The Expertise to Escape

Added on Feb 16, 2016

Rarely is Hollywood used to reinforce a principle of a High Reliability Organization…have you ever seen a pig with wings?!? No pigs in this story, just actors portraying generals in World War II…and you can draw your own analogies from that.

Patient Safety

The 1967 movie is The Secret War of Harry Frigg (Universal Pictures), starring Paul Newman. The story is about 5 allied 1-star generals who are captured at an Italian bathhouse, and interred in a rather luxurious prison…a Villa on loan from a Countess. Noting several weeks with no attempt at escape, nor communication, Allied leadership concludes these generals must have it fairly soft, or are incapable of agreeing on an escape plan…both conclusions accurate. A clever Colonel at HQ decides to find a master at escape…a private (Frigg) who can’t stay out of trouble, but repeatedly escapes his detention…and give him the rescue task. In order to provide him the needed authority with this ranking group, he is made a temporary 2-star general and dropped behind enemy lines for capture. Upon his arrival at the Villa, he succumbs to the temporary appeal of the lifestyle, yet remains focused on his mission of escape. Although his street-wise demeanor brings question to his authenticity, his rank provides the authority necessary to “win” the team’s support for his plan. The plan is disrupted on the night of execution (you’ll have to watch for the entertainment value), and the team ends up in a real POW camp. Heated arguments among the generals reveal Frigg’s true identity, and as the newly-dubbed outcast he proceeds to escape solo. Just as the generals resort back to their inability to agree, because each sees himself as more qualified, Newman returns with a devious plan to rescue them all. They yield to his demonstrated talent, and a happy ending ensues.

OK, fun story, but how does it pertain to high reliability and healthcare? Many lessons in Validate & Verify, Peer Checking and Tones are embedded in the script, not to mention the plot being essentially based on an Authority Gradient, but the key lesson here is Deference to Expertise. Weick & Sutcliffe list this as one of the 5 principles of High Reliability Organizations inManaging the Unexpected, under the Containment category, where the group is trying to get out of trouble.

As a private, Frigg would never have had access to a general, no less have the chance to convince each that he knew how to plan escapes. Each “warrior” in the group felt his own rank and position came with an expectation to take charge, and the accepted reputation that he should understand strategy & tactics. As equals, none were willing to yield to another’s idea...until the “higher ranking” Frigg appeared. The group deferred to his authority, somewhat trusting his plan, at the Villa…but due to delayed execution it was never tested. When his identity was revealed amidst the higher stress circumstance, all respect for expertise diffused. That is until he actually escaped! Upon his return, they were completely willing to follow his plan…Deference to Expertise… without regard to the authority gradient, because of his demonstrated talent.

Questions to consider:

  • How many of our providers fail to recognize the experience and expertise of assisting staff at the patient’s bedside or during an invasive procedure?
  • How many of our leaders assume their title or role brings the expectation of “the smartest person in the room”?
  • How often do any of us discount potential solutions (possibly saving Serious Safety Events) due to someone’s job title, youthful appearance, or other factors that allow us to dismiss the value they can provide?
  • Creating an environment where all team members feel empowered to speak-up, and enough humility to accept that another passionate care-giver may bring more expertise or the better idea, can mean the difference between life and death for our patients.