“The standard we walk past is the standard we accept”
– David Hurley, Governor of NSW and former Chief of Australian Defence Force
We arrive at work with certain expectations.
We expect that our work day is going to consist of a series of interactions that are geared towards the goal of achieving the best care for our patients. We expect that we will do this by working together, each to our own strengths, and within our own role, until we get the patient what they need and to where they need to go.
We expect that we will be respected for our knowledge, our skill and our experience. We expect that we will be supported should we run into trouble – if there is a gap in our knowledge, or if we need assistance with a procedure, or if there is a process or system issue with which we are not familiar. We expect that we will be given feedback that is constructive and useful, in order that we may enhance and improve our skills, individually and collectively.
In turn, we expect to treat our colleagues in the same way – with respect, support and feedback.
But sometimes things don’t quite work out like this.
We might get overlooked when we actually had something to offer. We might feel abandoned or isolated when we could have done with help, or at least a friend. We might be criticised for an action even when we were acting in good faith. Worse still, we might find out on the grapevine that comments were made in our absence about us or about something we did (or didn’t do).
This last scenario is one the most malignantly erosive acts that can occur within a workplace.
I suspect we have all been involved in something like this in some way:
We might be the recipient of such action – we may find out that the senior nurse was talking about how we failed a cannula on the ward and how our senior colleague had to come and rescue us; we may find out that the ward clerk was complaining to other ward staff that we were rude when we asked for a new prescription pad.
Alternatively, we might be a bystander when these back-door conversations take place. You might be in the tearoom when you hear two staff talking about how the new registrar missed the lumbar puncture (LP). You might be at the doctors’ station when you hear your consultant bagging her absent colleague for missing a fracture.
When this happens, it’s easy to be tempted to join in the stone-throwing. Because when we stand among the stone throwers, everyone is distracted from the fragility of our own glass house. We all miss cannulae or LPs sometimes; we probably once sent home a patient who came back two days later.
It is MUCH harder to speak up and say “Actually, we all make mistakes one time or another”, or “May I respectfully suggest that this is an unfair discussion, especially as the person involved is not here?”
To do so would mean:
(1) exposing our own vulnerability and imperfection
(2) risking finding ourselves “on the outside” of these exchanges, and potentially becoming a future target, and
(3) risking coming across as disrespectful or insubordinate, especially if the person making the statements is a senior colleague or a supervisor.
It is much harder to speak up. But imagine if we all committed to speaking up in the face of these exchanges? Eventually, the people among us who like to operate like this – by elevating themselves through diminishing the value of others – would have these interactions so consistently discouraged, that these actions would disappear over time.
Over time, we just may be able to build loyalty to each other, integrity around our actions – especially towards those who are not present – and this would contribute to a sense of cohesion.
The discussion around standing up for yourself or for another is gaining attention, particularly in the arena of Discrimination, Bullying and Sexual Harassment within the medical profession. It is recognised that bystander inaction helps perpetuate these behaviours, and it is worth thinking about how we, within departments, can support each other to speak up.
When we deliberately set expectations of ourselves and of our colleagues, and communicate these in a just and respectful manner, we build the courage to no longer walk past standards that are below those we are willing to accept.