Piping In or Checking Out; The Delicate Balance

[DwayneEMTP]

The fact that you've always done it that way more makes the case for it being more likely archaic, not less.

I've owned two relatively successful businesses that used learning instead of punishing significatly and successfully in their management practice.

In each place that I've worked the remote medic has a supervisory role that has to interact with the HR dept, so I'm aware of the rules, but don't agree with them more because of that. In each of my current gigs the medic is tasked with improving the performance and competency of the staff. My biggest struggle here is to get people to celebrate errors instead of hiding them. Why? Because the system that you love, accept (wasn't trying to be intentionally irritating) has been in place in these environments for far too long...

On the Maersk developer, while leased/managed by Exxon/Mobile certainly one of the most successful companies in the world, there was no punitive action, ever, for a first time error. And each error was brought up in the company safety meeting at the beginning of each shift complete with the names of those involved, as those involved almost always brought the error to light. Those making the errors were considere very productive for their honesty, both by management and crew, and the new information that they brought to the team to help everyone avoid making the same errors in the future.

Read the book, "Straight from the Gut" with Jack Welch, considered by many to be the most successful business manager in American history and he makes it very clear that removing any punitive measures from errors, and making the exposure of errors to everyone laudable, is largely responsible for taking GE from bankruptcy to one of the most successful and powerful companies in the world.

The only realistic argument that you can make for the practice is that it plays out better for some companies legally. There is no argument that I can see that you can use to defend that it's not archaic and counter-productive. It's just simply too well proved to be so...

[paramedicmike]

You're back to assuming that any personnel issue is punitive. Why?

[DwayneEMTP]

Because that has been the context of the conversation up to this point.

And not any personnel issues in general, we've been discussing errors in particular.

If the process is not punitive, then why is it not used to the full benefit for the learning opportunities possible for all?

[paramedicmike]

If it were punitive then there would be punishment of some sort involved. Retraining or remediation isn't necessarily punishment.

Education, or retraining, whatever you want to call it, can be public if it's a widespread or systemic problem. Then, however, it becomes an issue of an organization wide CME or continuing education program with no single clear or identifying incident that can be used to identify an individual patient or provider.

Otherwise it is a single person issue that can, and should, be handled discreetly.

[DwayneEMTP]

Again, it's crazy to wait until a problem is sytemic to identify it and try and mitigate it for the future...If one person's had the issue, it's likely another has already as well and simply hasn't admitted to it, or that another will have the same problem in the future. Why not take every opportunity to resolve small issues...why wait until they become larger to learn from it?

But again, it appears that you will continue to restate your feeling that a single person issue should be dealt with in private without really making any effort to show why that belief is productive either to the individual or the group, but instead only to an organizations HR manual.

[chbare]

We also must consider certain boundary conditions that exist in the United States. Primarily, that singling a person out in front of a group may be considered hostile work environment or some other related issue and said employee could take legal action. Often, we see these types of meeting occur behind closed doors and often with witnesses to minimise the potential legal consequences.

If a systemic culture and policy exists where people are comfortable with being singled out, I could see such a process working; however, this is something that would need a specific policy in place that has passed by the legal consultants and is part of the larger culture of a company. However, shoehorning something in is bound to lead to disastrous consequences, especially in companies that have a strong union presence and like involve union representatives and contractual obligations when it comes to these situations.

If a systemic issue is identified, then systemic changes can occur as they often do. However, these changes often involve dealing with all employees in an environment where no single person is singled out in front of their peers. Another helpful process that can occur is a medical director facilitated chart review where all names are removed and the call is reviewed for it's ability to promote productive dialogue, learning and change.

With that said, in a situation where somebody may make a sentinel event or error, it is your duty to do something about it. However, following an event or potential event, nothing good can come from finger pointing and singling people out in front of a large group of people.

[DwayneEMTP]

If a systemic culture and policy exists where people are comfortable with being singled out, I could see such a process working; however, this is something that would need a specific policy in place that has passed by the legal consultants and is part of the larger culture of a company. However, shoehorning something in is bound to lead to disastrous consequences, especially in companies that have a strong union presence and like involve union representatives and contractual obligations when it comes to these situations...

