If there’s one thing I love about being an author, it’s Skype.
I had a chat with Dee yesterday, who wanted to talk after reading my book.
Dee is a manager in a hospital in Amberclumsy, and the question she really wanted to focus on was:
“Why is the culture in Theatres so toxic?”
It is an interesting question. Thought provoking. And so she finished up sharing with me more time than I was worth as we batted around ideas.
It was easy, talking with Dee.
She has that same quality worn by others of her ilk:
Her eyes emit a sparkle lit with brilliance, authenticity and enthusiasm.
We pondered the presence of the high risk high pressure environment and the natural complexities of having a hundred people working in a walled-off, high intensity environment.
But in the end, we agreed that those things were merely poor excuses. Nothing more.
Then Dee patiently waited for five minutes whilst I searched the house for a deck of cards.
I wanted to show her a card trick.
In finding a solution to the cause of toxicity in a professional environment, it is important to think outside the box.
The card trick is this:
I start by talking about John Gibbs and I working with undergraduate nursing students in Recovery, and how we wanted to tailor their experience to capitalise on the educational opportunities specific to that acute clinical area, but which would also value add to their competence no matter where they finished up in the nursing world.
So having shuffled the cards, the trick began.
I pulled out all the Hearts I could find at a casual glance.
“Hearts cards represent cardiovascular” I told her.
From Ace to King, you can build a hierarchy that allows you to build a knowledge construct that takes you from pulse oximetry all the way up to cardiac arrest algorithms through anatomy, physiology and pharmacology.
The cards lead you on an interesting journey that unveils a useful body of knowledge.
In Recovery, cardiovascular assessment and management is our daily bread and butter.
Likewise we explored Clubs.
“See. It looks like an alveolus.”
Ace to King, another hierarchy, this time to do with respiratory management.
I could see her thinking “what’s this one going to be?” when I moved on to Diamonds.
“Diamonds: looks like the tip of a scalpel, so it’s pain!”
Again, our bread and butter.
3 bodies of knowledge.
In nursing, we are VERY good at teaching this stuff: Anatomy. Physiology. Pharmacology.
In fact we are so focussed on this stuff we feel it’s all we have to teach. Right?
And yet, a deck of cards has FOUR suits.
And so I start flicking through the Spades.
“Hang on a minute,” Dee interrupts, “what’s this one???”
“Spades? The MOST IMPORTANT suit in the deck. The 25% of all knowledge that we FAIL to teach ourselves:
All the different ways of shovelling your way out of the SH%T!”
In other words, the human factors skills, the ones that allow us to practice most safely most often as an emotionally intelligent member of an emotionally intelligent high safety high fidelity team.
“You should patent this!” Dee laughs. “It’s SO true!”
And the best part is this:
Anyone can buy a deck of cards from the hospital cafeteria for less than five bucks.
The biggest opportunity for a quantum leap in an operating theatre safety culture is also our most toxic miss: