Kathleen M. Sutcliffe

Communication failures: an insidious contributor to medical mishaps.

Purpose To describe how communication failures contribute to many medical mishaps. Method In late 1999, a sample of 26 residents stratified by medical specialty, year of residency, and gender was randomly selected from a population of 85 residents at a 600-bed U.S. teaching hospital. The study design involved semistructured face-to-face interviews with the residents about their routine work environments and activities, the medical mishaps in which they recently had been involved, and a description of both the individual and organizational contributory factors. The themes reported here emerged from inductive analyses of the data. Results Residents reported a total of 70 mishap incidents. Aspects of “communication” and “patient management” were the two most commonly cited contributing factors. Residents described themselves as embedded in a complex network of relationships, playing a pivotal role in patient management vis-à-vis other medical staff and health care providers from within the hospital and from the community. Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of medical mishaps. Conclusion The occurrence of everyday medical mishaps in this study is associated with faulty communication; but, poor communication is not simply the result of poor transmission or exchange of information. Communication failures are far more complex and relate to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict. A clearer understanding of these dynamics highlights possibilities for appropriate interventions in medical education and in health care organizations aimed at improving patient safety.

Comparing Alternative Conceptualizations of Functional Diversity in Management Teams: Process and Performance Effects

Functional diversity in teams has been conceptualized in a variety of ways without careful attention to how different conceptualizations might lead to different results. We examined the process and...

Mindfulness and the Quality of Organizational Attention

Mindfulness as depicted by Levinthal and Rerup (2006) involves encoding ambiguous outcomes in ways that influence learning, and encoding stimuli in ways that match context with a repertoire of routines. We add to Levinthal and Rerups conjectures by examining Western and Eastern versions of mindfulness and how they function as a process of knowing an object. In our expanded view, encoding becomes less central. What becomes more central are activities such as altering the codes, differentiating the codes, introspecting the coding process itself, and, most of all, reducing the overall dependence on coding and codes. Consequently, we shift from Levinthal and Rerups contrast between mindful and less mindful to a contrast between conceptual and less conceptual. When people move away from conceptuality and encoding, outcomes are affected more by the quality than by the quantity of attention.

Management team learning orientation and business unit performance.

Although research has suggested that teams can differ in the extent to which they encourage proactive learning and competence development among their members (a team learning orientation), the performance consequences of these differences are not well understood. Drawing from research on goal orientation and team learning, this article suggests that, although a team learning orientation can encourage adaptive behaviors that lead to improved performance, it is also possible for teams to compromise performance in the near term by overemphasizing learning, particularly when they have been performing well. A test of this proposition in a sample of business unit management teams provides strong support. The results confirm that an appropriate emphasis on learning can have positive consequences for team effectiveness.

Uncertainty in the transaction environment: An empirical test

Previous studies examining the relationship between uncertainty and vertical integration have produced a conflicting set of results. To clarify this puzzle we drew on the literature to conceptualize three distinct forms of uncertainty—primary, competitive, and supplier—and hypothesized that each had a different effect on vertical integration. The hypotheses were tested using experimental data collected from 308 managers. Consistent with our prediction of differential effects, we found that primary and competitive uncertainty were negatively associated with the decision to vertically integrate, but supplier uncertainty was positively related to the vertical integration decision. No interaction effects were found. Implications for theory and research are suggested.

