Good is not Good Enough: The Culture of Low Expectations and the Leader's Challenge

Karlene M. Kerfoot, PhD, RN, CNAA, FAAN,


Pediatr Nurs. 2010;36(4):216-217. 

In This Article

Abstract and Introduction


Unfortunately, people become accustomed to working in cultures where low expectations and mediocrity are the norm. They learn to tolerate bad things happening because "it's always been that way." Chassin and Becher (2002) tell the story of a woman who was not identified correctly and consequently was subjected to the wrong invasive test. In identifying the problems in the root cause analysis, there were 17 instances of discrete errors which led to this organizational error. The authors described the organization's "culture of low expectations" in which the participants learned to expect and tolerate a norm of faulty and incomplete information exchange, lack of information about patients, ignoring soft signs that this might be the wrong patient, and interpreting the sequence of events as mundane repetitions of the poor communications had become normalized. The authors created the term "culture of low expectations" to explain this phenomena. Unfortunately, there are many instances in health care when the staff believe that "this is as good as it gets." They adopt a disinterested and hopeless attitude and operate with mediocrity as standard. When mistakes occur, there is no robust investigation on the part of the leaders and staff to learn how to change processes to prevent another occurrence. Instead, the issue is explained away with excuses which result in the possibility that the error can be repeated many times.

Other authors such as Collins (2001) note that the concept of good is the enemy of great. When people believe that what they do is "good enough," excellence will never occur. As the demand for better health care escalates every year, achieving a ranking of very good just doesn't count because it leaves many disenfranchised staff, errors, and dissatisfied patients. Good is not good enough. Studer (2008) notes that successful organizations have employees who feel their job and their organization has a purpose, they do worthwhile work, and they make a difference. These factors ignite a passion within, and create the organizational flywheel that generates the momentum to move the organization from one of low expectations to excellence.


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