The new world of the digitised health ecosystem comes to balance efficient care, convenience, safety, privacy and affordability into one neat little package that sits in the innovative MedTech market. The incredible diversity that is alive in such and innovative sector directly feeds innovation and growth, but also comes with its own inherent dangers. This blog explores how inclusion is a driver for workplace safety & risk reduction and explores some of the best practises for to introducing inclusion to mitigate the risks.
Without an inclusive environment, there can be no guarantee of safety.
A bold statement but one that has many layers of truth within it.
Creating an inclusive environment – one where everyone with the capability to excel can do so – is something we accept as critical to future organisational success. We can hire better talent, retain a more diverse workforce, innovate better and so on. However, for many organisations, from oil to construction, from transportation to manufacturing, and of course within medical devices, there is an even more business-critical reason to do this work – and that is safety.
The business case for inclusion is strong one. The capacity for bias to unconsciously undermine inclusion and impact upon safety should not be underestimated. Bias can undermine organisational culture, affecting behaviours and decisions and in turn having a profound impact on safety. Bias unconsciously influences decisions at every level through organisations and there are many examples of where such interference has been catastrophic both in terms of the decision-making process itself and the culture it is made within.
Often the very environments where these actions take place can be labelled ‘macho’. Working cultures are critical to safety. Driven by the behaviours of all leaders, they can foster a productive culture that drives the strategy – or one that does not! Truly inclusive cultures enable and engage everyone in the organisation and drive the strategy, but if the culture is undermined by bias that restricts who or what we include and how, it can severely affect safety and risk management.
Robin Ely and her colleague Debra Meyerson highlighted the impact of inclusion on safety in her 15-year study on oil rigs titled “Unmasking Manly Men” . She identified how macho cultures exacerbated poor (often) unconscious decision-making, contributing to safety issues. Ely found that:
‘Men who work in dangerous places often act invulnerable to prove their merit as workers and as men—objectives that can lead to decreased safety and efficiency. In dangerous, male-dominated work settings, men’s tendency to gain respect by demonstrating and defending their masculinity is costly. Efforts to appear invulnerable block precisely the kinds of actions that encourage safety and effectiveness.’
Much of our work in this space centres on encouraging leaders to recognise their own biases and vulnerabilities. This extends to our lessening capability to judge talent in a changing world – in combination with our increasing desire to surround ourselves with ‘sameness’ when we feel fear –or potential fear. Affinity bias and promoting in our own image gives fuel to the macho culture as we feed a psychological need for comfort – and the repercussions can be disastrous for safety. Taking a culture of machismo and building one of openness calls upon the organisations to do many things. A mix of belief change and logical approaches is needed.
Driving the Change
Initially drawing a strong line between organisational success, safety and brand and how inclusion and bias reduction drives this is key. We encourage explicit conversations through training or ‘town hall’ type sessions that are embedded throughout the organisation. Although ‘Tone from the Top’ matters – having those in the culture make these connections is a bigger driver.
Secondly in order to change this we need to understand what is currently there. Examining unwritten rules – the hidden norms of the team or organisation and reflecting on what these rules prevent – calling out issues, new methodologies, or even actually seeing the impending disaster – is critical work. Ely talks about how creating the safe psychological space is essential. To do this, leaders have to be prepared to be vulnerable way ahead of their teams.
Uncovering the affinity bias towards masculinity is essential – disengaging the deeply held links between competency and how masculine you appear is something that can be challenged with something as simple as a cartoon drawing or short video.
Often organisations that have a lack of inclusion also are still reliant on a hierarchical structure. This link between lack of inclusion, hierarchical cultures and safety reflects James Reason’s established Swiss Cheese Model , to ‘unsafe supervision’, the ‘preconditions for unsafe acts’ and the ‘unsafe acts’ themselves. For example; an excluding hierarchical culture, intolerant of challenging views and where, macho behaviours are linked to high capability, will lead to ‘unsafe supervision’. Leaders will consciously or unconsciously endorse the culture through comments, ‘banter’ and body language. They choose to listen to those who are ‘in’ and those who offer warnings and concerns are derided, dismissed or unheard. This creates a strong ‘precondition for unsafe acts’, lower assessment of risk and higher levels of risk taking, increasing the likelihood of ‘unsafe acts’ occurring.
The solution is to create an inclusive environment where people can be heard and individuals are enabled to excel. Kotter  recommends developing a sense of urgency among large numbers of people. There has to be a widely understood personal and business case for inclusion driven by very real benefits to business strategy. Such a culture shift has to be seen to be driven from the top and authentically practiced by leaders while, at the same time, driving wider engagement and opening discussions across the organisation. Change has to start with individual recognition of our own behaviours and biases, leaders need to take responsibility for building their own and then others’ awareness supporting them and enabling a safe psychological space.
We are often asked if what we are asking of our clients is to ‘work with people we don’t like.’ Translated into this work the answer is clear. In committing to an inclusive environment where bias is reduced and difference is welcome – we have to ‘learn to like more people.’ By liking we respect, trust and listen to those who are not the ones traditionally we believed would keep us safe – but to those who actually will do.
 Unmasking Manly Men August 2008
 Joshua Howgego New Scientist August 2015
 Kotter Rathgeber (2016) “That’s not how we do it here!” Penguin Random HouseUK