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Skip to 0 minutes and 8 secondsWhat kind of organisation do you work in? I'd like to spend a minute reflecting on how frequently in your experience does the following problem occur in your organisation? Frontline staff being afraid to express disagreement with their manages, or junior staff being afraid to express disagreement with more senior staff? Reflect on that and then we'll show you some clear examples of this happening in practise.

Skip to 0 minutes and 46 secondsThis example is actually from the world of civil aviation. And it's about a fatal Air Florida crash that happened in 1982. The problem was that the plane took off with too much ice on the wing and crashed into the nearby Potomac River, killing all of the crew and passengers. When the flight recorder was listened to, it was clear that the first officer knew that there was a problem and tried to tell the captain about it. But he just did not clearly state the problem. So instead of doing that, the first thing he said was to mention to the captain, look at the ice back there on the wings.

Skip to 1 minute and 32 secondsDidn't get any response to that, so he then rather vaguely said that deicing a plane just gives you a false sense of security, doesn't it? And then finally, just as they are about to take off, he did say, shall we check the wing tips before we finally take off? And the pilot said, no, we're good to go. And off they went. So what the first officer should have done is to say something much more explicit like, I'm concerned, or we need to stop the takeoff because there's too much ice on the wing. And if we do take off, we'll crash. So what happened in the Air Florida cockpit?

Skip to 2 minutes and 11 secondsWhat were the barriers to the behaviour change which was needed, which was the plane should not have taken off? I think there are clear examples here of the culture of hierarchy and etiquette-- two barriers that [? Esmeda Turonny ?] spoke about earlier in this week. So clearly, the first officer felt uncomfortable about questioning or suggesting to the captain that they shouldn't take off. So that's partly an etiquette thing, but it's also, obviously, that there's a culture where first officers do not question pilots. And this crash, and other similar ones, made the civil aviation companies realise that they had an explanation for something that had been baffling them for ages.

Skip to 3 minutes and 6 secondsThey'd known about this, but they hadn't really worked out why it happened. So they knew that crashes were much more likely to happen when the captain was flying the plane than when the first officer was flying, which seemed completely counterintuitive. The captain's more experienced, and yet the crash is more likely to happen when the captain's flying. And the explanation is, that if the first officer's flying and the captain's in the co-pilot seat, they don't mess about in saying what needs doing. Whereas if the captain's flying and the first officer is in the co-pilot seat, they don't state clearly what needs to be done. In the next step, you're going to watch an interview between Michael Borg and Nick Barber.

Skip to 3 minutes and 51 secondsMichael Borg is a consultant microbiologist and infection control specialist from Malta. And Nick Barber is the research director for the health foundation. They're going to be discussing the cultural barriers to change that exist in hospitals. And they're going to be drawing on some of the information that we've just reflected on in relation to that Air Florida crash. So they'll use two terms which capture some of the cultural barriers that can arise. There are power distance and uncertainty avoidance. These are barriers to change, but they're not insurmountable. So Michael Borg will explain how he's adapted infection control and antimicrobial stewardship interventions to work in a southern Mediterranean culture where the hierarchy is probably more powerful than it is in Anglo-Saxon countries.

What kind of organisation do you work in?

In this video Professor Peter Davey explains “Power Distance” and its role in behaviour change.

He begins by asking what sort of organisation you work in and goes on to describe a fatal incident from aviation in which power distance played a part.

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This video is from the free online course:

Antimicrobial Stewardship: Managing Antibiotic Resistance

University of Dundee

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