Intelligent Disobedience | Disruptive Physicians A Good Thing

Intelligent Disobedience | Disruptive Physicians A Good Thing

26th Nov 2015

Intelligent Disobedience: The Medical Director and CEO's best friend?

A recent business article suggests that companies should embrace "intelligent disobedience" as a good means of identifying problems before they become major scandals. The recent crises at NFL and Volkswagen are cited as examples of troubles which could have been averted if employees had been empowered to speak up. There are multiple other cases involving hospitals such as the North Staffs case in the UK NHS.

Ira Chaleff wrote the book Intelligent Disobedience: Doing Right When What You Are Told To Do Is Wrong and used the examples of Guide Dog Training and Airlines to study disobedience in action. 

"We are all socialized from a very early age to obey authority," he says. "We can rebel against it, but there is deep programming inside of us that you don’t speak out of turn. For a few of us, this comes naturally, but for most of us it doesn’t. We follow the order even when we’re uncomfortable and think it’s wrong. We have to overcome this."

People can actually learn a lot from guide dogs, says Chaleff. When they’re trained, they spend their first 18 months being socialized, learning to obey commands. But then guide dogs take their knowledge to a higher level: The next step is that they’re taught intelligent disobedience.

A dog must know when it gets a command that, if executed, would produce harm for its team—itself and its owner," says Chaleff. "It must not obey even if a command is repeated. This provides a wonderful metaphor for humans."

Intelligent disobedience has been explored effectively in specific industries. Chaleff says groundbreaking work was done in the aviation industry where fatal airline crashes in the 1970s could have been avoided.

"The black box recording often shows that a member of the crew saw something wrong and tried to get captain’s attention but was blown off," he says. "When you listen to the recording, a minute and 20 seconds later everybody dies."

The aviation industry empowered its employees by making it everyone’s responsibility to assertively and repeatedly bring attention to a problem. If after a third time the command is ignored, the copilot is authorized to take control. "This dramatically improved airline safety," says Chaleff.

The medical industry, particularly hospitals, took the airline model and adapted it to its environment, reducing operating room errors. But while hospitals and airlines deal with life-and-death decisions every day, any company can benefit from intelligent disobedience, says Chaleff.

"From a risk-management point of view, boards of directors, CEOs, and senior leaders need to determine how they’re inadvertently creating a culture that doesn’t support candor," he says.

Chaleff says intelligent disobedience is different than whistleblowing. "We’re trying to create an internal culture where candor is invited and respected," he says. "It’s a place where problems can be internally corrected before there’s a need for whistleblowing."

The solution rests inside the culture of the company. You must create an environment to overcome this condition.

Empower voices

Develop a process for allowing employees to speak about problems within the company with assertion and identify a chain of management which will evaluate the claim of the employee and take action. It is no defence to allow unsafe practices to continue or to violate regulations.






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