“Mindful Organising” – for highly reliable performance.

Some time back I read Matthew Syed’s book “Black Box Thinking: Marginal Gains and the Secrets of High Performance”.  It’s a great book.  It contrasts the attitude “to reporting and learning from errors” of the commercial aviation industry and with that found in healthcare organisations.

Any failures or errors within the aviation industry are reported openly and investigated. Recommendations are mandated… thereby ensuring that lessons are learnt and similar failures are avoided.  Unfortunately, in many healthcare settings, any unexpected outcome – like death – is often be put down to “unexpected complications” or an “inability of the patient to respond”.  Worse in many situations there is a lack of “psychological safety” to enable staff to report concerns or errors without jeopardising their careers… and there may even be a keenness to avoid blame and any subsequent claims.  Hopefully healthcare organisations are addressing these barriers to improvement.

This week I have been reading about organisations which set in place structures to detect and correct errors.  It’s called “Mindful Organising”. This 2016 report in “Industrial and Labor Relations Review” surveyed 95 hospital nursing units in 10 hospitals. They found that for each significant increase in a team’s organising according to collective mindfulness principles, 10% fewer medication errors and 33% fewer patient falls were recorded. See here.

Achieving highly reliable (nearly error-free) performance in a high-risk setting requires the rapid detection and correction of anomalous or unexpected events. Several case studies – including those focusing on naval aircraft-carrier flight decks, nuclear power-plant control rooms and air traffic control operations – qualitatively linked “mindful organising” and “nearly error-free performance”. Case studies in healthcare contexts connected “mindful organising” with reductions in errors and to “highly reliable performance”. They provided quantitative evidence that “mindful organising” is associated with improved patient safety.

So, what is “mindful organising”?

The report defines “mindful organising” as “the application of respectful interaction to detecting and correcting errors and adapting to unexpected events”. It entails a set of actions and interactions through which members of a work group anticipate, prevent, and dynamically respond to errors and unexpected events by:

1) regularly discussing the various ways in which things can go wrong and collectively analysing early indications of trouble;

2) frequently questioning the adequacy of existing procedures and discussing potentially more reliable alternatives;

3) sharing with each other the most current information about their unique skills and knowledge;

4) committing to recovering quickly from setbacks by thoroughly analysing, discussing, and learning from them;

and 5) deferring to expertise rather than authority when resolving problems.

“Respectful interaction”, including “honest reporting”, enables employees to identify where potential threats reside and to more readily notice even weak signals of impending danger by fostering “perspective taking” (…acting with awareness of how one’s actions affect others) and “shared understanding”.  Promoting a culture offering “ psychological safety” is also essential (see my previous post here).

It seems that the openness, empathy, listening skills and objectivity of mindfulness practice might be a way of equipping staff with the attitude and skills to engage in “mindful organising”.  I hope so. I remain very keen to identify an organisation – perhaps in the care sector – who may be interested in a controlled programme to explore the benefits of becoming a Mindful Organisation.

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