Wednesday, March 6, 2013

Anita Tucker nurse study #2 - speaking up about problems, but not to improve the system

Anita Tucker from Harvard Business School has just published the initial results of a fascinating experiment testing how nurses handle problems they encounter while executing a process ("Fostering Organizational Learning: The Impact of Work Design on Workarounds, Errors, and Speaking Up about Internal Supply Chain Problems" link - PDF). We previously posted on this paper here.

Tucker created a simulation of a nurse's tasks in administering medication to a number of patients. Certain errors were embedded in the experiment - such as missing medication for one patient - as well as opportunities to work around the errors - medication for a patient that wasn't on the nurse's list (i.e., "extra" medication) or extra equipment that could be used for the task, but may be considered inappropriate (e.g., a syringe with different unit markings). This is an example of a complex operational process.

The second finding from Tucker's pilot test was that many nurses spoke up about the problems they encountered - 92%, in fact - but only about a third of those spoke up with the purpose of improving the process going forward. The remainder spoke up to solve their individual issue or to explain why they didn't successfully complete their task.

This seems like a small finding, but to me it has profound implications. It says that nurses (or any workers) are under pressure to get their jobs done, and this pressure has an adverse effect on sharing knowledge and improving processes. People are asked to improve their own productivity and throughput, with a result that errors that signal process failures (which may have huge impacts on productivity and quality) are worked around and complained about but not addressed.

There's more to come on this topic. Tucker and her team continued their project, studying ways that they could improve the nurses' willingness to share improvement suggestions.

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