Thinking Less: Coping with information overload

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I have had the great privilege of working with senior leaders in healthcare for several years. Senior managers, clinicians, nurses and midwives, board members, executive and non-executive directors, chief executives, and chairs. This is the second in a mini-series of blogs that draw from practical examples and academic literature and offer some ideas for responding to information overload at senior level. Let’s explore policies…

It is common for a multitude of policies to be acting on the same setting at any one time. One study (Carthey et al, 2011) looked at the example of an older person who was admitted for emergency surgery on a fractured neck of femur. The typical pathway involved 75 different policies, and that was in the acute hospital alone.

In one incident related to me, a quality committee reviewed a patient safety incident where a patient had come to harm when the clinical area was not cleaned between patients. After checking the organisational policy on cleaning clinical areas, the committee concluded that the member of staff was at fault for non-compliance. During the ongoing disciplinary process a different policy came to light related to the speed with which the clinician needed to see patients. The policies conflicted and it was IMPOSSIBLE for the member of staff to comply with both.

Many leaders spend time thinking about how to respond when things go wrong. In this example, the experience became something of a lightbulb moment for the leader involved: they had previously viewed their role as approving individual policies through governance committees and subcommittees of board. However, they now realized the most important value they could bring would be to look for, highlight, and flag interactions between policies. To ask questions like ‘what would stop you being able to follow this policy’? and to create the space for clinicians to use their professional judgement to make in the moment decisions that protect patient safety and quality.

In his provocatively titled book (The Safety Anarchist), Professor Dekker articulates a rigorous argument based upon years of academic research that policies and procedures stopped adding to the safety of our systems some time ago. They were associated with significant life protection for worker in years gone by but are now reducing our ability to respond in the moment to dynamic and complex environments. He also describes a counter-intuitive position whereby the more policies an organization has the more chances they are found non-compliant with a policy. And whilst this creates additional paperwork and scrutiny it doesn’t line up with the intended purpose of a safer workplace.

In the story shared with me, the team knew well how busy they were with patients, and how important cleanliness is to avoid harm. Imagine how different the investigation and learning would have been if the first question was ‘what stops you being able to clean between patients?’ Imagine the time saved if the policies weren’t developed and policed. Perhaps the harm to the patient would not even have occurred…

We need leadership in our healthcare to be less about paperwork and policing policy infractions and more about creating an environment for our clinicians to thrive and provide the best care they can to patients. It is important as a leader that you can take the time needed to not just approve more policies and protocols but ask serious questions that can help to remove barriers to excellent care like “What gets in the way of a clinician adhering to this policy?”. My advice to you as a leader would be to simplify and reduce the number of policies in your workplace. Reliance on policies alone can and has been used to defend bad care judgements as well as condemn clinicians when they are overstretched. You can support on-the-spot judgement of your clinicians that should be informed by but not solely driven by policy.

Less policy just might lead to more safety.