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In airplane crashes and chemical industry accidents, in the infrequent but serious nuclear plant accidents, in the NASA Challenger and Columbia disasters, and in the British Petroleum gulf spill, a common finding is that lower-ranking employees had information that would have prevented or lessened the consequences of the accident, but either it was not passed up to higher levels, or it was ignored, or it was overridden. When I talk to senior managers, they always assure me that they are open, that they want to hear from their subordinates, and that they take the information seriously. However, when I talk to the subordinates in those same organizations, they tell me either they do not feel safe bringing bad news to their bosses or they’ve tried but never got any response or even acknowledgment, so they concluded that their input wasn’t welcome and gave up. Shockingly often, they settled for risky alternatives rather than upset their bosses with potentially bad news. When I look at what goes on in hospitals, in operating rooms, and in the health care system generally, I find the same problems of communication exist and that patients frequently pay the price. Nurses and technicians do not feel safe bringing negative information to doctors or correcting a doctor who is about to make a mistake. Doctors will argue that if the others were “professionals” they would speak up, but in many a hospital the nurses will tell you that doctors feel free to yell at nurses in a punishing way, which creates a climate where nurses will certainly not speak up. Doctors engage patients in one-way conversations in which they ask only enough questions to make a diagnosis and sometimes make misdiagnoses because they don’t ask enough questions before they begin to tell patients what they should do.
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Edgar H. Schein (Humble Inquiry: The Gentle Art of Asking Instead of Telling)