Milgrams Theory and the Failure to Raise Concerns in Healthcare

FAILURE TO RAISE CONCERNS IN HEALTHCARE
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Failure to Raise Concerns in Healthcare Introduction Communication plays an important role in determining the outcome of patient health in a facility. However, there is an increasingly large number of health practitioners and patients that fail to speak when they encounter a problem (Umberfield et al., 2019; Nembhard et al., 2015). As a result, communication failure has evolved to become a leading cause of poor health outcomes and, ultimately, the death of patients (Walker, 2022). Understanding this phenomenon is therefore essential in developing the right approach to overcome these challenges in the industry. Milgram’s (1963) study on obedience examined the extent to which people could be influenced to perform actions that would harm others. Understanding the psychology in decision-making in specific contexts can help comprehend the underlying factors that cause unexplained actions. Health care practitioners have a duty of care to their patients to inform them of all matters pertaining to their wellbeing. However, this is not always the case when a mistake happens during the course of treatment. James (2013) highlights that more than 400,000 deaths per year occur in the United States due to preventable adverse events by health care practitioners. The human factor in the errors is attributed to aspects of wrong documentation of patient data, errors in medication and the interchange of patients (Brown et al., 2022). More so, it is also notable that patients fail to report some symptoms or reactions to medication, thus increasing the probability of adverse events occurring. As a result, such preventable deaths lead to the impairment of the patients and, in some cases, death. Milgram’s 1963 Study on Obedience             According to Milgram (1963), obedience is defined as a mechanism tied to an individual’s psychology, linking their actions to a specified political action. The experiment conducted involved ordering a naïve subject into punishing a victim through electric shocks. In this case, the severity of the voltage delivered to the victim increases to a maximum set value based on instructions given to the subject. Consequently, the researcher wanted to find out the extent to which an individual could “obey” instructions provided to him to hurt another person.             The findings of the experiment showed that human tendencies were abandoned in the situation where the subject was instructed to perform the actions. This means that despite the knowledge of the consequences to the victim, the subjects were still willing to continue with the experiment until a certain point (Milgram, 1963). While the researcher had no overarching power to force the subjects to perform as commanded, the subjects still went on with the experiment. Apart from that, a significant amount of tension was generated in the subjects during the procedure. Despite them developing a conscience and seemingly displaying emotional distress from the encounter, they continued to increase the voltage when commanded by the researcher (Milgram, 1963). This shows a staggeringly distinct feature of human nature based on instructions given under a situation of duress in an individual. Behaviour in a Hierarchical Environment in Healthcare Hierarchical Systems in Health Environments Hospitals nowadays practice a more hierarchical system of leadership, with each individual in a health institution having a defined role that is significantly emphasised. Such antiquated practice tends to have negative effects, especially in environments that pile much pressure on the employee (Salehi et al., 2020). This is due to the lack of flexibility for health practitioners to interact with their peers and consult on different matters without seeming unqualified or unprofessional (Green et al., 2017). In such cases, the possibility of employees raising concerns or voicing their opinions on different matters dwindles significantly. Consequently, achieving the high standards that form part of performance measurement in health care institutions becomes difficult due to increased negative outcomes and higher mortality rates. In an ideal case, the patient and their provider must have a mutual relationship based on respect, thus creating a beneficial partnership. This is essential because priorities are set based on the understanding that each party plays their part in achieving a better outcome. However, as the hierarchy of power in the hospital environment increases, the development of an interpersonal relationship between the patient and the provider becomes impossible to achieve (Fernandopulle, 2021). On the patient’s level, medical professionals may also create a barrier where the traditional relationship would perceive them as the lead during the treatment process (Hannawa et al., 2017; Palanisamy & Jenkins, 2015)). This means that a provider would provide an appropriate treatment plan which should be followed strictly to achieve a better outcome. Such relationships come about as a result of the extensive training that a medical practitioner has undergone, thus demoting the patient to a subordinate role in health care. Shared-decision making can easily prevent the occurrence of mistakes in health care when all parties involved can interact freely and voice concerns. Such decisions based on the patient’s needs and preferences coupled with the provider’s expertise can highly impact the outcome of the treatment (Troughton et al., 2019). However, a study by Bell et al. (2018) showed that patients and their immediate family members failed to voice their concerns in various encounters at the intensive care point. The results indicated that up to 50-70% of the respondents in the study were hesitant to speak up about possible mistakes, conflicting information and mismatched patient goals or objectives (Bell et al., 2018). Such decisions were based on the perception that the provider was too busy or the fear of being pointed out as a troublesome patient. This shows the level of entrenchment that such behaviour has affected patients and their caregivers to the point of failing to speak up despite acknowledging the presence of a problem initially and the risk of adverse outcomes. 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