Don’t look Medusa in the eye

After attending an NHS conference yesterday, I was cut-up on the way home. Not emotionally: that will come the next time my credit card bill arrives. But I was cut-up by another car, the driver of which thought that it was perfectly fine to merge from his lane into mine without indication, or apology. As a result, I was forced to brake hard and release a torrent of expletives that my mother must never hear.

I can’t remember the model of the car, but it was a hatchback. It was a colour that could generously be described as ‘lime green’ and it was being driven by someone with an unfortunate skin complexion and an even more unfortunate air of invincibility that belongs to all young male drivers. It had tinted windows, a sawn-off exhaust that made it sound emphysemic, thin tyres on brushed chrome alloys, an aerodynamic spoiler and a sound system that wouldn’t be out of place at Glastonbury.

I caught up with him at the next set of lights, and pulled up alongside him. My gut instinct was to repeat the expletives, perhaps adding a few more in for good measure. Or perhaps I should have taken the moral high ground and offered some sage advice on the perils of the road. I could have asked him how his mother would feel if she got a call saying he had been in an accident (relief possibly?).

In the end, I settled for a much more cutting ‘Does your mum know what you’ve done to her car?’

He clearly wasn’t expecting that, and as his bum-fluff lined chin dropped and his brain searched for a witty riposte (comes with age, sunshine), the lights changed. I smiled to myself, and turned left.

I like to think he sat there for a minute, ruminating on his life, before eventually being honked by the car behind him, which would lead him to offer an apologetic hand in his rear mirror before crawling off, forever changing gears smoothly and feeding the wheel, and always wondering what happened to the man that turned his life around that day. The reality is that he probably shrugged his shoulders, turned up ‘da tunes’ and went about harassing other motorists.

The point is this: whatever he did to his car, whatever colour he painted it, whatever Blaupunkt system he installed, however hard he revved the engine at lights and other motorists, it would still be the same car. Essentially, a hairdryer on wheels.

It got me thinking (and getting around to the point of this blog) about a key theme that came out of the Patient Safety Congress: that of culture. “We need to change the culture!”, “We must have a more open culture!”

I agree, entirely. The challenge is not in what but how. Saying “We need to change the culture” on its own is the equivalent of our mutual friend putting a set of shiny alloys or a fat exhaust pipe on his mum’s car. In the end, it will still be his mum’s car, fundamentally limited, however pimped up it is on the outside. If you really want to pimp a car (or the performance of a large public body), you’ve got to get the hood up and get into the engine, where the magic is. As John Travolta once put it “We’ll get some overhead lifters and four barrel quads…fuel injection cutoffs and chrome plated rods oh yeah…”

If you want to change the culture, I don’t think you do it by saying you are ‘changing the culture.’ Cultures don’t want to be changed. They are nebulous, ever shifting, and bloody stubborn. My own view is that the key to successful culture change is not to focus on culture change: to not look Medusa in the eye directly.

That’s because the culture of an organisation is the output from everything that you put in and if you want to change it, you have to do it without the culture noticing, or it will come at you and turn you to stone.

How? By doing the practical stuff. By developing an understanding of how to maximise the performance of staff (answer is not by demanding more for less); By designing ‘in’ safe working environments and tools that make it easy to do the right thing, and designing processes that make it hard to do the wrong thing; by striving to become a high reliability, listening and learning organisation (all human factors) by ensuring that decision making is devolved to those people who are best placed to make them. These are things that can be done, systematically, over time, and shared with others who are striving for the same goals.

Eight

It’s an exciting time if you are a football fan, with the World Cup in Brazil just around the corner. As I write this, breweries, tinned hot dog producers and flat-screen TV manufacturers up and down the land will be hoping that both England and the weather turn up on time. In workplaces, people will be planning annual leave and forecasting sick leave in roughly equal measure. Tabloid newspapers will be printing cut-out prayer mats and giving away free flags to whip the nation into a ‘1966’ frenzy before we inevitably go out on penalties in the quarter-finals. Probably.

It’s a chance to see some of the world’s best players. And Wayne Rooney. Argentina’s Lionel Messi will be causing defenders to wake up in cold sweats, whilst Cristiano Ronaldo will be doing the same for many female supporters. Spain will inevitably win the thing, having passed the ball around for a month, probably texting their mates and signing autographs at the same time, before eventually deciding they’ve had enough for the day and decide to put a few goals past their demoralised opponents. England, well, it’s England isn’t it? The Forrest Gump of International Football – “you never know what you’re gonna get.”

Still, the fans of all nations can look forward to the spectacle.

Apart from a few. Marcleudo de Melo Ferreira is one. He was working on the stadium in Manaus where England are due to play Italy when he fell 35 metres from the roof which was being installed. He was 22 years old and the third person to die during the construction of the World Cup stadiums. Since his death, after which there was a period of mourning before work resumed, five more workers have died, bringing the total to eight who have been killed during the construction phase.

It’s no secret that Brazil’s tournament has been beset by problems: delays, a collapsed roof, budgeting issues and an immovable deadline. On its own, eight doesn’t sound like a big number. After all, it’s less than double figures and if you can’t make an omelette without breaking a few eggs, can you expect to build twelve stadia without killing a few workers? Is that an acceptable price to pay? The problem with the number ‘8’ is that it’s just a number. It doesn’t tell the story of the workers who gave their lives for the World Cup to happen and the impact that their deaths would have had on their families, children, wives and co-workers. The ripples of their deaths will go on in their communities long after the carnival has finished and England have trudged home sheepishly.

It’s hard to get details surrounding the circumstances of the eight deaths, other than what has been stated in the press so understanding the root causes is pure speculation. Poor management systems? Weak leadership? Faulty or poorly maintained equipment? Lack of training? Weak safety culture? Time pressures? Possibly all played a part. The 2012 Olympic build in London showed that you can build significant infrastructure safely by embedding a strong safety culture (no workers were killed during construction) but to compare the two is a little unfair: the UK has a world-class regulatory system and has made major strides in the last century in protecting workers from injury and ill-health and even in the UK the construction industry remains one of the most dangerous with 29 deaths between April and December 2013.

Everyone knows safety is important but it’s crucial that each fatality is learnt from, that the foot remains on the pedal in driving safety improvements. Because whilst each dead worker is represented by a statistic in official figures, they represented so much more to their own families and colleagues. We should constantly seek new ways of communicating risk and ‘nudging’ people to truly understand not just the risks of their work, but the impact that their failure to follow safe practice can have on others. I’ll leave you with this picture as an example.