In a study from the Joint Commission International (JCI), an American health organisation that provides hospitals with quality and safety certifications, it was determined that 67 percent of medical errors were the result of miscommunication.
How can we prevent miscommunication? What is the role of communication in the learning culture of an organization? And how does communication contribute to a Just Culture?
It seems obvious. Good communication as the foundation of patient safety. However, open communication that creates a ‘learning’ and therefore safe organisation cannot just be bought from a consultant. It has to be tested, negotiated, and hammered out, ultimately leading to a consensus among all members of an institution. We wear our culture. And it is no jacket that you take on and off as you please.
It is important how the organisation itself is viewed. Or the awareness that success and failure stem from a complex system of interactions. And to what extent that can be discussed.
Harry Spaan, the Managing Director of the LUMC (a Dutch academic medical center), points to a number of important factors:
Spaan contends that management, despite often having significant scheduling problems, should regularly consult with doctors, heads of departments, etc. Direct communication. His style of management appears to increase quality. As a result, it has a positive effect on the safety culture within the healthcare institution. Ultimately, much to the great satisfaction of financial management, it also has a positive effect on cost management within the institution. Spaan recommends that:
Such a culture can transform into a learning culture. A culture with a narrative. A place where the story is important. It sounds a bit romantic, but it draws from age-old traditions in which all parties involved in a ‘crime’ (or for the modern-day healthcare institution, a medical incident) gave their account when a consequence was being considered.
This makes it important to not only focus on preventing risks, but also stimulating the flexibility of employees. Risk aversion measures unwittingly lead to more checklists and therefore, more bureaucratic regulations. It is essential in mutual communication to look at what is going well, otherwise nobody understands why things can go wrong.
One of the astronauts on a space shuttle project suggested that the quickest way to die would be to not follow all the standard procedures and that the second quickest way to die would be to always follow all the standard procedures.
This apparent paradox does an excellent job of showing how communication in a Just Culture has to be cultivated and shaped. Of course, there are clearer-cut areas and existing guidelines. However, the quality of communication within an organisation depends on the degree of trust and the feeling of safety for all those involved. Leadership and exemplary behaviour play a crucial role in this.
A manager guides by the capacity to achieve acceptable results under widely varying circumstances. This is all about human flexibility. A system of rules and regulations has no room for flexibility. Ultimately, it all rides on teamwork and team spirit. But most importantly: it is about the patient, who is really only looking for three things:
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