Yesterday I had a less than pleasant encounter with a nurse who was not wearing gown and gloves in a C difficile isolation room. In addition, she chose to wash her hands with alcohol hand rub instead of soap and water. When this violation of policy was brought to her attention, privately and not in front of the patient, she became very defensive and argumentative.Now, one could argue that the relative impact of contact precautions and even hand hygiene with soap and water on C difficile prevention is small. However, if policies are flexible and optional and if feedback is deemed threatening, we have a problem.
This morning, by chance, I came across this TED podcast by Adam Grant on How to Love Criticism, available here. The podcast highlights the value of criticism for personal and professional improvement. We need not embrace a policy of radical transparency and brutal honesty with all colleagues, however, by exploring extremes in modes of criticism we can gain new insights on how to foster improvement.
In a hypersensitive environment, where change must be accomplished in a non-threatening manner, frequently under the theme of shared governance, criticism can seem counter cultural. It need not be so.
If a top healthcare goal is patient safety, under the primacy of first do no harm, critical assessment of all processes and practices is needed. Standardized reports that highlight processes, outcomes and missed opportunities, with peer-to-peer or unit-to-unit comparison are a good start. However, a culture of constructive criticism really starts from the top, with executives setting an expectation and requesting criticism and feedback on their performance. The same would be expected of mid-level managers, physician directors and nurse managers. Regular staff meetings and daily unit/ward safety huddles are excellent venues to actively seek criticism and feedback on leadership, practice and processes. These would drive accountability and heighten the performance of both individuals and groups.
If we value patient safety, we need to critically seek our reflection in the mirror, no matter the result.