With th that said, in a situation where somebody may make a sentinel event or error, it is your duty to do something about it. However, following an event or potential event, nothing good can come from finger pointing and singling people out in front of a large group of people....

Agree completely. I don't disagree with the snipped sections, but am only trying to be brief.

I get frustrated with the, "Yeah, this can't work because...." arguments, though I don't mean to imply that anyone here is using them, because I've seen these systems work, and work so much better than traditional models. But you are absolutely right.

On the Developer I can't imagine there the situation where a rouchneck would have been laughed at or scorned for making an error, but the vast majority of the crew would have been angry to find that s/he'd tried to hide it. The attitude being, "You're smart, and that happened to you, and yet you were going to remain silent and let me make the same mistake someday?!?!"

At the time that I was there their production stats were through the roof, as well as their safety record, and they'd been over 6 years without a lost time medical incident....amazing. I love working in the culture, but it's one that they had to dream of, and then invest themselves, each person as well as the company, to develop, no one gifted them with it...

I've tried to follow that model here, where "face" is everything...it's been difficult, but amazingly satisfying....

[spenac]

I have worked where we had private discussions about problems with calls. Then we had shift meetings every few weeks where treatment issues were discussed as a group. Often a person would say hey that was me learn from my mistake but if they were to embarrassed about their mistake no one knew who had made the mistake. Really worked good because it helped a person get retrained in private. Sometimes in private they would even cry when they realized how bad their screw up was. Had the initial discussion been in public could have led to more problems issues.

[paramedicmike]

If only one person has the problem then there isn't any need for a public educational program to mitigate any future issues. It's one person. Individual counseling should suffice. If more than one person has the problem then there's reason to suspect there's a systemic problem and futher evaluation and education is necessary.

Addressing issues invididually is taking the opportunity to resolve small issues as they happen. If it's not a small issue then punitive measures come into play or a systemic problem is identified and educational corrections are implemented.

Single person issues should be handled in private for a variety of reasons. One, which I previously presented, deals with the protection of the service as far as reducing the liability of legal action with regards to the different treatment of different employees.

Another falls into the protection of the service in question by preventing hostile work environment complaints. Call out someone in public for an error they've made, no matter how big or small, no matter the lack of punitive action, no matter the educational factor involved, and you've immediately put an unfavourable spotlight on that employee. From the employee's point of view, s/he is now suspect in the eyes of management AND in the eyes of coworkers. From the coworkers point of view that employee is now suspect because the bosses found reason to single him/her out to make an example. Do it more than once and not only can it be argued that you are harassing the employee but you've got a room full of witnesses who can, and probably will, testify that you willingly singled out this employee in public to spotlight his/her faults.

A third reason falls into the need of catering to the lowest common denomiator. Since it's usually impossible to tell who these people are in advance, one has to protect him-/her-self and their employer. Usually, that means following the manual.

You want to call that catering to the HR manual? That's fine. I can live with that. There is some protection involved in that both personally and as far as the employer goes. The upside is that I know if there are wider educational issues that need to be addressed I'm creative enough to address them while protecting the privacy of any employee in question. (I'm not saying you're not creative enough to handle it.)

[DwayneEMTP]

Fair points from everyone...

[Edit] And Mike, I have no doubt that you are in fact creative enough to do so. I guess the parts of your posts that get under my skin a bit is the static nature of the thinking, at least to the way that I read them. "We can't do that because...." Add, "yet" and I'll have a much easier time leaning over to your side of the fence.

Like Chris mentioned, it's a culture, and as with any culture changes need to be planned, and nurtured, and that's just not happening in many places I think. Not because it's not doable, but because people are comfortable with the pathologic way that things are, and have always been. And that kind of thinking, in any area, just gets my back up...

The more open system works, it's nurturing and productive, all of the steps down the path have been laid out by others over the last 20 years, but implementing it just hasn't become easy enough yet for most. They're all waiting for directions to the trouble free, pain free path. That, of course, is unlikely to ever happen, regardless of the provable benefits.