Going off a Cliff and the Knowing-Doing Gap

If I ever needed an example of the infamous “knowing-doing gap” — the gap between knowing what to do, and actually doing it — I now have the perfect one.

Trainers have long struggled to get their students across this gap. We teach ideas, we even role play and practice, and then the magic moment comes, and … the perfect student is a non-performer.

All the training, and all the intellectual awareness in the world, won’t guarantee that a person who has learned an idea or a skill will actually use it.

Here’s my example.

A senior hospital executive I’ve long admired, a former client, was talking about the important new work being done to make hospitals safer for patients. Hospitals are systematically identifying the human sources of errors, and building in safeguards.

One of the most powerful tools in preventing a surgeon from making a mistake is for one of the other people in the room to notice it and speak up.

Turns out, because surgeons are so powerful and high status (and often so imperious, pompous and self-important) that the lower-status workers are afraid to speak up. Afterward, they’ll say things like “I figured he knew what he was doing” or “who am I to tell him he’s wrong” or “I didn’t want to get yelled at in case I was just mistaken.” (In the famous fable, think of all the people in the crowd who *didn’t* tell the emperor he had no clothes.)

So, there is a tendency for people to be too quiet in the presence of high-status people. And it means we have more preventable errors and deaths in hospital surgeries. How can this be overcome?

Turns out, there is a proven technique that is extremely powerful — the “safety statement.” This is where the high-ranking person asks everybody in the room to please speak up if they even suspect there’s a problem. It can be phrased many ways — one popular phrasing is “Everybody, please help me out and don’t let me drive off a cliff.”

I’m learning about all of this from my surgeon friend. She’s a champion of these reforms, and pushes the other surgeons to adopt the latest, best safety practices.

So, how often does she do the Safety Statement? About 60% of the time.

So, I laugh at her, and I rib her, and I play back all of the above (that she’s the champion, that she’s a role model, that she understands better than anybody how important this is). And she admits it’s all true, and frankly she’s not sure why she doesn’t do it.

That, in a rather oversize nutshell, is the knowing-doing gap. She knows the material. She believes in it. She knows she ought to do it. And, she doesn’t do it. And she can’t tell you why.

Tagged with: ,