Hat tip to Mike S. for pointing out this HBR article “Why “I’m Sorry” Doesn’t Always Translate.”
The piece talks about the differences in cultural norms about apologies in countries ranging from Japan, China, India, and the United States. I’m reading this, partly, with the context of thinking about hospitals being more open about apologizing to patients when mistakes are made. I’m in favor of openness and honesty… and not in favor of blame. Why do apologies equal blame in the U.S.?
From the story:
Our own work found that a core issue is differing perceptions of culpability: Americans see an apology as an admission of wrongdoing, whereas Japanese see it as an expression of eagerness to repair a damaged relationship, with no culpability necessarily implied. And this difference, we discovered, affects how much traction an apology gains.
The finding that Americans link apologies with blame is in keeping, we’d argue, with a psychological tendency among Westerners to attribute events to individuals’ actions. Thus it makes sense that in the U.S., an apology is taken to mean “I am the one who is responsible.” It also stands to reason that in Japanâ€”which, like many other East Asian countries, has a more group-oriented cultureâ€”apologies are heard as “It is unfortunate that this happened.” Researchers who’ve compared apologies in America and China have found a similar pattern: U.S. apologies serve to establish personal responsibility, while Chinese ones focus on the larger consequences of the transgression.
As I wrote about on Monday in my post about Dr. Berwick’s 1989 article, there’s a tendency to look for a single “bad apple” when there’s a problem in healthcare, instead of looking at systems and processes. I’m always reminded of Dr. Deming’s writing:
“American management is quick to assign blame to an individual when the problem, is in fact, a fault in the system.”
Deming said that 94% of problems and defects are due to the system (note he didn’t say 100%). I think the typical Western thinking is to assume a person is at fault 94% of the time.
When we teach leaders to stop blaming individuals, this is easier said than done. We’re fighting our DNA (tracing back to gorillas!) and it’s a big part of our Western culture.
So, if a physician or hospital apologizes for an error (which was most likely systemic in nature), does the recipient of the apology tend to blame the individual? There are studies that show patients sue less often when they receive a sincere apology. I’d rather prevent problems than apologize for them, but it’s interesting to think about all of these dynamics…
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the Chief Improvement Officer for the technology company KaiNexus.