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

Patient Outcomes and the Culture of Low Expectations

Unfortunately, patients and their families suffer irreparable harm and even death when they are cared for in the culture of low expectations. We know that we have many needless deaths and much needless pain in health care every year. If the airline industry harmed as many people every year as health care, people would be outraged and demand immediate action. However, we continue to hear excuses such as "Our patients are sicker," "We don't have the resources to do better," or "We can't prevent falls or pressure ulcers because our patients are different." All of these comments are indicative of cultures of low expectations. When we believe that we are helpless to insure that handwashing happens without fail in every instance, or that we are helpless to move the patient satisfaction scores to the top ten deciles, we express the basic beliefs of the culture of low expectations. Studer (2008) reminds us that what we permit we promote as leaders. Consequently we create the culture that allows many people to be harmed because we have not set the bar high enough to keep patients safe. Patients expect that they will be cared for in a high-performing culture. And we want that for our families when they need the health care system. So how do we move cultures in health care away from the concept of low expectations and tolerance for bad outcomes?


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