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Why? Because we've always done it that way
FEBRUARY 1999, VOL 69, NO 2
EDITORIAL
Why? Because we’ve always done it that way f you have ever been around a toddler who wants an answer, you have heard the “why” question. Toddlers have a strong sense of will, and when an answer does not satisfy their curiosity, they continue probing and asking “why?” Toddlers are not the only ones who raise questions and demand reasons, but at their age, they are able to question without judgment. Questioning someone is often perceived as challenging authority, and as adults, a resulting response, “Because I said so,” is blurted in frustration. If questioning is not encouraged and supported in health care settings, it could be because the people are vested in the idea “Because we’ve always done it that way.” As we reach adulthood, childlike behaviors are quickly replaced. We stop asking why as often and persistently because it seems challenging to others, even though we know it is important to understand and share rationale. When people do question information, they find themselves apologizing for asking, as though questioning is not an acceptable behavior. In hierarchical health care systems, asking why is not always an accepted practice because it appears to be challenging the system. During our struggles to make changes quickly and kill the sacred cows, the “why” question can be perceived as problematic and challenging authority, and it might even be frowned upon. Asking “why” sometimes brings
out answers we do not like or creates work we really do not need. As we are forced to change the systems we work in, asking “why” can be a way to get to the root of actions that may need to change.
WHY, WHY, WHY? When you talk to peers at a seminar, you get a sense of who feels comfortable asking why in their settings and who knows that the question is perceived as a challenge. It is also obvious that “why” is not an uncommon question in ORs. Why do we bring patients to the preoperative holding area from the preadmission area that is right down the hall to make them wait before surgery? Why do we prep for 10 minutes because it is surgeon’s preference when we have known for years that it is not an acceptable length of time? Why do we cover back tables if the surgeon is going to be late when we do not cover them during long procedures? Why do we document tasks on the nursing record when the outcomes are more important? Why does every place have to have its own intraoperative record when we are supposedly providing the same care? Why does everyone get a 3% raise at the time of performance review when some are better performers than others? Questions might be asked over and over because the answer “Because we’ve always done it that way” is not a sound, convincing rationale. 338 AORN JOURNAL
PERSISTENCE AND PATIENCE Have you ever asked a person “why,” and were not satisfied with the answer, yet BRENDA s. You knew GREGORY DAWES that you should not pursue the question? Feeling as though you received inadequate rationale should be a trigger to keep probing for sound reasoning. Questioning is not a way to rock the boat; asking “why” dredges up information and exposes performance that is deemed acceptable but that does not necessarily serve a purpose. Given the following scenario, when people ask “why,” the first response might be matter-of-fact and to the point. Question: Why do nurses check the camera and video equipment in the morning before a procedure when the nursing assistants have time to check it the day before? Answer: We need to be sure it works for the procedure, and the nurses will be held responsible if it does not. Inquisitive minds will recognize the matter-of-fact tone of information sharing and want to make a second inquiry. When a person speaks with authority, the scene does not allow a person to feel comfortable forcing the issue. Unless inquiries continue, the practices in question will also continue.
FEBRUARY 1999, VOL 69, NO 2
Question: I know that we want to make sure it works for the procedure, but why do nurses check it in the morning when there is time the day before and when we have personnel who can do it? Answer: We had a problem one time, and because we are using the equipment that day, we want to be sure it works the day of the procedure. The second inquiry might bring out a tone of paranoia, causing either participant in the conversation to feel uncomfortable. Questioning is not a game, and its purpose is not one-upmanship. Questioning behaviors will not work if the individuals involved in the conversation cannot come to terms with the fact that rationales do not always exist for behaviors and that some behaviors need to change. Question: I know that we are using the equipment that day and we want to be sure it works, but why is it important that nurses check the equipment the morning of the procedure when there is time and other personnel who can check the equipment the day before? Answer: We know that equipment problems can occur, and after having done this procedure with this physician for so long, I know it is just better if we check it in the morning. A thud question might push a button and challenge the emotions of the participants. Seniority or level of experience is often included in the rationale. Being
patient and evaluating the tone of the conversation can decrease a challenging atmosphere between people, but even in circumstances in which behaviors are acceptable, it is still difficult to not feel challenged. People who are questioning rationale are challenging the activity with an idea that it might be worth changing. These signs might lead the inquirer to know he or she is on the road to determining possible opportunities for change. After asking a person to rationalize behaviors several times, we revert to child-adult behaviors, and another inquiry will bring out the well-known response “Because we’ve always done it that way.”
