Part 3 in a 3-part series
In part 1 and part 2 of this series, we used the example of nurses filling foam canisters in hospitals (to increase the odds of hand washing that protects patients from infection) to demonstrate what it takes to build accountability in an organization. Accountability requires promises, which in turn require effective requests (or offers) and acceptance of those requests. If the goal is for everyone involved to follow a similar process, i.e. standardized work, then it’s important that they all explicitly promise to do this. But what do you do if a nurse isn’t following standardized work? According to Mark Graban, the first thing to do is to ask why. He proposes asking the following about a surgeon who fails to follow “universal protocol” before a surgical case, but the same applies to nurses who fail to refill canisters.
We can ask:
- Is it a case where the person CAN’T do the work properly?
- Do they not know how? This might be a systemic training problem. The individual can’t be held accountable for that.
- Does the person not have the right resources? Maybe they WANT to do it right, but they just can’t. Leadership needs to help eliminate those barriers.
- Is it a case where the person WON’T do the work properly?
- Is the situation one where the person truly has a choice and they made a bad choice?