EMS Insider, Expert Advice

The Resilient Organization, Part One

In desperate need of caffeine, Paul was looking for a coffee shop on his smartphone map app while walking out of his hotel. The porter pushing a luggage cart piled high with suitcases broadsided him and launched the phone into the air, followed by a crash landing in a large puddle. The mortified porter apologized immediately. Paul let him off the hook by saying, “This was my own fault. I was focused on my phone and walked right into your cart.”

After retrieving the submerged phone, Paul was thrilled to find that it still worked. The waterproof and shock resistant case he’d bought performed as advertised. It made his phone resilient.

Resilient products can take being tossed around and still function, like Paul’s cellphone case. Resilient people adapt well to trauma, tragedy, threats or significant stress. They bounce back from difficult experiences and still function. Medics and EMTs demonstrate this when they bounce back from dealing with an assaultive, combative, intoxicated patient who needs restraints to provide extra gentle care for a patient with a fractured hip.

When it comes to resilience in organizations, we tend to think of high-reliability organizations (HROs). Emergency service organizations must maintain resiliency, because one error by someone on the frontline can injure or kill employees or customers. “Resilience engineering” is the term used for designating products, systems, processes and organizations that are flexible and take the realities of human behavior into account as they focus on a new approach to safety.

Often when rules are broken by people working in organizations, the behaviors are driven by competing priorities or values, for example: “I know that I’m supposed to use a backer, but we get pressured for fast response times and I didn’t think that the tree branches were that low.”

Safety competes with production, or operations, or privacy. It’s common for managers to be surprised and/or frustrated when people choose to not follow a safety rule, but they are unlikely to do so when the safety rule interferes with something the organization (or the employee) values more—like money. HROs are building resiliency into their culture by paying very close attention to these values trade-offs. They are communicating obsessively with front line employees about the inevitable risks associated with trying to maintain that delicate balance between mission and safety.

It’s common to hear stories about a team member who spoke up when they saw a potential risk, and their immediate intervention saved someone’s life. “If I hadn’t waved away the helicopter, it would surely have struck those wires.” This type of story has become emblematic of the need for team members to speak up. There’s only one problem with it: In these stories, intervening always saves the day (or the patient).

Resilient organizations are paying attention to another metric: What happens when the person speaks up, production comes to a screeching halt and it turns out the person providing the warning was mistaken? Nothing was wrong, no undesired outcome was averted, but now production or patient care stopped (and egos were damaged) while we analyzed the potential risk. What happens to that person? Are they still a hero for speaking up, or are they overtly or covertly discouraged from speaking up in the future?

Resiliency, it turns out, is not just rooted in capturing rich information associated with known errors and near-hits, and evaluating whether the present system and behavioral expectations are adequate. Resiliency also includes paying close attention to how employees are treated when they do report problems, regardless of whether the perceived risk is validated, even when egos and production are impacted.

In future columns we will show you how to move your organization toward resiliency. In the meantime, watch where you’re walking with your phone!