from a traditional, hierarchical structure to a forward-thinking, futuristic setting need to encourage creativity in the problem solving efforts. The difficult part is to get the opinions out of the lounges and into a forum where changes can take place. Asking questions and being persistent in determining whether rationale is based on professional organizations’ standards, research, or other sound bodies of knowledge can only serve to accomplish positive outcomes when everyone has buy-in.
MOVING CREATIVITY INTO PROBLEM SOLVING Organizations embedded in trust, strong communication patterns, and respect among individuals possess qualities of survivors. The individuals who are decision makers determine the best way to seek information from others and are willing to give up their own beliefs to allow questions to be asked without reprimand. When “Because we’ve always done it that way” is an acceptable response and everything remains status quo, creativity is stifled and mediocrity is the norm. Every improvement tool being used in our settings is based on gathering ideas and thoughts from many individuals to solve problems. The leaders and followers who are needed to shift a culture
SUGGESTED READING M E Olson, The Standard: Because We’ve Always
PERMISSION TO ASK WHY Maybe it is time to adopt inquisitive, child-like behaviors and give permission to add “why” to our vocabulary. If asking “Why are we doing what we are doing?” elicits the response “Because that’s the way we have always done it,” the behaviors are worth revisiting without judgment of others and without expecting that answers will be found easily. Allowing and encouraging the question “why” can be an avenue to creativity and new information. The first step is to bring the questionable behaviors to the forefront; the next steps are to seek information that makes a difference to the patient’s care, to inform and educate others about the practices, and finally to commit to being part of risk-taking efforts that result in changes for the right reasons. BRENDA S. GREGORY DAWES RN, MSN, CNOR EDITOR
Done it That Way Here (Lake City, Minn: Practical
Innovations, 1998).
340 AORN JOURNAL
EDITORIAL
Why? Because we’ve always done it that way f you have ever been around a toddler who wants an answer, you have heard the “why” question. Toddlers have a strong sense of will, and when an answer does not satisfy their curiosity, they continue probing and asking “why?” Toddlers are not the only ones who raise questions and demand reasons, but at their age, they are able to question without judgment. Questioning someone is often perceived as challenging authority, and as adults, a resulting response, “Because I said so,” is blurted in frustration. If questioning is not encouraged and supported in health care settings, it could be because the people are vested in the idea “Because we’ve always done it that way.” As we reach adulthood, childlike behaviors are quickly replaced. We stop asking why as often and persistently because it seems challenging to others, even though we know it is important to understand and share rationale. When people do question information, they find themselves apologizing for asking, as though questioning is not an acceptable behavior. In hierarchical health care systems, asking why is not always an accepted practice because it appears to be challenging the system. During our struggles to make changes quickly and kill the sacred cows, the “why” question can be perceived as problematic and challenging authority, and it might even be frowned upon. Asking “why” sometimes brings
out answers we do not like or creates work we really do not need. As we are forced to change the systems we work in, asking “why” can be a way to get to the root of actions that may need to change.
