According to a 2013 survey from insurance provider AIG, negative organizational culture is the number one barrier to patient safety in the healthcare industry. While preventable medical errors is the third leading cause of death in the U.S., it is also one of the highest expenses for healthcare providers –“half of every dollar spent on healthcare costs is related to a medical error,” said Emily Rinehart, a registered nurse and vice president and division manager for healthcare risk consulting at AIG.

There are three main ways company culture can impact patient safety:

• Staff buy-in – How committed is your workforce?
• Communication breakdown – Is your medical staff communicating patient care effectively?
• Compliance vs. commitment – Are you more interested taking disciplinary action or correcting the problem?

First, do no harm – a phrase typically associated with the Hippocratic oath medical students take before transitioning into a licensed professional. While nurses and doctors pledge to uphold the highest standard of medical care possible, in corporate healthcare, some aspects of patient safety fall through the cracks.

Nursing and clinical staff face demanding work environments that, when mishandled, can devastate patient care. Long hours, heavy patient loads, and high turnover all contribute to putting patient safety at risk. When it comes to performing in such a high-stakes atmosphere, all applicants are not created equal. Our research shows that there are six personality-based competencies that accurately predict an individual’s ability to perform his or her job safely.

Download our newest safety ebook, First, Do No Harm, to learn what they are and find out how to minimize the risks of patient safety, starting first with your people.

We got a kick out of this U.S. Navy office safety video from the 1940s.

Although the office environment (and the tone of the safety videos) has changed a bit since then, the underlying point of the video remains relevant – some personalities make an individual more prone to carelessness and, even in the most mundane of environments, that carelessness can cause accidents.

For more information about how people’s personalities influence office safety, check out Hogan SafeSystem.

On January 13, 2012, the Costa Concordia luxury cruise liner passed approximately 150 meters off the island of Giglio, striking rocks that would tear a 50 meter gash in its hull. According to the ship’s operator, Costa Cruises, the captain of the ship, Francesco Schettino, made an unauthorized and unapproved maneuver, veering off his pre-approved route and bringing the ship dangerously close to shore. In his defense, Schettino says Costa Cruises ordered him to conduct such a maneuver and it was a common practice used to attract publicity and make passengers happy.

Whether the maneuver that caused the accident was approved or not, the actions of Captain Schettino have received plenty of criticism. It’s reported that Schettino has a history of taking risks and disobeying orders. He reportedly left Marseilles, France in bad weather, against company policy and coast guard orders. A former Costa Concordia captain who Schettino served under as first mate described him as “too high-spirited and a dare devil,” while officers who served under him at the time of the accident labeled him as risky, authoritarian, and inflexible. Transcripts of conversations between Captain Schettino and Coast Guard Captain Gregorio de Falco show a defiant Schettino as he failed to comply with orders to re-board and direct passenger and crew evacuation from aboard the Costa Concordia (a criminal act under Italian law). Instead, he claimed he would do so from a life raft with his 2nd in command (who happened to be in the same life raft Captain Schettino claimed he fell into after slipping from the ship).

There is also issue with the delay between the time the Costa Concordia made contact with the rocks and when a distress call and the order to abandon ship were declared. From most reports, a majority of the crew and passengers had no idea of the potential danger they were in. One can see videos of crew members telling passengers in life vests to return to their cabins – informing them the ship was only experiencing an electrical problem. Unfortunately, it appears even those who knew better declined to tell the whole truth; transcripts show that approximately 20-30 minutes after contact with the rocks, phone calls from the Costa Concordia to the local Coast Guard admitted the ship was experiencing electrical problems but failed to initially report the collision. Despite knowledge of contact with the rocks, and the fact the ship was taking on water and listing, it still was over an hour before the captain ordered everyone to abandon ship.

Whether he was confident he could handle the situation on his own, or frozen by fear at the outcome of his actions, Captain Schettino messed up. Accounts from those who have worked with him describe a man who enjoyed doing things his way, was willing to take risks, and had a “pronounced ego.” Audio of the conversations between Schettino and de Faclo show a man who seems to have panicked when his crew and passengers needed him most.  
Despite Schettino’s actions (and inactions), concerns have been raised about the practices of Costa Concordia’s operators, Costa Cruises. Since the accident, the terms “sail-by” and “salute” have become more common, and decidedly negative. During an interview with a Senate committee in Italy, Costa Cruises’s CEO, Pier Foschi, stated the company encourages its captains to bring ships close to shore, saying such actions were “in demand” and helped “enrich the product”; however, he noted the captain’s actions on January 13 were not authorized. Also, Mr. Foschi admitted the Costa Concordia conducted an authorized sail-by a few months earlier, but stressed the ship never came closer than 500 meters to the shore – GPS evidence shows the authorized trip actually brought the Costa Concordia even nearer to shore than the unauthorized January 13 route.

Many of the details surrounding this accident will emerge as the investigation continues. At this point, there are more questions than definitive answers. Was the sail-by actually approved/ordered as Captain Schettino claims? Why did Costa Cruises approve a similar route months earlier, but deny that their ship came as close as GPS evidence shows? Was it really happenstance that Captain Schettino fell and landed in a life boat with his 2nd in command during the evacuation? Answers to these questions will shed light on the actions and mistakes that resulted in the loss of at least 17 lives (15 people are still missing), damage to and the possible destruction of a $500 million ship, and additional costs from lawsuits, fines, penalties, and environmental damage that could approach $1 billion.

