I was first introduced to ‘followership’ at a seminar run by Dr Dave Williams. He is an amazing person; an emergency care physician and chief executive of a regional health centre in Canada. And he was a Canadian and NASA astronaut and aquanaut so he knows more than most about safety.
Healthcare is a high risk environment fraught with potential for errors, some of which have been catastrophic. Working in it can be challenging and stressful. Active followership can make it better for us and the people we care for.
Dave describes active followership as ‘a personal commitment to courageously contribute in a collaborative environment. It is an active process and requires commitment and personal responsibility’.
Followership is ‘upward influence’. It’s the behaviour and contribution we make in our teams which impact on outcomes – especially patient outcomes.
I remember an occasion early in my career when I worked on a large and busy unit caring for very sick patients. I used to dread being on duty with one particular senior nurse because she constantly seemed stressed, angry and unapproachable. I was intimidated and tried to get on and do my job without interrupting her. I felt unsupported, which was stressful for me.
One day I made a decision that I was not experienced enough to make but I felt as though I did not have a choice. Quite simply, I didn’t call for help because I was afraid of the reaction I might get. I totally failed my patient, his relatives and the rest of my team.
I can now acknowledge that these were my perceptions at the time. Looking back the senior nurse would probably be horrified that I felt like I did. She was trying to do the job the best she knew how but she had no insight in to her own behaviour and nobody told her.
If only I knew then what I know now! If the whole team displayed active followership the outcome may have been different. I would have demonstrated that personal commitment and courage to fulfil my personal responsibilities and upwardly influence.
As a team we would have supported her better by injecting positive energy, managing our own stress and helping her to recognise and deal with hers. We could have recognised her needs and shown empathy. I probably would have discussed the patient and not taken the decision alone.
I don’t know if the decision was wrong or whether he would have lived – probably not. But I live with the knowledge that I should have done something differently.
That’s the difference followership can make. Followership costs nothing and takes absolutely no more effort than the way we work now. Yet it can make healthcare safer. It has the potential to save lives and to make our working environment so much more enjoyable. Let’s do it!
Joy Whitlock is Quality and Safety Improvement Manager at Cardiff and Vale University Health Board.
This blog post was adapted from The Value of Active Followership, which appeared in Nursing Management.
Dr Dave Williams’ insights into followership have been captured in a 1000 Lives Plus white paper, Attaining Peak Performance [PDF].