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Could developing a deeper understanding of yourself be the first step on the road to providing safer care?

How creating a supportive safety culture starts with leading by example!

Like most people, I have felt upset watching the Hillsborough Stadium disaster documentary on TV recently. In particular, for me, it shows what happens when there is a pernicious and colluding work culture based on power and hierarchy rather than a culture based on congruent values and behaviours that support people to do the right thing.

Being supportive of colleagues can sound like motherhood and apple pie particularly with the ever increasing demands and pressures we are experiencing in general practice at present. However we risk, at our peril, crowding out the human feelings present in all of us. For me, now more than ever, actively giving people the time and safe space to be heard and voice their concerns in an open, supportive environment where defensiveness to hearing bad news is overcome and learning is encouraged seems so intuitive.

I wonder why it can be so hard?

People talk about time commitments, but the amount of time, let alone emotional upset, taken to deal with near misses and harms surely far outweighs the time it takes to talk about things in an open way and which will hopefully reduce the chances of an event occurring again.

Imagine if, back in the 1980’s, the police had taken more of a learning approach around improving the safety of their service and learning from near misses. Perhaps the Hillsborough disaster might have been averted and at the very least, the truth would have come out at the time with lessons learned rather than all these years later.  The pain for both the families and the professionals is upsetting to watch.

In my previous blogs I have mentioned various books and in this I encourage you to read ‘Intelligent Kindness’ by Ballatt and Campling. It provided some of the theoretical basis for the King’s Fund’s Top Managers Programme I was privileged to attend last year. Providing safe patient care is as much about ability as it is about motivation and attitude. An iceberg provides a useful analogy of this where the 10% of behaviours we express are driven by the 90% of feelings, attitudes and beliefs we hold below the surface. For me moving from a reactive safety culture to one that is generative relies on attitude more than anything.

My learning from the course was that the below the surface ‘attitude’ starts with ‘me’ and that ‘my’ battle over ‘myself’ has been the hardest battle I have faced. As a doctor I immediately assume a leadership role in the eyes of patients and the other professionals working with me on the front line, yet most GPs have had very little leadership training. It is so easy to retreat behind my Doctor title and the positional power that gives me. A lot of leadership comes down to emotional intelligence which starts with self-awareness. As I learned on the course I can behave as an ostrich, which although initially was quite confronting, was also a crucial first step in my quest to improve myself by better understanding my impact on others. My actions do not always have the impact on colleagues that I intend and having this fed back on the course, whilst initially threatening to my ego, provided amazing learning and an opportunity to improve my effectiveness. Being open to hearing some ‘bad news’ about my self was really hard but it was worth it!

I could write a volume on this topic as I feel so strongly about it, but as I have written in my previous blogs, it is easy to talk the talk, but walking the talk is much harder. Working in a collaborative work environment helps to frame practice discussions towards continuous learning and the improvement of patient care. A crucial part of this is the dominant leadership style that prevails in a practice system and which will either promote or inhibit a patient safety culture.

Traditional medical leadership is more hierarchical, based on a command and control style where it can hard to hear bad news. Contemporary leadership theory, together with my own experience, confirms to me that a more versatile and dynamic leadership style based around coaching is particularly empowering to the coal face. It supports the front line workers to identify their own challenges and then come up with solutions where leaders act as enablers as opposed to being perceived as blockers. Demonstrating kindness can act as a useful adjunct to forming a supportive safety culture. What I have noticed in my own practice is that the simple act of a colleague showing kindness can have an incredibly powerful impact on all of us.

Whilst acknowledging that, for some, demonstrating kindness can be psychologically complex involving personal feelings around vulnerability; the act of noticing a colleague is infectious and does bring joy and pride to a workplace.

photo taken of a popup stand, with the word kindness

One consequence of this climate is that patients and colleagues are more able to speak out about things concerning them and this can act as a vital early warning radar system both personally but also for the organisation. For me creating a supportive culture starts with leading by example. Becoming more aware of my own complex feelings and vulnerabilities has helped me to challenge my defensiveness and ego which, if left unchecked, greatly inhibits my personal learning and improvement. It can be really hard, but as Ghandi said, ‘Be the change you want to see’. A dose of humility together with trying to have some fun at work and a self-effacing sense of humour provide a useful tonic.

About the author

Since 2013, Hein has been a board member with the Gloucestershire CCG whilst also working as a half time GP in his Minchinhampton practice. The practice joined Sign up to Safety in April 2015. He is also the primary care patient safety lead for his local West of England Academic Health Science Network, where they are trying really hard to get primary care engagement (and that of commissioners) towards the patient safety agenda.

He has positively benefited from his experiences of working in several different health care systems and has developed a passion for improving the quality of healthcare, and for the impact collaborative working can have. Hein is a member of the health and wellbeing board locally and is leading a number of clinical programme groups including older people (and dementia), neurology and end of life.

This blog post was first published on the Sign up to Safety website on 20 May 2016.


Posted on June 22, 2016 by Dr. Hein Le Roux, local GP and board member at Gloucestershire CCG

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