Dealing with negativity in practice

Optometrist and lecturer Helen Court

Unfortunately, frustrations between team members might have appeared as a natural consequence of these changes. In cases where mistakes have been made (for example incorrect use of gloves by staff, or frames not being disinfected), practices might be experiencing a growing atmosphere of blame and negativity.

These are challenging times, which have presented practices with pressures that they have never encountered before. The unexpected nature of this year is forcing us to continually adapt the ways we work and serve our patients. If you are noticing rising levels of blame and negativity within your team, it may be helpful to reflect on the following few points:

There is no gain from blame

A natural reaction when things go wrong is to immediately find a person to blame. There is a belief that by identifying the person, we have identified the problem. However, this approach can leave us myopic to the true cause(s) of the problem. It impedes learning and can present risks to patient safety. A culture of blame will also make people less likely to admit their mistakes and to speak up if they notice problems.

As identified by Dr Lucian Leape, Harvard School of Public Health: “In healthcare, if we jump to blame, we may miss the opportunity to learn. The single greatest impediment to error prevention is that we punish people for making mistakes.”

In other words, it is important for our teams to understand that if we want to learn from mistakes, we need to move away from jumping to blame. By taking a step back and seeking to learn from the situation, we make space for true accountability and improvement to occur.

Look at the system, not the person

Moving our gaze from blame requires a refocus upon the system. It is critical that we remember that our optometry practices are complex healthcare systems, relying on a constant interplay of people, technology and processes. As noted by Braithwaite 2018: “No other system is more complex: not banking, education, manufacturing, or the military” .

For this reason, when you are making a change (or even multiple changes) in your practice, don’t be surprised if there are impacts you may not have accounted for. Within this complex environment we should be on the lookout for where ‘mistakes’ occur. But rather than discussing this with colleagues as a ‘failure’, rather consider that this is only ‘feedback’. By encouraging a culture where ‘mistakes’ are an opportunity to learn, the whole team can be empowered to have open minds and work together to make improvements.

Work together to find the problem

Removing the fear of retribution and blame within a team frees people to truly engage with making improvements. This requires clear communication with team members that this is a safe environment to speak honestly, backed up with actions. Dr Amy Edmonson, a professor at Harvard Business School, identifies this as ‘psychological safety.’ Research shows it is a primer for high performing teams. Therefore, if you truly want to identify the reasons for mistakes occurring in your practice, you need everyone to freely offer their perspective and understanding of the causes.

A culture of blame will make people less likely to admit their mistakes and to speak up if they notice problems

A simple exercise may be asking everyone to write down all the reasons they believe a mistake occurred. This process quickly reveals any common themes, and often reveals that the problem does not lie with one individual.

Once causes have been identified, involving insight from the team to determine solutions is highly effective. It is well known that if people are empowered to creatively design solutions, they are more likely to follow them.

Hopefully discussing the above points with your team can start a dialogue which will help diffuse the blaming and negativity, and lead to a more positive teamworking environment. If you want to delve deeper into improvement in practice, the NHS has guidance on this online. There is further guidance from NHS Scotland here.

References

1. Braithwaite, J. Changing how we think about healthcare improvement BMJ 2018; 361
2. Edmondson, A. 1999. Psychological Safety and Learning Behaviour in Work Teams. Administrative Science Quarterly, 44 (2): 350–383.