Be a Little Boulder

Added on Mar 27, 2015


Which line is the same

Speaking-up to stop unsafe acts is a critical part of patient safety culture. And sometimes – speaking-up in the face of high authority gradient is not an easy thing to do. Speaking-up for safety is a psychological safety concern. There can be consequences for the person who says “no.” We as safety leaders must make our cultures safe for those who would say “no.”

Too many people would rather go along to get along.

Look at this study in group conformance from US psychologist Solomon Asch in the 1950’s. These experiments were first performed in the 1930’s in Germany, re-performed by Asch in the 1950’s, and confirmed again by others in the 1970’s. Groups of subjects were asked to identify which line is the same length as the reference line (see inset left).

The correct answer to this one example is B as in bravo. When providing just their own answer, error rate was less than one percent – pretty easy.

However, most of the group were confederates of the researcher - only a few of each group were actual subjects. Then the real experiment began. Our confederates intentionally gave incorrect answers to obvious questions to see if the actual subjects would go along. They did.

75% of the subjects gave at least one incorrect answer to go along with the group. 32% of subjects always gave wrong answers to go along with the group. (The silver-lining is 25% of the subjects never gave a wrong answer to go along with the group. Let’s hope that those people are caregivers and providers in our systems!)

Now more experiment – what if one confederate did the speaking-up for what was the correct answer? Or even expressed some measure of doubt? With a little help from just one person in the group – the subjects who went along with the group dropped to 5-10%. Just one person shifted group conformance on a wrong answer from 75% down to 5%!

Which brings us to an insight from my daughter, Anne, who is16 years-old and attending Lake Norman High School. Her world history teacher likes to start each class with an interesting thought for the day – so Anne is always scouring the web for thoughts that are interesting, funny, and high-school-appropriate. Anne asked me:

  • What is the wish of every shy pebble?
  • To be a little bo(u)lder.

Funny and punny.

That is the same wish that we have for our little pebbles. We would very much like for them to have the courage to speak-up for safety – and they often do. To be a high reliability organization they will all need to always do.

To keep our patients – and each other – safe, we all have to be a little bo(u)lder. So if we can’t be the one to say “no” – we can at least be the one who expresses a little doubt. Say “ah…ah… I am not sure” or “uh… I was thinking something…uh…different” or “am I the only one who thinks this could be… uh… a bad idea?”

Please share this study with your shy pebbles. And ask them – they will tell you – which situations make them shy and which situations make them boulders. And follow-up with another question – what can we change or put in place for you to make it safe for you to speak-up for safety? Doing that would make true the wish of every shy pebble.

Read more in: Asch, Opinions and Social Pressure, 1955.

Boulder Community Hospital is part of our HPI client community through the VHA Mountain States collaborative. They must not have any problems speaking-up for safety – they’re already all boulders.