Chicken Little

Chicken Little is my hero. 

She is the smallest hen in the flock. 

When it comes to feed time and I scatter rolled oats on the ground so that the chooks can have the pleasure of foraging, she runs in wide circles around everyone for fear of getting pecked in the rush. 

I can’t vouch for everyone, but I measure a society by how it treats its most vulnerable, not how it treats its strongest. 

In clinical circles, that made for some interesting dynamics. 

When one colleague became the target of performance management, they came to me for help. 

Halfway through the first meeting, I nodded to my friend and we called a break. 

“What is interesting is that the focus seems to be on your handover being disorganised and taking too long,” I reflected. 

We re-engaged the meeting with a positive change strategy. The operating theatre notes had always been assembled in a haphazard way. 

There was no order, no folder, just a jumble of papers shuffled together. 

To this date, it remains the same. 

Even I had trouble with it because it defied every sense of systems thinking, the first rule being that if you want someone to do something, you have to make it easier for them to opt in rather than opt out. 

If the patient needs a script, have the script pad and a pen in easy, certain reach. 

If you want fluid order and medication chart filled out, place the paperwork in ordered succession, right behind the anaesthetic chart. 

Etc. Etc. 

My friend sailed through the performance management confident of forward plan. 

Nothing changed as far as the adhocracy went. There were no attempts by the managers to improve the flowing presentation of the paperwork. 

There was only the throw away comment:

“You might have gotten away THIS time, but we will get you next time!”

My friend was like Chicken Little. 

At the bottom of the pecking order for reasons beyond my reach. 

So whilst my friend was a very caring, intelligent and excellent clinician, all others wanted was an easy target for bullying. 

The big miss for our bosses was that my friend presented an opportunity for patient safety systems learning.

That opportunity was lost because the target was the person, not the evolution of systems excellence. 

Worse, how can we improve when our managers can only outline the problem and not provide clear architectures that will engineer and enable success?

My own note assembly and handover improved. 

I presented patient notes to the anaesthetist in logical order. 

In Recovery I was able to quickly rearrange the garbage order and find which orders were missing, and get them fixed before the doctors left the room. 

Handover to the ward was simple, comprehensive, and set out so that the next question the nurse was going to ask me was the next bit of information I was going to spread out before her. 

It was easy. 

Even better, when I went to Hobart to work in Recovery as an agency nurse, I took the methodology with me. 

“You are so ORGANISED!” they said to me, looking at my notes. 

Soon it became their adopted practice. 

Even better, University of Tasmania students started adopting my method to smash out well delivered, confident handovers. 

All thanks to my friend. 

The bullies are left in second place. 

For them, the sky has fallen. 

For those who will learn, it’s just the acorn of opportunity landing on our head. 


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