 

 

Risky Behaviour

Design a bad system and it will lead to an increased rate of human error and an increased rate of at risk or risky behaviour

David Marx

What do we mean by risky behaviour?

Risky behaviour is a choice that comes with risks.  It could be a deviation from a rule or procedure, it could be that it is easier to deviate from the required behaviour.  Some refer to this kind of behaviour as violation or simply cutting corners.

Humans make mistakes and they drift into risky behaviours, it is part of being human.  Throughout our day to day lives we take risks, some of us more than others.  We can be placed into various camps; the risk averse, the risk takers, the risk lovers.

The deviation could drift over time towards the risky behaviour becoming simply habit or the new norm and may eventually become such that the level of risk and the new behaviour is accepted.

David Marx suggests that error, risky behaviour and reckless behaviour all have their own defined meanings.  That they are labels that can guide our actions and guide decisions in relation to individual performance and actions.  Being able to differentiate them is important in order to determine what might be done with system design and how we might understand the individuals behaviour within that system.

Is all risky behaviour bad?

Not necessarily.

  • Is it risky behaviour for people to adjust what they do to match the conditions of work or the patients they are caring for
  • Is it risky behaviour to interpret policies and procedures to make them work
  • Is it risky behaviour for people to change what they do so that they succeed under unexpected conditions

What do we do about risky behaviour?

Behind every error and every risky behaviour there is an explanation.  When you see people exhibiting risky behaviour then one step would be to ask them about it, try to understand why they are behaving in that way and provide them with a form of coaching, a conversation about the risk they are taking and whether they see it as a risk to either themselves, their colleagues or their patients.

For healthcare in particular it is imperative that we move away from the punitive approach to risky behaviour and to create a learning culture so that individuals are encouraged to talk about what they are doing and why.  We need to understand that what some may see as risky behaviour for others it may be providing the most optimum service for patients in their care.

Ref: David Marx in Dave’s Subs: a novel about workplace accountability

What is a safety culture?

I remember when I first started as a nurse and learning about the intricacies of caring for patients when one of the nurses who was supervising me said about a particular task; ‘this is the way we do it round here, you might go to the ward next door and they do it slightly differently but ‘this is the way we do it round here’.  This phrase has been used time and time again during my training and beyond.  When I moved into intensive care, when I moved to another hospital … ‘this is the way we do it round here’.

People who study safety culture often say that it is ‘the way we behave when no one is watching’ – the things we do as routine, the things we do without thinking, the way we behave to one another because that’s how it is.

The definition of culture is ‘the ideas, beliefs, customs, and social behaviour of a particular people, ethnic group or age group in society’.

Anthropologists describe it as the sum total of ways of living built up by a group of human beings and transmitted from one generation to another’ i.e. the way we do things round here.

Within the NHS there are multiple groups of people, multiple teams, multiple cultures; people who work in organisations with thousands of staff through to isolated individuals working in remote communities.  Professions, teams and departments with formal customs and hierarchies that prevent people from challenging others.  Professions, teams and departments that go out of their way to gather people together to hear from everyone no matter how disparate their views.  Professions, teams and departments that all have their own ideas, beliefs, customs and behaviours.

If culture is a combination of ideas, beliefs, customs, and social behaviour of a particular people, ethnic or age group in society’ and ‘the way we do it round here… when no one is watching’ – what is a safety culture?

If safety is both a state where as few things as possible go wrong and a state where as much as possible goes right (Ref: Eric Hollnagel) then a safety culture is the mixture of the behaviours, decisions, beliefs, the way we do it found here, in order to make this happen.

A safety culture is therefore:

  • one that is mindful for the potential for getting it wrong, for risk and harm, one that takes steps to prevent that and to minimise its effects if it does
  • one that seeks to learn when things do go wrong or nearly go wrong; learn so that things can be changed to the system to the designs of what we do to intuitively help us get it right
  • one that seeks to learn from the day to day and seeks to learn from when we get it right in order to replicate it, and seeks a way of optimising what we know we do well

This beautiful combination will as Eric Hollnagel and others suggest help us move the language from ‘one person’s job’ or a topic of ‘patient safety’ to helping people work safely.  This is the task of policy makers, leaders, managers, clinicians – all of us.

At Sign up to Safety we believe that in order to do this we need a different way of working together.  One where we are kind and respectful of each other.  That we need to help people connect and create the relationships that are vital for safety; where people are able to speak out, and are listened to when they do.  This culture needs to be fair and consistent both when things have gone wrong and when things have gone right; a ‘just culture’.

At Sign up to Safety we are therefore seeking to help everyone grow and nurture and achieve the ultimate safety culture:

a mind-set and a set of behaviours that become the very essence of what we do so that working safely is embedded into our beliefs, customs, social behaviour, ‘the way we do it round here’

 

 

The way we work

In order to develop a more proactive approach to preventing harm and improving the safety of patient care there is a need to understand how people actually work.  Steven Shorrock writes eloquently on the subject and describes the different ways people work (Shorrock 2016, Shorrock 2017).

Shorrock proposes that there is a difference or a gap in relation to how people think that work is done and how work is actually done. He suggests that there are four basic varieties that can be considered: work-as-imagined; work-as-prescribed; work-as-disclosed; and work-as-done. These varieties, he says, usually overlap, but not completely, leaving areas of commonality and areas of difference.  It is important to know how work is actually done because with only with this knowledge can we start to think about how it can be replicated or improved.

Let us look at this a little more…

Work as imagined

With a complex organisation such as the National Health Service (NHS) it would be virtually impossible for anyone to truly understand how all of the work is actually carried out everywhere.  However, if people are responsible for developing guidelines or standards or policies and procedures then relying on what you imagine someone does rather than what they actually do could mean that the policy is either incomplete, unworkable or fundamentally wrong.

