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Maybe this would be better titled “What Oprah and Brené Brown Don't Know That They Know About How Vulnerability As Strength and Confidence Could Improve Medical Decisions, Medical Team Performance, and Patient Safety.” But that would be too long.
Recently, while browsing radio channels on my way to work, I caught a bit of Oprah and Dr. Brené Brown discussing vulnerability. They described vulnerability as the cornerstone to confidence, and the place from which all innovation and creativity are born. At first, that seems counterintuitive. Both women agreed that society tends to view vulnerability as weakness – something to be squelched, especially if you are a leader. Indeed, my thesaurus agrees: synonyms for vulnerability are “liability,” “weakness,” “defenselessness,” and “helplessness”. But also, “openness.” Oprah said that she attributes much of her life's success to living in vulnerability. This idea really resonated with me because many of the current trends in medicine and patient safety require us to abandon traditional medical training practices and embrace vulnerability. Here are three examples:
1. Asking the team for input. Not long ago, and in some places still today, if a physician leading an emergency stops and asks the other team members for ideas about what to do, that physician would have seemed weak or unsure. Today, a doctor who asks for support from his or her team is seen as an even stronger leader. We share the facts and ask what the team thinks is the diagnosis. We share out loud what we’ve done and plan to do, and ask if there are other ideas. We explicitly say: “Are we missing anything?”
We used to value decisiveness and swift action. We’d say, “Often wrong, but never in doubt!” to describe someone, and intend it as a compliment. Today, we value teamwork. We must be sufficiently confident in ourselves that we do not perceive teamwork as somehow condemning our individual skills.
2. Speaking up across authority gradients. Speaking up makes us vulnerable to a host of discomforts I’ve written about before, including fear of being wrong, looking stupid, and jeopardizing relationships. In some places, there is a movement toward “flattening the team” – the implication being that all team members hold the same hierarchical status. No one has seniority, whether by years of education, degrees and certificates, or gray hair.
Whether a hierarchy exists in a formal or perceived way, we should still all speak up and listen up. Anyone can (and should) question potential threats to safety, and those who are questioned should thank their team members for having their backs. No medical professional wakes up and comes to work thinking “I’m planning to harm a patient today.” And yet, at the 2014 TEDMED conference earlier this year, the Army Surgeon General Patricia Horoho said that as many as 400,000 preventable harm episodes happen annually in US hospitals. Since we’re all in this together – patients, loved ones, medical professionals – let’s start acting like it.
3. Using decision support. Routine use of checklists and cognitive aids is quickly becoming the standard of care. For example, consider the impact of the Surgical Safety Checklist, and the explosion in recent years of a variety of emergency manuals and protocol aids. In this high-tech age of information, any accidentally omitted steps in treatment will be seen as simply unacceptable, especially if a cognitive aid was not consulted. There is no reasonable argument against incorporating decision support tools, even when an expert is managing the event.
So, vulnerability really is a place of courage, confidence, and openness to innovation and ideas. When we stop viewing it as weakness, and instead see the incredible benefits to be reaped, we will make better medical decisions and great strides in patient safety.
Have you ever felt vulnerable about a medical decision or on a team? What did you do?