Goldilocks and the Power Gradient


You may be familiar with the story of Goldilocks and the Three Bears. In this sequel, when she goes to take a nap, the three beds available are all automatic hospital beds – a new model called the Power Gradient, a term she thought she’d heard before in Culture of Safety training.

Power Pin_example2_Page_6     Goldilocks figured she can work with any of the beds, but soon found that each handled power in a different way.

The head of the first bed was steeply inclined and really uncomfortable, but she couldn’t get the bed to change, and she needed to nap. Besides, she was scared of heights and afraid she’d fall out and hurt herself if she reached for the call button to speak up (as if anyone was listening!).

The second bed was totally flat. She felt unsupported and wanted to change the setting but there was a veritable committee of buttons to control all the functions and no clear directions.

The third bed had a nice incline — and was adjustable! — just right for napping or pressing the call button to order a meal when she woke up.

That’s what power gradients in an organization are like, too.

When power gradients are too steep — where the psychological distance between the staff and the person in authority is too great — staff may be too intimidated to speak up, to have a voice, or to offer suggestions. When power gradients are too flat, where a consensus is needed by everyone to take action, confusion for decision making and delays occur.

“What’s just right is when an organization’s leaders are inclined to use the right degree of power needed to get the job done, and staff are engaged in a teamwork environment that’s focused on ensuring the job is done well,” said Sharon DiRienzo, interim Vice President, Quality and Safety.

What do you think or feel when the time comes to talk with a more senior colleague or someone “with a title”? What do you think the people you work with are thinking when they need to talk with you? If you make a mistake on the job, would you prefer that someone you work with bring it to your attention or leave you hanging out to dry?

“In the end, of course, it’s not about them or you. It’s about why we’re here,” noted Pat Walsh, Manager, Risk Management/Patient Safety. “Main Line Health recognizes that to fulfill our commitment to the community, every member of the team needs to be engaged in the actions that support the mission. One important part of our mission is to eliminate preventable harm, and sometimes a steep power gradient gets in the way.”

Paoli Hospital has undertaken a campaign to ease the power gradient and increase communication using “I’ve Got the Power” buttons (see graphic), to remind all employees and partners to overcome the hesitancy to recognize and call out safety issues, regardless of perceptions of power and authority:

  • Speak up for Safety.
  • Communicate openly.
  • Work as a team.
  • Ask clarifying questions, and, if necessary, “ARCC UP.”

Said Walsh, “Our Culture of Safety relies upon each member of MLH taking personal responsibility for that which is under their control.”


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