Thursday, December 4, 2014

Some Thoughts for Today. What is The Role of Culture?

Air Medical Resource Management Operates at the Intersection of Psychology (what's going on between my ears) and Culture (what's going on in my organization) ... William T. Winn

By Dan Foulds

I am going through my AMRM presentation slides today, making some changes and preparing for classes next Monday and Tuesday. I decided this was worth sharing and hope you agree. If you have any thoughts let's hear 'em. And "war stories?" We love stories.

As a medical crewmember, communications specialist, mechanic, or member of hospital security, at times we hesitate to speak up, to ask a question. We don't want to appear dumb, we worry about appearing to lack trust. We worry about being perceived as a trouble-maker and perhaps losing our job.
As pilot, we may hesitate to speak up for fear of showing weakness.

This hesitation is especially prevalent in new crew-members. The nurse who died in a crash in Newberry SC was new. The nurse who died in Georgetown SC was new. 

You don't get to be new here. You must ask and learn NOW.

Ridicule, intimidation, and sarcasm have no business in this business. Culture begins with senior leadership and ends with you.

The National EMS Pilot's Association has prepared a great cultural health assessment tool, CHAMPS. It only costs $500 to find out what your cultural "pulse and pressure" are, and you can compare your organization to others ( no identifying information is shared). You can also compare one part of your program to another part. Visit NEMSPA to learn more.

Corporate Culture: A Case of Monkey See, Monkey Do?

Written by Fred Nickols

Did you ever wonder how your company's culture – that set of beliefs, traditions, and behavioral norms that determines "the way things work around here" – came to be? Or why, when you try to change it, it seems so resistant? Well, here's a little story about a scientific experiment that shows how culture comes into being and why it is so resistant.

The experimenters began with a cage, a set of externally enforced boundaries. Inside the cage, they hung a banana on a string and placed a set of stairs under it. They then introduced five monkeys into the cage. Before long, one of the monkeys started to climb the stairs toward the banana. As soon as it touched the stairs the experimenters sprayed all the other monkeys with really cold water. When another monkey made an attempt to get the banana they again sprayed the other monkeys with cold water. After a while the monkeys prevented any of their group from going after the banana.

After the cultural prohibition against "going for the banana" had been established the experimenters put away the cold water. They took one of the original monkeys out of the cage and introduced a new one. Upon spotting the banana the new monkey went after it. To its surprise and dismay all of the other monkeys attacked it. After another attempt and attack the new monkey learned that if it tried to climb the stairs and get the banana it would be assaulted and so it stopped going after the banana. It had been acculturated, assimilated into the cage's "don't go for the banana" culture.

Next the experimenters removed another of the original five monkeys and replaced it with another new one. The second new monkey went to the stairs and predictably it was attacked. The first new monkey took part in this punishment with enthusiasm! Similarly a third original monkey was replaced with a new one, then a fourth, then the fifth.

Every time the newest monkey took to the stairs it was attacked by the other monkeys. Most of the monkeys that were beating it had no idea why they were not permitted to climb the stairs or why they were participating in the beating of the newest monkey. After all the original monkeys were replaced none of the remaining monkeys had ever been sprayed with cold water. Nevertheless, no monkey ever approached the stairs to try for the banana. Why not? Because as far as they knew: "That's the way it's always been done around here."


  1. This make s me think of a story from last year. we had completed a flight to our local trauma center. The crew consisted of myself, a very seasoned former coast guard pilot and a new flight RN. It was approximately 0400 in the morning and we all wanted to get home. This wasn't our second flight of the night, it was our third and bed was sounding awfully attractive.
    Prior to lifting from the rooftop helipad, we evaluated the weather and identified low clouds and obscured local mountain tops. ( at least thats how i remember it. Its been a while and i just remember the weather being bad bad.)
    The pilot stating something to the effect of “I think i can get down and around some of that stuff and get home…” to which the new flight nurse proclaimed “uh….yeah, OK. im good with that.”

    The only thing that was ringing in my head after watching this go down was “Josh…..this is how crews get killed. They're tired, they want to sleep and they're willing to push a bad call to get there. This is what we've always been warned about and now your staring down the barrel of saying something or just going with it.”

    What i was seeing was a pilot that is used to flying in worse than crap weather. But in a suitable aircraft. And i was seeing a new flight nurse that didn't know how to say no, or didn't want to.
    So i said something. “Hey guys, im calling 3 to go here. Im not comfortable launching in this weather. I know we all want to get home; i do too, believe me. But lets not push bad weather and make a bad decision. Lets hang out, watch the weather and see if it starts to break up or not.”
    They agreed and we waited. I received no flack and no push back. I felt like i almost watched their faces go, “wow, we almost made a dodgy decision. That would have been really dumb. Yeah, lets wait for stuff to clear.” We waited till we could see stars, and the weather continued to break. We lifted with clear skies and stars in our windscreen and made an uneventful flight home.

  2. Wonderful story. Happy ending. Thanks Josh for sharing. Someone will read this and be there and know the right thing to do.


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