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

Breaking the Culture of Low Expectations

Black and Gregersen (2008) discuss three barriers to change the manager must address. The first is the failure to see on the part of the staff and leaders because of the mental maps that blind people. These authors note that we can be blinded by the light of what we are doing and we can't see other options. A successful leader must break through the powerful mental models that people have that in this case have normalized deviance and low expectations. Everyone in the organization must learn that what they believed was right is now wrong. Black and Gregersen (2008) suggest that the leader must break through the mind mapping that creates the barrier with powerful shock waves that will help staff see the need for change. Patient stories that awaken the empathy and passion within are powerful tools. Creating a culture of transparency of internal and external measures can also be a powerful tool to bring to everyone's attention that patients are being harmed in this culture of low expectations.

Second, Black and Gregersen (2008) note that when we do see the need to change, there is often the failure to move. It is easier to feel competent about what we are doing now than to feel incompetent doing the new thing that is right. People fail to move because they cannot clearly see where they need to go, do not believe they have the resources to make the move, or that the new right thing will have no value for them. To create movement, these authors recommend making the destination clear, insuring there are the right resources, and also insuring the rewards are targeted at the new right, not the old wrong.

Black and Gregersen (2008) note that the third failure is the failure to finish, which happens when people get tired and lost. Having champions of change in place to reinforce, encourage, and reward provides that sense of instant feedback that is motivating and energizing. Unit-based safety champions or quality champions are a proven, effective method to channel a major change process to the front line. If these barriers are not addressed, the culture of low expectations continues and becomes even more hardwired in the organization.


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