Avoiding human errors in the health care arena is crucial.
Efforts to address communication-related or “soft skill” failures have been ongoing since many years ago.
When we rely on extrinsic approaches to reduce human errors - such as using only color-tinted intravenous tubing or keeping detailed checklists - it’s harder for us to make mistakes.
Such human interactive skills are linked to patient safety, patient experience and staff health.
Even though extrinsic approaches to controlling human behavior are essential, we should also consider intrinsic approaches that prepare health care professionals to optimize their own behavior.
In order to appreciate how important this concept is, a basic understanding of complex adaptive systems (CASs) is required.
CASs are made up of elements that are interconnected and able to respond to change in various ways.
A flock of birds is a good example of a CAS.
Consider a flock flying towards a feeding area or away from danger.
Moving as a group, they respond to the environment instantly.
No one is telling each bird where or how fast to fly, while no bird attended an in-service to prepare for changes in wind velocity.
Instead, they are following a few simple rules that guide their relationship, such as maintaining distance from each other and matching speed with their neighbors.
They also share common goals e.g. finding food or safety.
In a health care workplace, all participants also share a common goal: making sure patients receive the quality health care service they deserve.
There are seven primary properties of CASs closely related to important soft skills in such a setting.
We will discuss three of them here: adaptability, the butterfly effect and emerging behavior.
Adaptability refers to the ability of the participants to adapt and learn from changes in their environment.
In a high-stakes, high-stress health care environment, we could not be adaptable without consistent, effective and respectful communication.
For example, inviting feedback on an issue and listening to it is key for engaging staff.
Managers sometimes avoid such engagement because they assume that staff will expect them to follow all recommendations, which could lead to conflict if they don’t.
Instead of validating, considering feedback and setting limits, they simply avoid asking.
Staff who don’t feel heard may become disengaged or resistant to solutions (consciously or subconsciously).
Whereas, many people will accept reasonable criticism, if they feel heard.
Managers may also embrace this idea to increase staff accountability for stubborn problems like, for instance, hospital-acquired infections.
By asking staff, “What do you need to comply with hand-washing protocols?” and then listening carefully to the responses leads to creating the conditions for learning new information that might help and relaying the message that feedback is valued.
The butterfly effect
The butterfly effect refers to a minor event happening locally, e.g. a butterfly flapping its wings, resulting to a major event happening someplace far away, such as a hurricane on the other end of the world.
The butterfly effect i.e. lack of respect in communication, can be seen in these two health care-related examples:
- A doctor yells at a nurse on Tuesday.
On Saturday, she hesitates to call him to report a subtle change in a patient’s condition.
Instead, she reports her concern to the oncoming nurse, who makes it a priority to check with the patient.
Meanwhile, the telemetry alarm goes off and the patient dies.
- Nurse A overhears Nurse B talking about her in a negative way and interrupts the conversation.
“I would appreciate that if you have concerns about my work that you discuss them with me directly.”
Nurse B apologizes and later helps Nurse A get pain medication to her post-op patient quickly.
The patient and his wife feel cared for.
The patient experience scores improve.
Emerging behavior refers to how we behave instantaneously and in relationship to others.
To gossip or not, to offer or take in constructive feedback versus avoiding conflict, to speak up or remain silent about a concern are soft skills that are intrinsic in each of the following behaviors:
- The nurse assistant who was holding the patient’s hand overnight, when he realized that the patient was uncomfortable and worried.
- The surgeon who tells his team that he expects each of them to watch for and report problems.
- The social worker who reminds the unit coordinator that the computer system will be down during the evening shift.
- The nurse leader who negotiates budget allocations for delegation skill training for nursing staff.
- The nurse who shares her insight with the clinical team that a post-op patient’s fear of falling was the reason that she was afraid to walk with the physical therapist.
These soft skills and how they relate to outcomes in health care may be hard to see, but now that you know how to look for them, you’ll spot them more easily.
As you do, you may see or suspect their impact in the workplace.
Did the nurse who hurt her back ask for help?
Was the surgeon receptive to challenges during the wrong-site surgery?
Would the patient have fallen, should the nurse assistant sat with her for a few minutes and listened to her concerns?
Hard-to-measure, yet critical, behavioral soft skills can improve the health care services we provide to our patients, the workplace culture and the rewards of our important work in the health care industry.