Pass Incomplete — How to Keep Healthcare Clinicians from Dropping the Ball
In this article, Melanie Barlow explores the importance of training healthcare clinicians to appropriately respond to potential errors in care and the effects of failing to do so. Barlow discusses this topic, alongside collaborators Bernadette Watson, Elizabeth Jones, Kate Morse, Fiona Maccallum, and Jenny Rudolph. in “Building a Workplace-Based Learning Culture: The “Receiver’s” Perspective on Speaking Up,” a recently published article in The Journal of Applied Behavioral Science.
Imagine in a game of American football if the quarterback threw the ball for the final play of the match and the wide receiver — instead of taking the catch — stands still and watches it fly past them over the sideline. If you were to keep sending the ball and your teammate rarely caught it, or caught it and threw it hard back into your face, of course you are going to stop throwing the ball to them! The end result, everyone feels disheartened because you routinely lose the play and often the match.
Well, in healthcare speaking up, we teach clinicians how to throw the ball (how to speak up about a potential error in care, or have a safety concern), but overwhelmingly fail to teach them how to catch it (receive the message and respond). As a result, voiced concerns are often missed, misunderstood, ignored, or receivers don’t know how to manage their emotions, so they get defensive about someone potentially pointing out an error and rudely respond (throw the ball back hard). The frequent end result, we lose the match as patients get physically harmed, whilst clinicians get psychologically stressed.
As a registered nurse I have had to speak up for patient safety innumerable times, however on one occasion the ball was thrown exceptionally hard back at me and we absolutely lost the match, a patient was harmed. Later in my career as an educator developing a speaking up program, I thought, right! Let’s train the receiver.
How do I do that? At the time, there was not a single paper within the healthcare literature that had studied receiver behavior within speaking-up interactions. Well, if no one else has researched this, then I need to. Six and half years and three research studies later, there are clear patterns as to what influences speaking up message reception and response. Hierarchy, professional identity (clinical discipline), context (who else is present) and how the message is delivered all are of influence. Results help clarify that how we currently teach clinicians to speak up via standardized mnemonics is just not cutting it. The standardized wording does not account for context or professional identity, key influences on the receiver. It is like throwing the ball the exact same way (strength, direction) to someone who is standing still vs running or jumping in the air or actively being tackled. The receiver is going to have a hard time catching the ball!
This paper is a qualitative element to one of the three receiver-focused studies. The goal is that this collective work will inform how to start training our clinicians to be more proficient in catching the ball.
