Process driven or People driven? What’s your Focus?
I had the privilege last weekend to be with a family grieving for one of their family members, Margaret, in ICU. I was sitting with them beside her as she fought for her life. At first I found myself being an observer. I sat back and took it all in. I watched the staff do their thing. It was their world and I was just a visitor.
It’s a workplace. It’s quite mundane really. Well so it seemed for them. It’s just like any other job, there are many machines, there’s lots of paperwork, measures, numbers and checks. Sometimes there are even double checks. And then there’s managing the fatigue of a long 12 hour shift.
It didn’t take me long to ask questions to know more. To understand more and to get a sense of how Margaret’s nurse, Steph, makes sense of her working world.
This is a person who understands her world. She’s been a nurse for 30 years and in ICU for 10. As much as her experience, knowledge and skills are an advantage or some may say an asset it can also become a risk. When you understand One Brain Three MindsTM then you understand how we make decisions. You can then start to understand more how Steph can easily be working in ‘Mind 3’ a majority of the time. She’s reliant on ‘gut instinct’ and ‘automaticity’. In other words she’s heavily reliant on her unconscious mind to make decisions and judgements for her.
How to manage it all?? How does she manage this risk?
I asked her more questions because that’s what I do. I know there are processes because I saw her following protocols. I wanted to know how she made decisions on the job. How she managed working on automatic or becoming complacent because she’s on autopilot.
She said one thing that stood out for me. She said in ICU some nurses are process driven and some nurses are patient driven! Steph stated that she knows there are processes to follow but she will always focus on her patient.
She gets a sense of how her patients are going by observing them not the machines. She said she ‘just knows’. It’s just a ‘thing’ (thanks James Ellis) that some of them have. Steph said not all nurses have it but she says it’s a critical part of care in ICU.
This told me a lot.
This says she understands how easy it is to get caught in process. Focussing only on process can be difficult to see the bigger picture. Things can get missed. Steph understands that although the nature of the job is repetitious and mundane the mere fact that she has a human being responding differently to her mundane world makes it a dynamic work environment.
So in the world of Weick and understanding High Reliability Organisations we know that when there are plans and processes we can easily become fixated and biased into thinking that they will prevail. This is the critical nature of resilience and adaptability. ICU nurses adapt quickly because they don’t always get so caught up in process.
When we talk with the people around us we learn how people perceive risk and understand their work environment. More importantly it allows us to understand how people manage their world and the risks
I learnt a lot over those days I sat with this family. One very important thing that we can learn from ICU staff is that they understand their world is complex when dealing with people and they never lose sight of that. The processes and protocols are there for a reason but they know that it’s also critical to get to ‘know’ the people they are dealing with to fully understand and manage their work environment. Adapting is knowing and understanding that a fixation on process doesn’t allow a person to learn and deal with risk.
GABRIELLE CARLTON
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Gabrielle Carlton
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