Marilyn stared at herself in the mirror and shuddered as she recalled almost missing a medication error that would have resulted in her patient becoming comatose. As a seasoned nursing professional, her dedication to doing no harm was unwavering, and a tragedy had been averted. As the last line of defense in a dynamically complex medication prescribing system, she could no longer tolerate these events. However, she and others had previously attempted to eradicate this problem without success.
Like so many other medical professionals, Marilyn must literally make life-saving decisions every day for the health of her patients. Her commitment to do no harm calls her to take action, action that in hindsight would be called “leadership.” As with most technically trained professionals, she wants to solve the problem while at the same time experiences dissatisfaction with past failed solutions. When repeated application of existing expertise fails to address challenges, medical professionals may need to give up established practices.
The adaptive nature of leadership typically challenges the current norms of the organization, including norms regarding use of authority, application of technology and the dependency of the patient. Adaptive work utilizes a set of practices to shape culture and fulfill the commitment to do no harm. It requires leadership to utilize practices such as taking a stand, getting on the balcony, conducting humble inquiries, establishing a holding environment, ripening challenging issues, conducting conversations for action and diffusing learning.
Using Marilyn’s dilemma as an example, this series of articles will explore how each of these leadership practices can support the elimination of patient harm.
Eliminating Patient Harm
Marilyn is committed to her patients well being and to the complete elimination of patient harm. In fact, for her it is more than a commitment; it is a stand for a healthcare future currently not thought possible by most people. On this basis she finds the prescription issue intolerable and takes a step toward adaptive work. Marilyn is willing to test that she and her colleagues do not know how to address the issue of prescription mistakes and that applying known technical expertise is insufficient.
For Marilyn, once she considers patient harm an adaptive issue, as with people who are ill, a diagnosis is required before proposing possible novel solutions. The first step in her diagnosis would be to design a compelling open-ended question relevant to her situation at the hospital. The compelling question would be asked on a listening tour of those affected by the issue. By engaging in this inquiry Marilyn will begin to reveal multiple points-of-view regarding the issue while drawing attention to the need for its resolution.
In the second part of the series we will learn what compelling questions Marilyn considered and what the response was to her listening tour. For the reader, we invite you to identify an adaptive challenge you currently face at work and then design a number of compelling, open-ended questions you might inquire with during a listening tour within your organization.