First, what is “cultural power distance”? Cultural power distance is an idea that emerged during the 1950s psychological and sociological studies of the world’s cultures. This idea basically covers an individual’s (or a groups) perception in the distance between the people at the “top” of the organization and the people at the “bottom” of the organization.
The United States is actually rated as one of the nations with the lowest cultural power distance. As we recently saw in the last election, both Barack Obama and John McCain tried to appeal to the “Joe sixpack” in every American. They attempt to make everyone believe that you could sit down and have coffee with your next door American president. This being said, politics and the general American society make reflect that value, but how often do you really see it within the health care environment?
One of the top contributors to “wrong site surgeries” is that nurses are unwilling to challenge a physician, one of the top contributors to medication errors are that LPNs are unwilling to challenge RNs, and one of the top reasons medical support personnel leave health care is that “only doctors are important”. Why do we see this in a clinical culture when the American culture on a whole is so distinctively flat?
The airline industry used to have this exact same problem. “NEVER QUESTION THE PILOT!” No one ever did. A flight engineer may know that they were about to crash, but the horrible itch of “never question the pilot” would override his good judgement and let them crash before saying anything.
Do you see this in your organization? What do you do to combat the “physician is infallable” cultures?
One of the things I have seen is a devoted and organization wide effort to implement a concept from LEAN methdology called “Stop the Line”. LEAN, typically used in manufacturing to increase effeciency and eliminate waste, is a very useful tool in health care overall. The “Stop the Line” concept is allowing any indiviudual in a process to stop the process. No matter where you are in the process flow, you have the ability to stop the entire project if you see a major problem. In health care this allows anyone from the registration desk on through to the surgical resident to stop a surgery or a procedure if they see something is wrong. This model empowers your staff to feel that they have a major part of the processes and flows of your organization and significantly narrows the gap they feel between themselves and others.
This is a very simple concept. However, cultures are never easy to change and never change quickly. A single class will not change your organization. This will have to be a large part of a multi year plan to evolve your systems and procedures. In the short run this may be painful, but in the long run it will add to clinical quality and increase your ability to provide high end clinical care.
