Learning from Everyday Work - Part 1
A Series on Learning and Patient Safety????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
December 02, 2024?|?Read Online
Introduction?
I was at the gym last week when something caught my eye on one of the overhead television screens - an old episode of Undercover Boss. For those unfamiliar with the show, its core premise involves inserting high-level corporate executives undercover (for a few shifts) as entry-level employees within their own companies. The general goal is to learn something about the state of frontline operations, the everyday lives of their workers and the challenges they face. Sometimes these insights are translated that into positive change (locally or at scale).
Unconvincing disguises and porous back stories aside, there is often a wholesomeness to the interactions on display - in the way workers look out for newcomers, the goodnatured ribbing they inflict on the newbie for their hopeless lack of shop floor skills, or the candour with which workers often talk about the challenges in their work and personal lives. Why they would choose to do so with a complete stranger (with a camera crew in tow), is completely beyond me - but it makes for good viewing.
Sprinkled throughout each episode are cutaway scenes of the leader in their native environment (aka head office): high-powered board room meetings, the many trappings of success and montages of dynamic “leadership” work in action. These are no doubt intended to create an emotional connection between the audience and the leader’s challenges. Personally, I find this implicit “leaderism” my least favourite part of the show.
This leaderism surfaces in various ways. Sometimes it is through invocation of the ‘leader-as-judge’ narrative, where poor practices are publicly “outed”, managers and workers named, shamed, and sometimes fired for issues that likely have deeper roots than implied. Another is the ‘leader-as-saviour’ arc: magnanimous offers of second chances, large unexpected bonuses and grand gestures of life-changing generosity for some young worker with an irrepressible spirit and an ineffable devotion to their minimum wage job.
Yes, it can be a tad contrived but whatever it lacks in nuance, it makes up by serving as an excellent reminder of two things: that everyday work is a crucial window into the health and success of organisations while simultaneously highlighting the pitfalls of trying to interrogate it without a sufficient awareness of the assumptions we bring to these situations.
The Golden Krust Carribean Bakery
Just as I glanced up at the screen, the CEO of Golden Krust Carribean Bakery and Grill, Lowell Hawthorne, having donned his minimalist “disguise” of a Rastafarian beanie, was walking into the kitchen of head chef Odean at their Fort Lauredale branch (about 16 minutes in to video below). What followed is workplace safety comedy gold - with a vibin’ reggae soundtrack to boot. Odean, all of 22 years old, knows his craft well and after the usual pleasantries, Odean hands Lowell a serious looking kitchen knife to get on with the job of prepping the red peppers.
Lowell nervously asks Odean if they have some safety gloves he could use, because “I don’t want to lose my fingers.” Odean cracks up at the suggestion. He doesn’t want Lowell to lose any fingers either, but knows of no gloves suited for the job - rather, you need to learn to “protect them for yourself”. Odean genially proceeds to teach Lowell the important skills he needs to handle a knife safely - starting with the 'tuck’ and ‘glide’.
In the next scene, Odean is demonstrating how to make his world famous, marriage-proposal-inducing, banana porridge. Lowell casually asks if Golden Krust has a standardised recipe book to follow (which we all know they obviously do). Odean unfortunately doesn’t display any awareness of it whatsoever. The vision cuts to Lowell debriefing his thoughts on the exchange. Lowell say “One way in which Golden Krust maintains consistency is through the Corporate recipe book - it’s essential within the Golden Krust system.”
I haven’t gone back to see how the story turns out for Odean. I do hope he gets to achieve his dream of opening his own restaurant. He certainly has the confidence and drive to do it. Lowell, for his part, comes across as a reflective and open-minded leader so there is a good chance he might look to the bigger picture rather than dwell on that particular faux pax. Yet, this little passage encapsulates many lessons for those of us that seek to study and improve everyday work.
Undercover Boss (perhaps unknowingly) taps into a timeless motif that cuts across cultures. Folklore and history are filled with stories of kings and leaders doing similar things, from Harun Al-Rashid (the Arabian Nights) to Akbar the Great (Mughal India) and tales of various Japanese Emperors. Not to mention Siddhartha Gautama’s 'four encounters’ while disguised as a commoner, arguably the defining experience on his journey to enlightenment.
At minimum, these stories illustrate the value to be gained (to those that govern) from direct connection with the everyday lives of people and the insights that are available from genuine efforts at developing empathy. The implications of this on patient safety improvement work are quite apparent, but just turning up with an empathetic mindset is not enough. The capacity to interpret everyday work in meaningful ways is vital too.??
How Safety is created in Everyday Work
Practitioners readily associate the work-as-imagined’ (WAI) and ‘work-as-done’ (WAD) distinction as a contribution of the Safety II paradigm. While this phrasing is certainly unique to Safety II, by Erik Hollnagel’s own admission, these are “two concepts borrowed from ergonomics” [1]. In fact, the rapidity with with the WAD/WAI framing caught on (as a “new” thing) was a cause of much bemusement amongst human factors and ergonomics (HFE) colleagues, who had been practicing within this philosophy for all of their careers. However, Safety II does introduce new shades of meaning to the concept.
A focus on normal work performance emerged as a foundational idea in HFE and has a pedigree that traces back to the B-17 cockpit controls studies conducted Chapanis and Fitts from seven decades ago. Chapanis wanted to understand the causes of increasing accidents during landing and takeoff in the World War II era allied bomber. But rather than relying on retrospective analyses of investigation reports, Chapanis focused his attention on the pressures of cockpit operations (normal work). This interest in work design and performance has endured as a central tenet of HFE ever since.