WHY, WHY, WHY? When you talk to peers at a seminar, you get a sense of who feels comfortable asking why in their settings and who knows that the question is perceived as a challenge. It is also obvious that “why” is not an uncommon question in ORs. Why do we bring patients to the preoperative holding area from the preadmission area that is right down the hall to make them wait before surgery? Why do we prep for 10 minutes because it is surgeon’s preference when we have known for years that it is not an acceptable length of time? Why do we cover back tables if the surgeon is going to be late when we do not cover them during long procedures? Why do we document tasks on the nursing record when the outcomes are more important? Why does every place have to have its own intraoperative record when we are supposedly providing the same care? Why does everyone get a 3% raise at the time of performance review when some are better performers than others? Questions might be asked over and over because the answer “Because we’ve always done it that way” is not a sound, convincing rationale. 338 AORN JOURNAL
PERSISTENCE AND PATIENCE Have you ever asked a person “why,” and were not satisfied with the answer, yet BRENDA s. You knew GREGORY DAWES that you should not pursue the question? Feeling as though you received inadequate rationale should be a trigger to keep probing for sound reasoning. Questioning is not a way to rock the boat; asking “why” dredges up information and exposes performance that is deemed acceptable but that does not necessarily serve a purpose. Given the following scenario, when people ask “why,” the first response might be matter-of-fact and to the point. Question: Why do nurses check the camera and video equipment in the morning before a procedure when the nursing assistants have time to check it the day before? Answer: We need to be sure it works for the procedure, and the nurses will be held responsible if it does not. Inquisitive minds will recognize the matter-of-fact tone of information sharing and want to make a second inquiry. When a person speaks with authority, the scene does not allow a person to feel comfortable forcing the issue. Unless inquiries continue, the practices in question will also continue.
FEBRUARY 1999, VOL 69, NO 2
Question: I know that we want to make sure it works for the procedure, but why do nurses check it in the morning when there is time the day before and when we have personnel who can do it? Answer: We had a problem one time, and because we are using the equipment that day, we want to be sure it works the day of the procedure. The second inquiry might bring out a tone of paranoia, causing either participant in the conversation to feel uncomfortable. Questioning is not a game, and its purpose is not one-upmanship. Questioning behaviors will not work if the individuals involved in the conversation cannot come to terms with the fact that rationales do not always exist for behaviors and that some behaviors need to change. Question: I know that we are using the equipment that day and we want to be sure it works, but why is it important that nurses check the equipment the morning of the procedure when there is time and other personnel who can check the equipment the day before? Answer: We know that equipment problems can occur, and after having done this procedure with this physician for so long, I know it is just better if we check it in the morning. A thud question might push a button and challenge the emotions of the participants. Seniority or level of experience is often included in the rationale. Being
patient and evaluating the tone of the conversation can decrease a challenging atmosphere between people, but even in circumstances in which behaviors are acceptable, it is still difficult to not feel challenged. People who are questioning rationale are challenging the activity with an idea that it might be worth changing. These signs might lead the inquirer to know he or she is on the road to determining possible opportunities for change. After asking a person to rationalize behaviors several times, we revert to child-adult behaviors, and another inquiry will bring out the well-known response “Because we’ve always done it that way.”
from a traditional, hierarchical structure to a forward-thinking, futuristic setting need to encourage creativity in the problem solving efforts. The difficult part is to get the opinions out of the lounges and into a forum where changes can take place. Asking questions and being persistent in determining whether rationale is based on professional organizations’ standards, research, or other sound bodies of knowledge can only serve to accomplish positive outcomes when everyone has buy-in.
MOVING CREATIVITY INTO PROBLEM SOLVING Organizations embedded in trust, strong communication patterns, and respect among individuals possess qualities of survivors. The individuals who are decision makers determine the best way to seek information from others and are willing to give up their own beliefs to allow questions to be asked without reprimand. When “Because we’ve always done it that way” is an acceptable response and everything remains status quo, creativity is stifled and mediocrity is the norm. Every improvement tool being used in our settings is based on gathering ideas and thoughts from many individuals to solve problems. The leaders and followers who are needed to shift a culture
SUGGESTED READING M E Olson, The Standard: Because We’ve Always
PERMISSION TO ASK WHY Maybe it is time to adopt inquisitive, child-like behaviors and give permission to add “why” to our vocabulary. If asking “Why are we doing what we are doing?” elicits the response “Because that’s the way we have always done it,” the behaviors are worth revisiting without judgment of others and without expecting that answers will be found easily. Allowing and encouraging the question “why” can be an avenue to creativity and new information. The first step is to bring the questionable behaviors to the forefront; the next steps are to seek information that makes a difference to the patient’s care, to inform and educate others about the practices, and finally to commit to being part of risk-taking efforts that result in changes for the right reasons. BRENDA S. GREGORY DAWES RN, MSN, CNOR EDITOR
Done it That Way Here (Lake City, Minn: Practical
Innovations, 1998).
340 AORN JOURNAL