Can the utilization of a problem-solving framework (for example, PDSA or FMEA) impact the organizational culture or perspective on improvement in

Carmen Discussion:

Hello,

My name is Carmen I am majoring in healthcare management. My future goal is to be employed by a hospital system working in administration. The culture within healthcare facilities has a big impact on how well they provide healthcare to their patients. In many of these places, there's a culture of blame and denial (Moore, 2020). When something goes wrong, people within the organization tend to blame individual employees instead of looking at larger issues. This kind of culture makes it hard for employees to talk openly about mistakes and can make them afraid to report problems. A culture of safety focuses on being transparent, taking responsibility, and always learning. Leaders who support a culture of safety look at solving bigger problems instead of blaming individuals, which makes it easier for people to talk about mistakes and improve patient care (Lee, 2024).

My initial reaction to the examples of resistance to improvement initiatives I feel worried, but I also understand why it happens. It is concerning to me to see how behaviors like fear of retaliation and not speaking up can have a direct effect on hurting patients and stop healthcare organizations from improving (Moore, 2020). These behaviors often come from long standing cultural norms that focuses on blaming individuals and following a strict hierarchy instead of working together and taking responsibility. When healthcare employees are forced to worry that they will lose their jobs for making honest mistakes, it makes it hard to make things better (Lee, 2024).

There are a few reasons why healthcare workers might be hesitant about making improvements. Employees are often afraid of getting in trouble for admitting mistakes or talking about safety. This fear leads to a culture where people stay quiet instead of being honest. The strict hierarchy between employees can make it hard for lower level and new employees to share concerns, especially when leaders need to show responsibility (Moore, 2020). Employees might not have the right training to deal with high stress situations, so they might get defensive and not want to try new ways of doing things. Meeting financial goals of the healthcare organization and dealing with not enough staff, can make it seem like there's not enough time to focus on making things better (Lee, 2024).

These important reasons for being hesitant still matter a lot in healthcare today. The pressure to meet financial goals of the healthcare organization and the fear of getting in trouble for making mistakes keeps people from talking about patient safety. Many healthcare organizations still have strict hierarchies that discourage lower level employees from speaking up and miss chances to make things better for the healthcare organization (Moore, 2020). It is more important than ever for leaders to make open communication a priority and look at bigger issues instead of blaming individuals a priority (Lee, 2024).

References:

Lee, S.-N. (2024). Examining the Impact of Organizational Culture and Risk Management and Internal Control on Performance in Healthcare Organizations. Advances in Management and Applied Economics, 14(1), 61–88. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=ecn&AN=2084718&site=eds-live&scope=site

Moore, M., Bates, V. (2020). Going from a Culture of Blame and Denial to a Culture of Safety. Health Management. https://healthmanagement.org/c/hospital/issuearticle/going-from-a-culture-of-blame-and-denial-to-a-culture-of-safety

Victoria Germon:

Victoria Germon, BSN, RN, OCN. I became a second-degree BSN after working as a

scientist in a large biotech company. I began my nursing career as an in-patient oncology staff

nurse and have continued to grow in the oncology specialty including staff nursing, clinical

research nursing, nurse management, and nurse education. I am currently an oncology clinical educator for a large pharmaceutical company.

            My reaction to the examples of resistance was initially unaffected and then I quickly became disappointed because the themes within each of these stories is still evident in modern day healthcare. I enjoyed this selection of articles because it shows the resistance is not strictly a nursing-problem, rather, a healthcare problem. Doing a literature search on resistance as it pertains to nursing, I felt validated in my opinion of an unchanged system when I saw many recent articles seeking to define reasons why resistance occurs today. Cheraghi et al. (2023) did a nice job breaking down the complexity of change resistance into three main factors (individual, interpersonal, and organizational) which, in my opinion, seem relevant.

As I read each of the required articles, I could see that the aversions to change were complex, originating from narcissism, biases, personal expectations, poor organizational structure, poor communication, lack of teamwork, lack of trust, lack of resources, and discomfort. The story of Ignaz Semmelweis was most interesting because of the longevity of the resistance, the disagreement amongst professional peers, and how far the resistance spanned geographically. To me, Kadar et al. (2018) did a nice job demonstrating different phases of individual resistance from uncertainty, to defense, to threatened feelings, and conflicting interests. The authors also showed the power of organizational influence such as lack of support and resources. Then when enough data was presented, years later, practice changes were readily accepted, adopted, and now celebrated.

All the reasons for resistance that I originally mentioned are applicable in today’s healthcare environment. Change is very much relevant in our healthcare systems with emerging technologies, increased healthcare demands with an aging population, a more novice workforce, shifting policies, and changing infrastructures (Nilsen et al., 2020). Depending on what the individual, interprofessional team, or organization is challenged with, each are going to deal with struggles in the face of change.

References

Cheraghi, R., Ebrahimi, H., Kheibar, N., Sahebihagh, M. H. (2023). Reasons for resistance to

change in nursing: an integrative review.  BMC Nursing, 22, 310.  https://doi.org/10.1186/s12912-023-01460-0

Kader, N., Romero, R., & Papp, Z. (2018). Ignaz Semmelweiss: “The Savoir of Mothers” on the

200th anniversary of the birth.  American Journal of Obstetrics and Gynecology, 219(6), 519-522.  https://doi.org/10.1016/j.ajog.2018.10.036

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., Schildmeijer, K. (2020). Characteristics of

successful changes in health care organizations: an interview study with physicians, registered nurses, and assistant nurses.  BMC Health Services Research, 20, 147.  https://doi.org/10.1186/s12913-020-4999-8

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