Comments on: "No Blame" Doesn’t Mean "No Accountability" http://www.leanblog.org/2009/10/no-blame-doesnt-mean/ Mark Graban's leanblog.org - Lean Healthcare, Lean Thinking, Lean Manufacturing, Toyota Production System Thu, 09 Feb 2012 15:26:57 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Of Course An Individual Got Blamed — Lean Blog http://www.leanblog.org/2009/10/no-blame-doesnt-mean/#comment-6269 Of Course An Individual Got Blamed — Lean Blog Tue, 05 Jan 2010 09:02:24 +0000 http://leanblog.bigbigdesign.net/2009/10/no-blame-doesnt-mean-no-accountability/#comment-6269 [...] When will we evolve (pun intended) away from using blame as a default “management” strategy? Will more hospitals adopt “no blame” cultures like ThedaCare did, moving away from “blaming and shaming” as the norm? Note: “no blame” doesn’t mean “no accountability” (as Dr. Bob Wachter wrote about). [...] [...] When will we evolve (pun intended) away from using blame as a default “management” strategy? Will more hospitals adopt “no blame” cultures like ThedaCare did, moving away from “blaming and shaming” as the norm? Note: “no blame” doesn’t mean “no accountability” (as Dr. Bob Wachter wrote about). [...]

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]]> By: Marc Rouppe van der Voort http://www.leanblog.org/2009/10/no-blame-doesnt-mean/#comment-5630 Marc Rouppe van der Voort Sat, 10 Oct 2009 09:17:47 +0000 http://leanblog.bigbigdesign.net/2009/10/no-blame-doesnt-mean-no-accountability/#comment-5630 I tend not to agree. What en how do people learn the first weeks at their new job? How do clinical leaders and team leaders respond when someone does not wash their hands? How does the team reflect on this issue? How does the team receive feedback on the consequences of not washing their hands?<br /><br />In my experience hospitals put a lot of energy in putting up signs and similar actions to remind people of the desired behaviour, but this is in miy view the least effective part of changing the system. More effective is the system by which people learn and by which dominant thinking patterns and dominant behaviours develop. <br /><br />I learned from Toyota 'be hard on processes and soft on people'. I think also washing hands is a system problem.<br /><br />Marc<br />Manager Innovation<br />St. Elisabeth Hospital<br />Tilburg, the Netherlands I tend not to agree. What en how do people learn the first weeks at their new job? How do clinical leaders and team leaders respond when someone does not wash their hands? How does the team reflect on this issue? How does the team receive feedback on the consequences of not washing their hands?

In my experience hospitals put a lot of energy in putting up signs and similar actions to remind people of the desired behaviour, but this is in miy view the least effective part of changing the system. More effective is the system by which people learn and by which dominant thinking patterns and dominant behaviours develop.

I learned from Toyota 'be hard on processes and soft on people'. I think also washing hands is a system problem.

Marc
Manager Innovation
St. Elisabeth Hospital
Tilburg, the Netherlands

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]]> By: Wiljeana Glover http://www.leanblog.org/2009/10/no-blame-doesnt-mean/#comment-5627 Wiljeana Glover Fri, 09 Oct 2009 14:48:06 +0000 http://leanblog.bigbigdesign.net/2009/10/no-blame-doesnt-mean-no-accountability/#comment-5627 I think that hand-washing is a personal accountability issue. I wonder if proper hand-washing and hygiene rates would be higher if the focus shifted from keeping patients healthy to keeping the health practitioners healthy. Would people be more likely to engage in proper hygiene practices if they are thinking about their own health? I'm sure this will not completely solve the issue (some people will simply not be responsible, regardless of the motivation), but taking a 'personal safety' instead of a 'patient safety' stance could be a more effective motivation for some. I think that hand-washing is a personal accountability issue. I wonder if proper hand-washing and hygiene rates would be higher if the focus shifted from keeping patients healthy to keeping the health practitioners healthy. Would people be more likely to engage in proper hygiene practices if they are thinking about their own health? I'm sure this will not completely solve the issue (some people will simply not be responsible, regardless of the motivation), but taking a 'personal safety' instead of a 'patient safety' stance could be a more effective motivation for some.

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]]> By: Anonymous http://www.leanblog.org/2009/10/no-blame-doesnt-mean/#comment-5626 Anonymous Fri, 09 Oct 2009 13:47:49 +0000 http://leanblog.bigbigdesign.net/2009/10/no-blame-doesnt-mean-no-accountability/#comment-5626 I never thought the dictionary definition of "accountable" had anything to do with "accounting" even though they start with the same letters. I think you're nit picking about semantics, Tom. I'd rather hear an example of where you think accountability or responsibility is called for instead of vaguely blaming "the system."<br /><br />Rather than being cute about language, please give us an example that helps. I never thought the dictionary definition of "accountable" had anything to do with "accounting" even though they start with the same letters. I think you're nit picking about semantics, Tom. I'd rather hear an example of where you think accountability or responsibility is called for instead of vaguely blaming "the system."

Rather than being cute about language, please give us an example that helps.

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]]> By: Tom Jackson http://www.leanblog.org/2009/10/no-blame-doesnt-mean/#comment-5625 Tom Jackson Fri, 09 Oct 2009 12:18:09 +0000 http://leanblog.bigbigdesign.net/2009/10/no-blame-doesnt-mean-no-accountability/#comment-5625 In general I agree. Ultimately, failure to adhere to standard work is grounds for dismissal. Having said that, let me express a concern about the work "accountability." Perhaps it is time to rethink. Isn't this word "code" for management accounting? As a practical matter, the audit system of management accounting is all about blame. I prefer the term "responsibility." Actually, this is the term that John Shook uses in his latest Shingo Prize winning book, Managing to Learn. <br /><br />Tom In general I agree. Ultimately, failure to adhere to standard work is grounds for dismissal. Having said that, let me express a concern about the work "accountability." Perhaps it is time to rethink. Isn't this word "code" for management accounting? As a practical matter, the audit system of management accounting is all about blame. I prefer the term "responsibility." Actually, this is the term that John Shook uses in his latest Shingo Prize winning book, Managing to Learn.

Tom

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]]> By: Jamie Flinchbaugh http://www.leanblog.org/2009/10/no-blame-doesnt-mean/#comment-5624 Jamie Flinchbaugh Fri, 09 Oct 2009 10:04:57 +0000 http://leanblog.bigbigdesign.net/2009/10/no-blame-doesnt-mean-no-accountability/#comment-5624 I agree and well said, but when did people start thinking that 'focus on the system' and 'accountability' are mutually exclusive? Having a system for accountability means there is a way to know if people aren't following the system and a consistent means of corrective action, even if that leads to dismissal. Not having a system is randomly seeing things get out of control and then finding someone to 'make an example.' There is a difference.<br /><br />It's not ether or.<br /><br />Jamie I agree and well said, but when did people start thinking that 'focus on the system' and 'accountability' are mutually exclusive? Having a system for accountability means there is a way to know if people aren't following the system and a consistent means of corrective action, even if that leads to dismissal. Not having a system is randomly seeing things get out of control and then finding someone to 'make an example.' There is a difference.

It's not ether or.

Jamie

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