Speaking Up

Abstract

How often have we seen something that was a potential hazard or risk, yet we walked on by? How often have we heard the line, “If anyone was going to have an accident, we knew it would be him/her?” When this happens, it reflects a culture wherein we believe that someone else will speak up or “handle it.” At the pointed end of the spear in our air medical community, the final barrier on Reason's Swiss cheese model is us—the pilots and crew members who head into the dark night. At this point, there is no one else to “handle it.” If we are not ever vigilant and do not maintain the highest level of situational awareness, then the adverse results can easily follow. One can have superbly designed safety management systems and neat looking bulletin boards and posters, but if we are not always aware and ready to spot potential gremlins, then we can miss the critical piece of the puzzle that would have stopped a potential accident in its tracks. Awareness is just part of the problem; action is the key. A strong safety culture insures that when any trouble is spotted, it is dealt with. If the pilot is pushing into weather that makes us uncomfortable or a crew member is exhibiting potentially unsafe behavior, the time to speak up is now, not later. There may not be a “later.” That sometimes means very simply speaking up and feeling comfortable doing just that. A just culture is the operative term here. “A just culture recognizes that individual practitioners should not be held accountable for system failings over which they have no control. A just culture also recognizes that many individual or active errors represent predictable interactions between human operators and the system in which they work. However, in contrast to a culture that touts no blame as its governing principle, a just culture does not tolerate conscious disregard of clear risks to patients or gross misconduct, such as falsifying a record, performing professional duties while intoxicated, etc.” 1 Brunt BA. Health Leaders Media, May 18, 2010. Google Scholar