Why You Should Dare to Disagree - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

“The biggest catastrophes that we’ve witnessed rarely come from information that is secret or hidden. It comes from information that is freely available and out there, but that we are willfully blind to.” Margaret Hefferman

I attended a class early in my leadership career where we watched the film The Abilene Paradox. The film involves a family that makes a decision to take a trip to Abilene for dinner. Abilene is 50 miles from their home. At the end of this long and tiring trip, they learn that no one in the group wanted to make the trip but each had mistakenly believes that their own preferences were counter to the group’s and, therefore, did not raise objections. No one wanted to “rock the boat’. I was reminded of this story recently during a board meeting. There was an attempt to rush through a decision on a very important issue. I spoke up and said that the process being suggested was not consistent with our usual very thoughtful decision making. I felt like the lone ranger in the raising this concern. The decision was reconsidered in a different way. What was most surprising was when several board members later told me that they too had concerns but had not raised them.

Why You Should Dare to Disagree

Throughout our lives, we often receive message that conflict is negative, and we should strive for agreement. But is group agreement always a good thing? We know in health care that it can result in medical errors. Dr. Mark Chassen President of the Joint commission that accredits health care organization, noted in February of this year that the incidence of wrong-site surgery could be still be as high as 40 per week. In a study conducted by the Joint Commission examining the root causes of wrong site surgery, communication was found to be the number one problem. Some root cause analyses of these events paint the picture of cultures where some staff did know that there was a problem or that a procedural step had been skipped but no one dared to disagree.

In one of the most widely viewed TED talk leadership videos, Margaret Heffernan (a business leader and writer) discusses how good disagreement is central to progress. She illustrates how the best partners aren’t echo chambers — and how great research teams, relationships and businesses allow people to deeply disagree. Great ideas can and do emerge from seeking diverse points of view on a topic. Powerful moments can and do occur when someone in a room takes a risk and disagrees.

Some of our very best leaders in history such as Abraham Lincoln understood this. Doris Kearns Goodwin tells the incredible story in her book Team of Rivals, which is coming out as a movie next month. When he was elected president, Lincoln assembled a cabinet of his former rivals because he wanted his viewpoints to be challenged. Goodwin presents a compelling case that had Lincoln not possessed the wisdom and confidence to select and work with the best people, he could not have led the nation through one of its darkest periods.

The Art of Constructive Conflict

There is a difference between constructive conflict and destructive conflict. In destructive conflict, we seek to prevail with our viewpoints. Destructive conflict often flows from narrowly defined or rigid goals, and most often produces negative results. Individuals involved become less flexible and assume that the opposing party must suffer defeat. Constructive conflict involves a different approach. It is entering the situation with a dose of skepticism and an alternative viewpoint while remaining open to other possibilities. The parties to the conflict feel comfortable with the level of disagreement and acknowledge a need to compromise. Constructive conflict relies on a steady flow of communication and a shared willingness to embrace change. It is really caring about coming to the best decision or reaching the right resolution. As Heffernan notes, “”Because you simply won’t commit that kind of energy and time if you don’t really care. And it also means that we have to be prepared to change our minds”.

Disruptive innovation is badly needed in health care today. It will only come when professionals are willing to come forward and through that act of daring to disagree keep challenging the status quo.

Read to Lead

Harvey, Jerry B. (1988). The Abilene Paradox and Other Meditations on Management. Jossey-Bass Publishers

Hefferman, M. (June 2012). Dare to Disagree. Global Ted Talk.

Goodwin Kearns, D. (2006). Team of Rivals: The Political Genius of Abraham Lincoln. Simon and Schuster.