I search for meaning (& patient safety)

It is likely that many reading this blog will be familiar with the Austrian Psychiatrist Victor Frankl and his book, Man’s Search for Meaning, published in 1946, soon after his liberation from Auschwitz.

The book describes Frankl’s experiences wedded with an interpretation of what he saw through a lens of Humanistic Psychology – this he later translated into his own field of Psychiatric theory, Logotherapy – literally, meaning-therapy.

First things first; if you haven’t read the book, please go to out and buy or borrow it.

Beyond this, the main principle of Logotherapy relates to the necessity for meaning in life; this is closely wedded to Nietzsche’s ‘He who has a why to live can bear almost any how’ – meaning beats method.

My reason for bringing this to my blog, other than to perhaps get people reading Frankl, is to reflect the similarity of this teaching, derived first from 19^th Century European Philosophy, then 20^th Century human suffering and now in use in 21^st Century patient safety and quality improvement in healthcare.

The modern interpretation relates to a component described at the conference I attended the other week in London, hosted by the BMJ/IHI.

The session focused on joy in the workplace – and, it’s associations with high quality, safe care.

Happy staff provide safe care.

So, how do you keep your staff happy?

How do you create a culture of joy in the workplace?

Safety. Psychological, physical, occupational, spiritual safety.

Only when we are not on the lookout for threat can we begin to connect with our imagination, our creative spark. Fear sends people to the bunkers, you sit and wait for the storm, the fear or the threat to pass.

One element therefore of creating a safe, enjoyable, creative workplace is to allow people to be themselves, away from fear, away from criticism and analysis.

This links to another great work – To Err Is Human, published in 2000, which reflects the untold story of patient safety in healthcare – showing for the first time to a stunned public, the extent of the harm, predominantly through error, mistake and human factors in hospitals.

The title focuses on the reality of life in any complex system – we are all human, we all make mistakes; it so happens that the more fearful an environment, the more likely are people to err, inherent in this concept, is the way to fix the system – how to address the errors.

This suggests that punishment or retribution for those who err does not help – it just makes everyone else more fearful and creates a culture of deeper fear; you improve safety by acknowledging that we are all human and all prone to error and the response to error is early identification and learning.

In recent years with Albert Wu and others’ work on second victims we have learned that learning for the person, the team or organisation involved with the error is not enough – the individual caught-up in the mistake needs support.

And here is the connection back to Frankl. A safe workplace is joyful. Safety is achieved through the staff having a sense of control of their own lives and meaning for their efforts.

This is when we call on the famous quote – ‘I’m not mopping the floor, I am helping to put a man on the moon’ (sorry for all these male slanted references – most are from last century).

Allowing staff to understand their role, to see that whatever they do is part of an overall project of improvement, of patient recovery and wellbeing, is critical.

When staff are involved in helping determine the way to achieve that goal, one that is meaningful to them, we have something special. When an adequate sense of safety pervades the workplace so that anyone can ask anyone why? Without fear; or when people can propose solutions, work-arounds or fixes that are outside of the hierarchy, outside a systematic approach to management and organisations, that is when you are on to something.

This is when meaning and joy come together to create a happy, resourceful, sustainable and safe workplace.