Welcome to the new Outpatient Surgery website! Check out our login FAQs.
Fear: The Hidden Killer
Being afraid to speak up cripples communication, prevents teamwork and leads to tragic results.
Chet Wyman
Publish Date: May 25, 2016
OR Excellence
Chet Wyman, MD Chet Wyman, MD

Speaker Profile

  • Lectures extensively on effecting change and improving patient care.
  • Expert in promoting teamwork and improving communication between disciplines.
  • Co-author of "Trauma Anesthesia and Critical Care."

We in medicine have struggled for years to understand why errors continue to proliferate, despite many concerted efforts to reduce or eliminate them. One big reason is fear, says Chet Wyman, MD, chief medical officer for patient safety and quality at Johns Hopkins Bayview Medical Center in Baltimore. People are afraid to speak up. They don't know how to handle conflict constructively. And they feel powerless. In "Fear: The Hidden Killer," Dr. Wyman will explain how to eliminate fear and foster open communication.

  • The cycle of fear. It starts with the fact that we don't really see reality. We see our interpretation of reality. Since it's human nature to make assumptions about people's actions, we assume we know people's motives, but we often attach negative emotions or ulterior motives and respond accordingly. Then, when someone sees you respond in a negative fashion, she starts having negative thoughts, and that cycle just keeps spinning.
  • Close to home. In most hospitals, the nurses will tell you, This is really a doctor-run organization, and the doctors will tell you, This is really a nurse-run organization. The question is who's really running the organization. People feel powerless, which leads to a lack of trust and fear running rampant through our operating rooms.
  • The solution. You have to spend time together working as a team. This is something we don't do well as organizations. Departments of surgery have their own meetings, and departments of anesthesia have their meetings, and nursing has their meetings, but when does everybody ever get together to talk and practice as a team? We've known for 20 years that it's all about teamwork. But for the most part, people don't do it. They operate in silos.
  • The silo effect. When people don't communicate well, errors happen. And sometimes they're tragic errors. Nearly all of the Joint Commission Sentinel Reports involve failures to communicate. How is that possible in an industry with some of the brightest people in the world?
  • Practice teamwork. Great teams know you have to practice together as a team, because you have to learn how to anticipate each other, you have to understand each other's body language and you have to understand how people are thinking. Great athletes and musicians don't practice on their own. They practice as a team.
  • Dealing with conflict. There are great programs out there that help people learn how to speak to others respectfully and handle conflict effectively, but you can't just give people a course. You've got to do something on a regular basis. Maybe once a year take your entire OR staff somewhere and work on communication skills. Then maybe come back together as a group once a month and practice working through issues by using effective dialogue. Create scenarios and give people positions and have them work through how to do conflict. Conflict isn't necessarily bad. You want to have some conflict. But you've got to be able to handle it constructively. If you can't, people won't want to talk to each other. Without communication, there's no accountability, and without accountability you're not going to have results. OSM