Motivating staff to own up to mistakes

Ever wondered how to motivate staff to report mistakes such as medication errors or minor injuries at work?  I've spent time in many workplaces over the years, in agriculture, volunteering, healthcare, and education.  Each workplace has had its differences, and issues, but in every one of them I saw people hiding their errors.  Mostly this was because when they had 'owned up' in the past, they were punished for it.  It has happened to me plenty of times in my working life, and often I didn't report errors if I thought no-one would otherwise know about them.  The problem with this outcome is that the organisation ends up with a low rate of incident reports which might sound like a good thing, but it's not.  An incident-report rate below expected norms for the relevant industry might mean the company is brilliant at safety and quality, or far more likely it means that the company lacks a safety and quality culture that values incidents as learning opportunities.
How then can a workplace motivate staff to report errors?

1. Adopt a no-blame approach to incidents.  This is critically important, and has to come from the very top of the organisation.  Staff may well be nervous when implementing a no-blame approach and find it hard to trust that it is real.  Leaders and managers must realise that one badly handled incident will set the process back by months or years.  Don't blame your staff for errors, and don't knowingly allow any outsiders to blame them either.
2. Give credit.  Acknowledge the courage of staff who report incidents especially ones which would otherwise be unknown.
3. Highlight the positive gains that arise from incident reporting as they relate to workplace goals.  Safety and quality is the key, not paperwork.  Celebrating the introduction of a new checklist is not a positive gain in workers eyes if it does not relate to observable benefits in safety or quality.  That's not to say that such things are un-needed.  Just don't highlight them as key achievements.
4. Apply consequences to line managers and senior managers who breach the no-blame approach, and do so transparently.  If workers don't trust management, the problem won't get fixed 'behind closed doors'.
5. Make incident reports a Key Performance Indicator for the organisation in the domains of worker engagement and safety and quality.  If the rate of incident reports is well below industry norms, critically appraise how they are managed and whether or why there is significant under-reporting.
6. Educate all staff from the most senior manager to the student on work experience about the crucial role of incident reporting in securing improvements in safety and quality.
7. Include incident reporting history in performance appraisals and staff development agreements, by linking a strong track record of incident reporting to a commitment to a culture of safety and quality.

None of this is easy, but it is all readily achievable if the organisation takes it seriously.

Leadership

To pass the time on night shift, I was having a discussion with a colleague about various things affecting the nursing profession.  We covered a lot of things, and one of them was leadership.  It is sometimes (or often?) said that nursing suffers from a lack of leadership.  What does that mean?  What is leadership anyway?

In 2009-2010 I had the great privilege of participating in Course 16 of the Australian Rural Leadership Program, so I may have some answers. Or not.

Leadership is about moving forward, taking a group of people towards a shared goal.  It involves inspiration, encouragement, and negotiation.  It requires integrity and commitment, and a healthy dose of self-awareness and self-criticism for the leader.  An effective leader is one who is able to see both the day-to-day realities that impact on outcomes, but also the big picture that shows what it's all about and where we are heading.  He or she needs to be able to communicate the vision, and inspire other people to strive towards achieving it.

If this sounds like a tall order, that's good.  It is a tall order, and the reality is that if we settle for anything less from our leaders, we are shortchanging ourselves.  Leadership is not meant to be easy, although there are some very inspirational leaders who make it look easy.  Don't be fooled by appearances - it is very likely that these people work extremely hard behind the scenes to make things work up front.

So does nursing lack leadership?  I guess that depends on what standards you set, and which branch of the nursing tree you focus on.  The whole organism has some excellent leaders, such as the Commonwealth Chief Nurse (Rosemary Bryant), but the same cannot be said for all of the specialties.  For example, remote health relies on a few dedicated individuals to raise the standards and push for meaningful reform, but the general tone is one of mediocrity and pettiness.  The peak professional body CRANAplus can and does provide some of the leadership required at the big-picture level, but what is often sorely lacking is grass-roots leaders.  People are needed who are willing to step up to the plate and make their own practice exemplary, then accept the challenge to be role models to their peers.  'Tall poppy syndrome' is very real, but leaders have to rise above such petty jealousies and show the way to improve the world around them.  After all, if you can't make a difference by being a good leader, or by following one, what's the point?