The Dashbridge Flying Book Club

On Tuesday afternoon we were offered a book by our CEO during a chance meeting:

"Why Hospitals Should Fly," by John Nance.

Three days later, I returned it, fully read.

It is very much an utopian novel which makes the same assumption all good utopian novels make:

They appeal to human logic;

And the narrator assumes everyone is just like them.

I can't hold that against Dr Nance.

Plato made the same assumption.

As did Saint Sir Thomas Moore.

Surely John and I held the same belief.

'Below Ten Thousand' as a noise and distraction abatement, situational awareness and high

performance team methodology appeals directly to logic.

So why has it failed so comprehensively to capture up front success thus far?

Our CEO asked the same question, but in a different way:

"Why do Theatres have so much difficulty complying with the Surgical Safety Checklist?"

Effectively the same disbelief: "Why do intelligent, educated and highly motivated people refuse to

apply simple logic to their daily practices?"

In my naivety, I used to think that the quality chasm was a rift of perspectival understanding

between management 'groupthink' and their misconstructed 'realities' of the clinical floor.

Surely for us clinicians, that is the most palatable reason for why things don't happen as they should.

In reality, though, even where we have the capacity to engage with more positivity and greater

safety, our experience has proven that fellow clinicians can and will choose to remain stoically

disengaged, tempted to do things the way we do because that is the way we've always done them.

Even when we make changes, it is a matter of degrees, overarchingly an 'SBD' mentality.

'Below Ten Thousand' started life as a 'voluntary' conduct code.

In other words, it asked nurses and doctors and Techs to put their money where their ethical

mouths supposedly lay.

In truth, the ethical argument has less power than the will to complain.

When faced with an opportunity to improve, we will always find reasons not to.

That is human nature at its best.

It is not all one sided.

Complaining comes from poor collaborative technique and poor trust.

It comes from poorly communicated goals, and not making sure those goals are equally shared.

Lastly, it comes from a poor notion of team and a poor team plan.

Looked at from a different standpoint, it looks like this:

"You can't tell me what to do."

"You will do as I say."

On this terrain, everyone gets enmeshed in a powerlessness struggle, because each of these

statements are both true and false.

Powerlessness equals complaints.

Complaints become groupthink irrationalities which cascade into a raging river of discontent.

The 'Cascade of Irrationality' gains power when opposed groups defiantly mistrust each other.

Try to stop it, and you will drown, because each side of the divide more stoically inhabits their own

groupthink stance, and so the torrent grows:

"You can't tell me what to do."

"You will do as I say."

Frightening stuff, especially when viewed from within.

When it comes to safety culture, you cannot be scared, you cannot displace trust.

You require more than a clear vision.

You must have a clear vision AND a game plan.

And to have a game plan you must have coaches and training and match reviews and rewards.

And the wisdom to know that building capacity takes time, effort, patience and benevolence each and every step along the way.

If we want to get through 'Below Ten Thousand' to the next step of creating High Performance

Teams, we have to start being in a completely new way.

Everyone.

Scary stuff?

You would think so.

Even scarier is staying the same way.


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