Magazine article Stanford Social Innovation Review

Wise Guys

Magazine article Stanford Social Innovation Review

Wise Guys

Article excerpt

Evidence-based management works best in wise organizations. Harvard Business School researcher Amy Edmondson found out that within such organizations, employees are seldom quiet or well behaved - at least by traditional "the boss is always right" standards.

In the mid-1990s, Edmondson was doing what she thought was a straightforward study of how leader and co-worker relationships might increase or decrease nurses' errors. She was flabbergasted when nurse questionnaires showed that the units with the best leadership and best coworker relationships reported making 10 times more errors than the worst.

Edmondson later realized that better units reported more errors because people felt "psychologically safe" to do so. In these units, nurses said, "mistakes are natural and normal to document" and "mistakes are serious because of the toxicity of the drugs, so you are never afraid to tell the nurse manager." In the units where errors were rarely reported, nurses said things like "The environment is unforgiving. Heads will roll."

The physicians who helped sponsor her research no longer view error reports as purely objective evidence. Instead, they understand that they are partly a reflection of whether people are learning from and admitting mistakes, or covering things up to avoid blame.

In another study of nurses, Edmondson and colleague Anita Tucker concluded that those nurses whom doctors and administrators saw as most talented unwittingly caused the same mistakes to happen over and over. These "ideal" nurses quietly adjusted to inadequate materials without complaint, silently corrected others' mistakes without confronting the error makers, created the impression that they never fail, and found ways to do their job quietly, without questioning flawed practices. …

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