Safety Culture & Virtue 5: Tidying Up (8 mins)

Do you ever hear coworkers say, "Someone should fix that"? Have you ever wished Marie Kondo would come to your healthcare facility and tidy up? This episode looks at the physical environment as a sign of safety culture.

Key Points:

-The Van Halen Effect

-The Psychology of your workspace

-Someone should fix that

References:

-Ozden, E. (Sept. 28, 2021). The Reason Behind David Lee Roth’s Brown M&Ms Request for Live Shows. Rock Celebrities. https://rockcelebrities.net/the-reason-behind-david-lee-roths-brown-mms-request-for-live-shows.

-Vanbuskirk, S. (April 3, 2023). The Mental Health Benefits of Making Your Bed. VeryWell Health. https://www.verywellmind.com/mental-health-benefits-of-making-your-bed-5093540.

Transcript

In the 1980s, Van Halen added a clause to their tour rider to exclude all brown M&Ms from their dressing room, and every music group since then has included similar odd demands. What a bunch of divas! Or are they? As band member David Lee Roth explained, the brown M&Ms were a simple litmus test to determine if the rest of the contract had been followed carefully: If they walked into the dressing room and there were brown M&Ms in the bowl, they walked out because they knew that if they could not trust the venue. Had they correctly setup the pyrotechnics, the electrical connections, and the structural specifications also suspect? The outrageous requests were actually a safety measure to protect the band from harm.[1]

Today’s measure for effective safety culture is all about the brown M&Ms of our organizations: that one thing you can walk in and definitively say, “things are going well here.” And that one thing is do staff tidy up their workspace? This may seem like a strange idea since tidying equipment for an audit is about the only time that this concept comes up in a traditional safety assessment: where we would ask if the fire doors are blocked or if the crash cart is up to date and in the correct location. However, if you’ve ever been on a nursing unit when someone gets up and starts restocking cabinets and putting away stray papers, you may begin to sense why this simple action is a key symptom of virtuous safety culture.

Think about it. How many of us devoured everything we could about Marie Kondo’s Kon-Mari tidying methods? And there are studies about the psychological benefits of making one’s bed in the morning.[2] Is it any surprise that a tidy isolation cabinet could serve as a simple litmus test for compliance and safety standards? After all, cleanliness fights germs, and tidiness fights chaos.

This idea shows up in behavior as well. In my experience, people who feel that they have a voice are more likely to get up and tidy their workspace, but people who feel that they are not in control of anything and have no say in the organization will watch trash pile up and feel helpless to change it – even when a trash can is resting nearby. That’s why this measure works. You can send endless surveys to an employee, and they will faithfully answer that they know that they can go to their manager if there are any problems that come up. But it’s a lie. They know objectively that it is a possibility in the hierarchy but behaviorally they would never do it because they don’t feel like they have a voice, and it would only be risking to their own neck if they said something. 

On the other hand, if you walk by at 3 o’clock (because that’s often the slow time whether it’s 3pm or 3am) and you see an employee restocking their isolation gear, then you have a sure sign that this is an employee who is willing to speak up if something goes wrong. This is an employee who has a voice in the organization, and it shows in the way they “own” their workspace. If a unit is taking responsibility for the tidiness of their area, then they are also taking responsibility for safety and for their patient’s well-being.

Where this behavior is lacking, it leads to endless issues such as not updating software when the computer is due for upgrades, not double-checking a surgical order, and removing monitoring devices because they seem more troublesome than helpful. In short, it leads to a helpless apathy rather than an engaged and motivated employee.

So what if you walk around your organization and no one is cleaning or restocking and employees complain that they cannot find what they need when they need it? Delays are occurring and people are frustrated. What if they believe that “someone should fix the problem” but they do not seem to realize that they could be part of the solution? 

First, investigate. Make sure that there are no major system issues with the supply chain, for example. Sometimes the par stock is messed up and the supplies are not available because of errors in the par stock. Sometimes trash bags are unavailable or the service that picks up garbage doesn’t work on holidays. If the supply chain is good, then the next step us to start modeling the behavior you want to see. Trust me. If you are an administrator and you start rummaging through isolation gear and refilling water pitchers, it will set an example to staff for the behavior you want to see in them, and it will also help them with an immediate need which builds trust.

And lest you doubt my pro tip, I can vouch that it’s not just me that thinks this is a big deal. Of all the things I did as a nurse, tidying up and hourly rounding were the two behaviors that people commented on the most. People would ask me why I was doing it. People would comment that if they needed care, they would want me to be their nurse because of it. People would say how nice things looked when they came into work for the next shift. It was a small but powerful tool for culture change and, unlike many tools for culture change, it was immediately useful. After all, someone was going to need that isolation gear soon!

Now if you want to get bonus points, tidy up the break room – but please, oh please, do not go around and throw away your employee’s possessions. This happened to me repeatedly, and I’m still bitter. Surprisingly, though, many of the best hospitals have not mastered how to care for the break room. While the patient areas were clean, the employee areas were often filthy, full of expired food, piles of crumbs and takeout boxes, and layers of school catalogs selling Christmas wreaths and chocolate bars in July. So in addition to a good wipe-down, why not get a photo book or bulletin board for all the notes and cards that patients and caregivers send to the nursing staff? And it might be helpful to place some stickers conveniently near the fridge to make it super easy to label food appropriately with the date and owner’s initials. After all, when the break room is woefully neglected, it sends the message that employees are neglected. Healthcare professionals are often the worst about being so busy taking care of others that they are do not take care of themselves, and it often shows in the break room.

So if you have staff that get up and restock and tidy up without being asked, give yourself a point on our safety culture assessment. If you have a clean, liveable breakroom for staff, give yourself two points! But if you do not see these behaviors in your workplace, start by modeling it yourself and see how quickly it catches on. Once you communicate ownership and virtue to staff, it does not take long to take off as your workplace flourishes.

[1] Ozden, E. (Sept. 28, 2021). The Reason Behind David Lee Roth’s Brown M&Ms Request for Live Shows. Rock Celebrities. https://rockcelebrities.net/the-reason-behind-david-lee-roths-brown-mms-request-for-live-shows.
[2] Vanbuskirk, S. (April 3, 2023). The Mental Health Benefits of Making Your Bed. VeryWell Health. https://www.verywellmind.com/mental-health-benefits-of-making-your-bed-5093540.