Just Culture – How IT and technology organisations can learn from healthcare

by Guest Author on October 26, 2021

in Guest Posts

Six months into my CIO role with a large technology company, I sat down with the Chief Executive. “You are doing a great job, we haven’t had many IT outages since you joined us”, I was told. My heart sank, it was the worst thing I wanted to hear. You may wonder why a well-intentioned positive comment was received badly by me, and I will explain why. However, I knew then that the culture at the organisation had gone sour, and that my time here would eventually be cut short. I was right on both counts.

I’ve also spent several years on the board of a healthcare organisation, which has taught me more about desirable culture than 20 years in the technology sector. Healthcare systems are unique in that their design is a result of many decades of political change, fluid funding strategies and a lot of human emotion. They are staffed by some of the most courageous, intelligent, and resilient groups of people you will ever come across. If you had a clean piece of paper, you would not design healthcare systems in the way they operate today, the design of healthcare systems is certainly imperfect. As we know, imperfect systems generally come with one unavoidable facet – Risk. 

Just Culture

Healthcare organisations take risk enormously seriously; risk management is central to almost everything they do. And yet, despite robust risk management, eventually a risk is exposed, and something goes wrong. The people most likely to trip over a risk, are those people who work on the front line. It isn’t the people in the back office or corporate functions of the organisation that will be exposed to risk, it is the clinical and medical operational staff who have chosen to work on the risky front line. The front-line staff didn’t design the imperfect system, it wasn’t they who created the risks, but they are the people who end up being affected by it. So, when an incident occurs, when risk is exposed and something regrettable happens, what is the right way to support those front-line staff?

Enlightened healthcare organisations have been building a Just Culture in recent years. It has many facets but there are two key tenants to a Just Culture that should be adopted. First, a recognition that the imperfect system, with its imperfect risks, was created by everyone who works in that organisation. Whether that be the finance team, the HR department, as well as the medical and clinical work force, everyone played their role (however small) in building the imperfect system. So, it is everyone which must take a shared responsibility for something going wrong. In practise this means supporting the front-line workforce most directly affect by what has happened, supporting the patients involved, and having a totally transparent and honest investigation into what happened. The second tenant is a commitment for everyone in the organisation to learn from what has happened and do everything to ensure it does not happen again. It doesn’t mean tweaking a few processes or adding something to a checklist (although that might be necessary), it means everything from new investments, a change to how the organisation was operating to implementing whole new ways of working. The plans an organisation might have had for the months ahead, are now different plans. 

Non-Enlightened organisations, some might say ignorant organisations, have found the opposite to be true. Trying to apportion blame solely to the front-line staff, whilst the people who work in the cosy corners of the organisation dish out their unhelpful hindsight – leading to two certainties. First a lack of transparency; people who have a distrust of the organisation will be less likely to be transparent about things that have happened. Second, a lack of learning; the organisation with lack of trust does not learn and does not do what is necessary to prevent reoccurrence. 

Technology Culture

Back to my conversation with the Chief Executive of the technology company – who noted that I, the CIO, must have done a good job to prevent IT outages in the preceding months. The counter point is that a run of outages during that time would have indicated I was doing a bad job. It has been my 20-year experience that IT stability (or instability) is something that is built up over many years – choices on investment, or lack of investment, choices to deliver things quickly, to get to market ahead of competitors, to prioritise new features over operational stability. The gradual creation of an imperfect IT landscape – and an inherently risky one – is built by each unconscious decision that the organisation makes over many years. Decisions that where right and justified at the time, but decisions that added to risky foundations brick by brick. 

When the inevitable happens in the IT world, it is the IT engineers and the operational staff who are on the sharp end of the exposed risks. Often at unsightly hours, and usually outside the working day, they work hard to quickly get systems back up and running. Regrettably, it hasn’t been my 20-year experience that technology organisations rally around the engineers on the front line. Too often, an organisation snarls at the inconvenience of the outage, and those from the cosy corners normally have a good dose of unhelpful hindsight to offer. Corporate amnesia often spreads, memories of the decisions that created the risky landscape are forgotten. Certainly, a collective responsibility and a Just Culture is not often seen. The organisation then misses out on the two most important things – transparency of what happened, and total organisation commitment to ensure it does not happen again. 

I have often been involved in discussions with senior executives as we convince ourselves that our organisation does not have a blame culture. Various bits of evidence, surveys and staff interviews have convinced us senior executives that a blame culture is not dominant. Many organisations I’m sure have that same conversation. But it is a little like checking what the weather is like and being satisfied that there isn’t a hurricane or biblical flood. Being satisfied that you are not the worst example of what you could become is hardly uplifting. I can’t recall too often technology organisations asking whether they truly have a Just Culture, whether there is positive trust across the organisation. It is great to see everyone celebrate the successes of an organisation, but it says more about an organisation as whether everyone takes a share in responsibility for its short comings. 

It is often said that technology organisations and IT departments should aspire to the airline industry. The airline industry is probably the most advanced in designing perfect systems. Imperfection and managed risk are not what the airline industry does – they work tirelessly to engineer the perfect system, the perfect procedures. But when an aeroplane has a minor problem or when there is a shortage of staff, the plane is grounded; the doors are shut, and disappointed passengers are sent home. In technology organisations, just like healthcare, you can’t close the doors until you have the perfect system. It is not practical to aspire to such perfection, and therefore the management of risk (rather than its avoidance) is always at the core.

As technology becomes central to virtually all industries and all companies, it is an inconvenient truth that all companies are therefore building imperfect, risky landscapes. Such risky environments are unavoidable and are the natural consequence of progress. Most companies will have some form of risk management function, it is essential to all good governance. But how many companies view risk management like they might view hand sanitiser, in that you should be able to spread it around and neutralise infectious risks? The enlightened technology company should now be seeing that good risk management should include the acceptance of failure and the culture of how failure is managed. In that regard, my experience in recent years is that technology companies can learn a lot from healthcare, and those technology companies who want to learn, grow, and have a culture of transparency should certainly do so. 

As for me personally, I started my own online homeware and furnishings business, and as a business leader I am taking my own learnings into my new organisation and trying to build a Just Culture

Guest article written by: Martin North is a technology leader and business owner, and technology writer. 

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