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Yet, given HFE’s origins in engineering psychology and the emergence of these ideas within the context of fairly well-defined human-system interactions (in military and commercial aviation and nuclear safety), early research and practice typically conceptualised safety as a function of optimal interactions between the design of engineered systems and the capacities (and limitations) of human operators.
There is nothing inherently wrong with this lens, yet its capacity to explain all the complex paths through which failures arise has narrowed over time. With the locus of interest (within the discipline) shifting towards industries (like healthcare) where networked and social complexity plays a bigger role in shaping risks than human-machine interactions do, the ideas about everyday work and how it shapes safety have evolved too.
A New Orientation to Everyday Work
This is where ‘new view’ approaches add something distinctly novel to our consideration of everyday work. We begin to see workers not just as operators of systems (which they often are in amongst other roles), but also as navigators of complexity. We begin to view workers as adaptable and adapting agents, who rely on expertise, experience, creativity and relationships (within their teams) to reconcile a multitude of conflicting goals and to balance tradeoffs in satisfactory ways. As famed organisational theorist Russell Ackoff once said, the job is no longer “to solve simple isolated problems, but to manage messes.”
This reframing entails two pivots. First, the nature of everyday work looks a lot less like a set of well-defined interactions and more like a continually changing landscape of constant adjustments that are made in context (and therefore no two decisions are ever alike). Second, the philosophy of safety enhancement activities expands out from a strict focus on technical optimisation to broad social/systemic one, which seeks to enhance the capacities of teams to succeed under varying conditions.
Future issues of The Human Stream will likely tackle specific conceptual & practice frameworks (Safety II, Safety Differently, HRO et cetera) separately and in more depth. For now, it will suffice to say that in order to enhance safety through meaningful engagement with everyday work, we must learn to recognise and amplify these positive capacities. This requires letting go of certain assumptions while adopting some beneficial ones.
What you look for is what you find
Several years ago, I ran a series of human factors and systems thinking workshops at a local hospital in Brisbane, Australia. I tried to make these as interactive as possible as my goal was as much to deepen my understanding of how various clinical and managerial colleagues approached questions of improvement, as it was to share some of my skills with them. One hypothetical scenario I would often put to groups would involve them receiving a request to review a hospital ward that was experiencing an increasing adverse event rate. I would then ask how each of them would go about developing an initial impression of the situation.
Many participants would talk about the attitudes and tools they might take into the project, some would go straight back to the adverse event data. Invariably, I’d elicit at least one response (usually from more senior attendees) about trusting one’s intuitions and how they had cultivated an innate ability to “read the signs” by walking the floor. To them, you could determine a lot about a team from an overflowing linen skip or a neglected patient journey board. While it is not my intent to criticise executives who take this view, it does come at a cost.
Much like in the Undercover Boss episode, if we latch on to deviations from an idealised standard, it severely limits our ability to go any further since the ‘problem’ has already been diagnosed in our mind (see earlier issues in this series to review some of these cognitive traps). If seeing an overflowing linen skip slants one’s thinking towards an initial impression of a poorly run ward, all subsequent data will only serves to confirm this. You are unlikely to gain a sufficient understanding of the shared logics within the team that make an overfilled linen skip tolerable in situations (or even a desirable in some contexts where other priorities take precedence).
Safety II has given us many memorable phrases and What-you-look-for-is-what-you-find (WYLFIWYF) is one such gem [2]. It highlights the specific blind spots and predetermined paths that accident investigations become predisposed to as a result of the accident causation models they emerge from. This extends to the study of everyday work as well.
In the linen skip example, there is an underlying assumption about the nature of work that primes one set of interpretations over others. Often, these problematic assumptions are the ones that privilege a ‘work-as-imagined’ (WAI) picture - for instance, expectations of widely standardised practice, a high view of procedural compliance and a sense-making approach that seeks explanations for deviations from idealised practice rather than to understand what actually goes on and why.
In my workshops, I would steer the conversation towards moving past initial impressions and towards the skills practitioners might require to elicit and explain why things happen in ways they do - not just from the standpoint of external observers but from that of those engaged in doing the actual work.While many things about my approach (in how I teach and practice) have changed in the ensuing years, my interest in everyday work has only deepened. To the point that today, for all of the emerging tools and frameworks on the horizon, I believe the patient safety movement stands to gain the most from becoming better at engaging and learning from everyday work.
Conclusion to Part 1
Odean likely didn’t follow the official recipe book because it was not how he learnt the ropes himself. This is not a failure if the recipes are embedded in the everyday routines and practices across the company, in how new people are trained and corrected, how workflows and stock are organised, through the expectations that front of house staff set with customers, and modulated to local tastes. Maybe its a sign of true success - that practices persist even after the recipe book is forgotten!
In many ways, the acid test shouldn’t be whether a porridge is prepared in accordance to standards set by head office executives, but rather whether it tastes good to paying customers who walk through your doors whether it be in Fort Lauredale, Florida or Irvington, New Jersey. Standard operating procedures (and recipe books) can be a means to that end but can equally get in the way of this.?
In part two, we look at specific strategies for practical learning from everyday work, from ways to create low-stakes feedback mechanisms, to storytelling and work shadowing. In the final issue of this series (the one after the next), I hope to pull together a compendium of methods to learn from failure and success.?
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? 2024 The Human Stream
Work Systems & Human Factors Engineer | Consultant & Educator | Specializing in talent retention, health-promoting job design, inclusive system change, organizational change-readiness, healthy organizational culture
3 个月So glad to read an article about the centrality of daily work - in this author's examples, to promote patient safety and service quality. I focus on it to promote employee retention and health. I also share a love for the show "Undercover Boss," although it might be contrived, I believe a lot of daily operations reality is lost when people climb the management ladder. It's so easy to forget or minimize what others are contending with.