When facts have been separated from speculation we will know what truly happened on the Costa Concordia that night. However, in reference to Dan Paulk’s recent blog, we can be sure that many of the scales he outlined are applicable to this situation. By most accounts, Captain Schettino was confident to the point of arrogant, willing to take unnecessary risks, and defiant in the face of authority. Once the accident occurred, he clearly panicked. Expanding on Dan’s analysis, questions have also been raised about the leadership at Costa Cruises. Do they foster an environment which rewards risk taking? Are they trying to use Captain Schettino as a scapegoat for poor industry-wide practices?

This could be a prime example of what can happen when safety takes a back seat to profit and publicity. Unfortunately, as is often the case with safety-related accidents, the costs associated with the Costa Concordia will not only be measured in dollars but in lives.   

A group of young hikers, anxious to explore the treacherous mountain ranges of Alaska, interviewed a number of guides at a remote outpost. "Yep, I'm the best there is," bragged an older, very weathered looking man; "I know every mountain and valley in Alaska – been hiking them for over 50 years.“

Impressed with his obvious experience, the hikers chose the elderly gentleman to lead their expedition. Days into their journey, the group seemed to be wandering aimlessly, passing by landmarks they'd seen before. Cold, hungry, and very skeptical, the group questioned, "We've been hiking 6 days and we're lost – you said you were the best guide in Alaska."

"I am," snapped the old-timer, "but we're in Canada now!”

Moral of the story: be careful who you follow.

Following last week’s deadly capsize and chaotic evacuation of the ultramodern cruise ship Costa Concordia, maritime experts have been raising questions about the captain's behavior, crew preparedness and bungled evacuation procedures.

The preliminary indications are that there may have been significant human error on the part of the ship's master, Francesco Schettino, which resulted in grave consequences, including 15 deaths and as many as 17 missing persons to date.

In an article entitled “The Link between Personality and Human Error: Using Assessments To Hire Safety-Minded Employees,” Greg Ford (HRVoice.Org) observes the strong role of personality and safety:

What’s interesting is that up to 90% of incidents are due to human error, not faulty equipment or other factors. For the past fifty years, social scientists have been researching personality . . . there has been more and more research into how certain personality types are naturally more “safety-oriented” than others.

Hogan Research Division (HRD) has been researching predictors of safety-related behaviors for nearly 30 years across a variety of industries. In a seminal whitepaper, they conclude:

Our research shows that individual differences in personality predict both safety related behaviors (as indicated by supervisory ratings) and on-the-job accidents and injuries. This research stands in contrast to previous findings showing little to no relationships between individual personality measures and safety incidents.

Employees with an “at risk” personality can be identified by assessing them on the following six dimensions:

“Everybody has a default personality. Some call it hard-wiring,” says Stephen Race, an assessment specialist with Performance Vector (HRVoice.Org). Race says, “We can teach people to behave in a certain way for short periods of time, but they will always revert back to who they are, especially when faced with unexpected circumstances.”

Captain “Sully” Sullenberger, who famously and safely ditched U.S. Airlines flight 1549 onto the Hudson River after crippling bird strikes, epitomized the expression of a safety conscious personality. Consistently described by all who know him as “cool, calm, and collected,” Sully credits his upbringing, family bonds, and a strong sense of personal integrity. He felt this led to him being hard-wired for safety.

Despite the remarkable fact that there is no training for such emergency landings, Sully described having a strong physiological reaction toward handling this unknown situation. His default personality was calm and focused, rather than panicky and overly reactive to this crucial situation, and as a result, all 155 passengers were able to rejoin their families and feel the embrace of their loved ones yet again.

The analysis of the cruise ship tragedy has just begun, and the role of Captain Schettino’s actions does not look good. He’s admitted that he messed up. Captain Sullenberger, in his book, Highest Duty: My Search for What Really Matters, offers a deeply inspiring message for all of us. Sully says, “We need to try to do the right thing every time, to perform at our best, because we never know what moment in our lives we’ll be judged on.”
 

Like many people, my coworker is afraid of flying. We encourage him to take sleeping pills and try to distract him with entertaining stories during takeoff, but despite our best efforts, he usually remains anxious throughout the flight.

Because of his fear, my coworker is drawn to news stories about plane crashes and equipment malfunctions, and shares them with us as proof that his fear is legitimate. And there have been many headlines about pilot error leading to tragedy; in early 2009, a commuter plane crashed into a New York house after the pilots were mindlessly chatting and then panicked when they realized the aircraft was in trouble. More recently, a Russian passenger airplane missed the runway and crashed because the navigator was drunk.

Given all of the doom and gloom in the headlines, it’s refreshing to hear about pilots who do things right. For example, in 2009, US Airways flight 1549 famously crash-landed into the Hudson River after striking a flock of geese during takeoff. The pilot, Chesley “Sully” Sullenberger, was described as “cool, calm and collected” as he maneuvered the plane into a safe landing position. Because of Sully’s focus and composure, a tragic accident was averted and all 155 people onboard survived.

Earlier this month, pilot Tadeusz Wrona safely crash-landed a passenger plane in Warsaw’s main airport after the landing gear failed to deploy. Luckily, all 230 passengers and crew members survived the belly-landing. Wrona and his crew remained vigilant and focused during the flight, immediately taking notice when the landing gear failed to open on the second attempt. After identifying the problem, the crew began to review belly-landing training guidelines while flight attendants explained emergency landing procedures to passengers. The flight crew remained calm and steady during the perilous situation, preventing hysteria from breaking out in the cabin.

When reading news stories like these, you realize the importance of the pilot’s training, skills, and personality when you board any airplane. From unsuccessful crash-landings to heroic ones, pilots’ behavior greatly affects passengers, crew members, the airline industry, and the general public (not to mention my co-worker). As such, organizations must take great care when hiring for jobs like pilots where the consequences of an unsafe decision can mean life or death.