The Safety Organizing Scale Development and Validation of a Behavioral Measure of Safety Culture in Hospital Nursing Units

Background:Evidence that medical error is a systemic problem requiring systemic solutions continues to expand. Developing a “safety culture” is one potential strategy toward improving patient safety. A reliable and valid self-report measure of safety culture is needed that is both grounded in concrete behaviors and is positively related to patient safety. Objective:We sought to develop and test a self-report measure of safety organizing that captures the behaviors theorized to underlie a safety culture and demonstrates use for potentially improving patient safety as evidenced by fewer reported medication errors and patient falls. Subjects:A total of 1685 registered nurses from 125 nursing units in 13 hospitals in California, Indiana, Iowa, Maryland, Michigan, and Ohio completed questionnaires between December 2003 and June 2004. Research Design:The authors conducted a cross-sectional assessment of factor structure, dimensionality, and construct validity. Results:The Safety Organizing Scale (SOS), a 9-item unidimensional measure of self-reported behaviors enabling a safety culture, was found to have high internal reliability and reflect theoretically derived and empirically observed content domains. The measure was shown to discriminate between related concepts like organizational commitment and trust, vary significantly within hospitals, and was negatively associated with reported medication errors and patient falls in the subsequent 6-month period. Conclusions:The SOS not only provides meaningful, behavioral insight into the enactment of a safety culture, but because of the association between SOS scores and reported medication errors and patient falls, it also provides information that may be useful to registered nurses, nurse managers, hospital administrators, and governmental agencies.

Firm and industry as determinants of executive perceptions of the environment

This study examines variation in top executives’ environmental perceptions within firms and within industries. More specifically, we investigate how industry and organizational membership affect top executives’ perceptions of five environmental attributes. Results indicate that significant homogeneity of perceptions exists within firms and also within industries. Approximately 40 percent of the variance in individual top-level executives’ perceptions of aspects of their respective organization’s environment is explained by their organizational and industry membership. Implications of the findings for strategic management and organization theory and for future research are presented.

Hospitals as Cultures of Entrapment: A Re-Analysis of the Bristol Royal Infirmary:

High performance is often attributed to an organizations culture. However, culture can just as easily undermine performance when it blinds decision makers to important performance issues and entraps them in unfortunate courses of action from which they cannot disengage. The dynamics of cultural entrapment are explored in the case of the Bristol Royal Infirmary, in which pediatrie cardiac surgeries continued for over a fourteen-year period despite evidence of poor quality care and performance that was far below that of other comparable pediatrie surgical centers. A single organizational process of behavioral commitment explains how the cultural mindset originated and why it persisted. The sequence of small, public, volitional, and irrevocable action; socially acceptable justification for that action; and the potential for subsequent activities to validate or threaten the justification created a causal loop that stabilized subsequent action patterns.

Learning Through Rare Events: Significant Interruptions at the Baltimore & Ohio Railroad Museum

The collapse of the roof of the Baltimore & Ohio (B&O) Railroad Museum Roundhouse onto its collections during a snowstorm in 2003 provides a starting point for our exploration of the link between learning and rare events. The collapse occurred as the museum was preparing for another rare event: the Fair of the Iron Horse, an event planned to celebrate the 175th anniversary of American railroading. Our analysis of these rare events, grounded in data collected through interviews and archival materials, reveals that the issue is not so much what organizations learn “from” rare events but what they learn “through” rare events. Rare events are interruptions that trigger learning because they expose weaknesses and reveal unrealized behavioral potential. Moreover, we find that three organizing routines---interpreting, relating, and re-structuring---are strengthened and broadened across a series of interruptions. These organizing routines are critical to both learning and responding because they update understanding and reduce the ambiguity generated during a rare event. Ultimately, rare events provoke a reconsideration of organizational identity as the organization learns what it knows and who it is when it sees what it can do. In the case of the B&O Railroad Museum, we find that the roof collapse offered an opportunity for the organization to transform its identity from that of a museum to that of an attraction.

Organizational resilience: Towards a theory and research agenda

In this paper we outline the contours of a theory of organizational resilience as well as a research agenda. First, we identify how the notion of resilience has become increasingly important to all organizations and argue that organization theory currently does not reflect its importance. Second we reconcile varying definitions of resilience to create a definition of organizational resilience. Third, we identify the affective, cognitive, relational, and structural mechanisms constitutive of organizational resilience. Fourth, we develop research questions regarding the antecedents and mechanisms of resilience.