Open Cultures: Do They Create Mistakes?

Open cultures

A couple of weeks ago I wrote about the sound of silence. I claimed that in the best-run workplaces, bosses are open to discussions about problems. They have a “no blame culture”.

Fact or theory?

Is there any data to support my claim? Or was I just running my mouth off? — Heaven forbid.

In the 1990s, Amy C Edmondson started to measure “openness” in hospitals. She did this quantitatively, making a number of observations:

If there was a medication error what was the management response to blame or learn?
How did the senior nurses spend their time? Managing or Nursing?
Was the senior nurse hands off or hands on, approachable or controlling?
How did the senior nurse dress? Suit or Scrubs?
What did the senior nurse think of her staff? Were they hard on themselves, or did they need discipline?
What did the staff think of the senior nurses? That they were a super leaders or overbearing?
How did the staff feel about mistakes? They were natural and should be reported. Or that the environment was unforgiving and that heads would roll?

Using this quantitative scale, Dr Edmondson scored the culture in eight different departments. Not all hospitals were equal; here are the results:

Does culture drive performance?

If my hypothesis is correct — management openness creates better performance — then I would expect the more open hospital wards would be safer. This is what Amy Edmondson expected as well.

To test the hypothesis she collected data on reported error rates in each ward. She measured how often mistakes were made that were potentially dangerous for patients.

Now the data looked like this:

Openness correlates with mistakes

The results blow my theory out of the water. They are completely counterintuitive. The more open the culture of the ward, the more accidents there were. To put it another way, open cultures perform badly.

Another take

There is of course another explanation.

The statistics were for reported errors, not total errors. It is easy to believe that staff report errors in open cultures but in blame cultures they do not.

Unfortunately, the numbers don’t show the number of critical mistakes. The number of times patients were actually injured. But it is worth considering the Swiss cheese safety model. The surest way to reduce dangerous accidents is to report and act on all minor incidents.

Covering errors up and hoping nobody notices is a recipe for disaster.