Even if you have past experience of that area, the moment you step away from the frontline you start to become removed from it. Change in healthcare happens quickly and people’s memories become distorted.  Also even if you go out and about and talk to people who work there you may only be getting a partial story; if the culture is inhibitory then people  may say what they think people want to hear not what is actually happening.

Work as prescribed

Sometimes it is important that the work we do is prescribed. Apart from the obvious in terms of medications there is a need for prescribed laws and regulations to ensure care is being provided safely for example in radiotherapy or chemotherapy.  These are the ‘islands of reliability’ that Vincent and Amalberti (2016) refer to.

In healthcare we have an abundance of prescribed work; targets, checklists, guidelines, requirements and standards and so on. But do we have ‘work as prescribed’. Similar to work as imagined the work that is prescribed is often done so by those with some distance from the frontline.

The problem as Erik Hollnagel would say is that in healthcare it is usually impossible to prescribe all aspects of what we do, even when that work is well-understood.  Healthcare constantly requires people to adjust what they do to match the conditions they work in and the patients they are treating.  No two days are the same so there are many ways in which the work can be done.

Work as disclosed

Work as disclosed is how people describe what they do either in writing or when they talk to each other. However this may not always be what is actually done.  For many reasons, it may be the partial truth.  This may be because explaining every little detail would be too tedious or that because we do things automatically we may forget some of the details.  We also often explain things differently depending upon the audience.

Explanations may be too simple because we want to help make it understood or we say what we want people to hear.  This could be the case when we are being scrutinised or audited; ‘just tell people what should happen not what does happen’.  One fascinating aspect that Dan Ariely (author of The (honest) truth about dishonesty 2012) says is that you may not get the truth because as humans we lie to ourselves and others every 10 minutes.

Work as done

Work-as-done is actual activity – what people do. Shorrock emphasises that work-as-done is the most important and yet most neglected variety of human work.  Both he and Hollnagel say that work-as-done is mostly impossible to prescribe precisely.  Safety II describes how safer healthcare is achieved by adjustments, variations, and trade-offs.  These compromises are necessary to meet the conditions within which we work. These adaptations are based on our day to day experience.

Work-as-done can be observed but like all ethnographic study it is challenging. People may behave differently when they are being observed, (the Hawthorne effect) it may also be really hard to understand just from observation alone.

Shorrock (2017) updates these four activities with his recent posts about seven archetypes (with his own summaries in brackets):

  1. The Messy Reality (Much work-as-done is not as prescribed (either different to procedures, guidelines, etc., or where there are no procedures), and is usually not known to others who are not at the sharp end of the work. The focus of The Messy Reality is the actual work and the messy details).
  2. Congruence (Much human work is done ‘by the book’ – at least in general terms if not the fine detail – and is done much in line with how people who are more removed from the actual work imagine. Such work is often even disclosed, since there is no reason not to. However, prescribed work can have unintended consequences. These, of course, were not imagined, at least by those who designed the work.)
  3. Taboo (This is activity that people don’t want to talk about outside of one or more groups. It is often not in accordance with official policy, procedures, etc., or there is no relevant policy, procedures, or if it is described in procedures, others would find the activity unacceptable. As such, the activity is often not widely known outside of specific groups. The main defining feature is that it is not openly discussed)
  4. Ignorance and Fantasy (This is what people don’t know about real work and what they imagine happens. The imagination relates to official policy, procedure, standards, guidelines, etc. that people assume are in force, or there may just be a general impression of how things work and should work. The primary focus of Ignorance and Fantasy is the imagination of those removed from the actual work)
  5. Projection (We are prone to imagine that things will work according to a plan, and prone to wishful thinking, ignoring the potential for problems. The focus of Projection is the imagination of the future, as we think it will be, or would like it to be)
  6. P.R. and Subterfuge (This is what people say happens or has happened, when this does not reflect the reality of what happens or happened. What is disclosed will often relate to what ‘should’ happen according to policies, procedures, standards, guidelines, or expected norms, or else will shift blame for problems elsewhere. What is disclosed may be based on deliberate deceit (by commission or omission), or on Ignorance and Fantasy, or something in between… The focus of P.R. and Subterfuge is therefore on disclosure, to influence what others think)
  7. Defunct (Some forms of prescribed work are not enacted, or else drift into disuse, but are still officially in place. Some will imagine that these are in place, while others know or think they are not. However, the existence of the Defunct work may be used to judge actual activity)

Steve Shorrock (2016 and 2017) explains in much further detail so I would head to his blog at:  https://humanisticsystems.com/2017/01/13/the-archetypes-of-human-work/

Kitchen Tables.. why?

Its Kitchen table week from next Monday!!!

How exciting is that.  Here are some quick key points for you to think about what you are trying to achieve.

‘Your kitchen table could help you……

  • Find out from your staff how your organisation could be better at listening
  • Bring people together from different parts of the organisation working on different things to share experiences and insight
  • Bring people together to share what they think works really well when they care for patients so that we can start to make the transition from Safety I to Safety II a reality
  • Reach out to people who may not normally be included in the conversation like porters and catering staff to find out what they know about keeping people safer
  • Talk to each other about how you think your corporate objectives relate to working safely
  • Take a moment to reflect together on what you are doing now in your safety work and what you wish for the future
  • Share ideas for steps you can all take that are free and don’t need permission but can make all the difference in building positive relationships and a strong safety culture; our website is full of them!
  • Reach those who find it difficult to take time to connect by going to them. Many of last year’s kitchen tables were really kitchen trolleys!

What matters is helping people feel welcomed, heard, listened to and understood.