I’ve always been fascinated by how culture—national, tribal, organizational, etc.—impacts performance. Malcolm Gladwell’s analysis of airline crashes that were caused by a cultural norm that says “never question the authority of the pilot” was a great read, perhaps because nowhere else had I seen such a clear example of the disastrous potential consequences of unquestioned cultural norms.
In a recent issue of Newsweek, Claudia Kalb examines a similar phenomena in her feature article Do No Harm. Medical errors, which kill something like 100,000 Americans a year, are often caused by the culture that says a nurse cannot question the authority of a doctor. But it goes deeper than that; a nurse quoted by Kalb says that problems that are handled between you and your manager feel “very blamelike” in the typical hospital culture. In the hospital this nurse works in now, which has undergone a culture change, “errors are considered a flaw in the system, not an individual weakness.” In other words, rather than trying to get nurses and other hospital staff to overcome the taboo against questioning authority, we simply change the concept of error so that it is no longer a matter of questioning authority, it’s a matter of questioning a system or procedure.
Imagine this sort of transformation in other types of workplaces. Yeah, I can hear the managers: “But it really is a individual performance problem sometimes, and I can’t have people trying to change tried and true systems to cover up their own deficiencies.” Maybe. But I know most people are much more willing to make behavioral changes when it doesn’t feel like a “blaming” environment. When we sit down to ask questions about what would work better, it allows a person to focus on the issues rather than be paralyzed by defensiveness.
Medical schools are making inroads with culture change. Kalb quotes a fourth-year medical student, Mengyao Liang, who says that a culture of openness makes sense to him. “It’s not a sign of weakness to say ‘I made a mistake,'” he says. “I think our generation will say, ‘Why are you not questioning me?” If the medical profession can do that, despite its historical culture of hierarchy, authority and, some would say, personal arrogance, then why can’t we all?
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