As a health care leader, you worry that patients are safe in your facility, so you put together programs to make sure employees and providers are focused on patient care. But you may find that your staff members are still not as engaged as you would like, seem distrustful of management and generally maintain an air of frustration in their work.

No one will tell you what the issue is, almost waiting to see whether you can figure it out yourself.

You have just experienced the risk-perception gap challenge.

Risk-Perception Gap

A gap in perceptions of the level of risk emerges between the people closest to the danger and those at some distance. The farther the distance from actual harm, the less a person perceives the impact of that harm. The shorter the distance, the more heightened the risk is perceived to be and the more likely that the threat becomes a distraction.

Best practice risk assessments should include an examination of risk-perception gaps within a facility. For example, if frontline staff fear a potential danger, they will be distracted from work activities and instead focus on the perceived threat. However, these fears are often not perceived at the same intensity by the C-suite because of senior management's greater distance from the threat. And so the gap emerges - a disconnect between the focus of senior management and the focus of staff. Staff members feel like senior management don't understand them, and senior management perceive the employees to be remote and disassociated from their tasks.

And progress halts.

Uncovering the Gap

A recent illustration of the risk-perception gap occurred in a facility where new management had promptly begun to make changes to improve patient safety without consulting frontline staff on their fears and needs. The changes were implemented - new policies, new personnel, new goals and new areas of focus. However, senior management continued to find the staff distrustful, remote and less than engaged.

To get at the root of the distrust, we performed a risk assessment, talking to personnel at all levels of the organization to identify their top challenges in patient care. Several areas of focus rose to the top: a distrust of the new management team, a feeling of staff-management disconnect, and ultimately, a feeling that management was not working in the staff's best interest.

Where, we thought, was this coming from? The management team seemed very interested and focused on improving the hospital.

Digging deeper, we toured the property with the risk manager and discovered that a number of security cameras in the employee areas (e.g., parking lot, walkways) were not working and had not been working for years. It was unclear whether anyone had communicated this problem to the new management, but staff clearly assumed that management knew of the inoperable cameras. With prodding, staff members revealed that the neglected cameras were indicative of management's “lack of caring” for the employees. The staff perceived that management had more concern for patient safety than for employee safety.

And staff members, being close to the risk of potential harm, perceived the threat as very real. They had a family member drop them off at the hospital rather than risk parking in the dark lot or walked in groups to the hospital. It was a risk in front of them every morning and every evening - they started and ended their day worried about their own safety.

Because of the risk-perception gap, management did not have the same perspective on the possible security risk in the parking lot. In fact, management parked in a different area on campus and therefore did not find themselves walking in the darkness or worrying about their safety. Once we alerted senior management to this perceived risk, they committed to an immediate repair.

Did the camera fix solve all of the staff-management disconnect? No. Other factors came into play. But it did trigger a huge change in the staff's perception of management. And with that, staff and management could start talking and working together toward their goals, rather than working against each other.