On the day my grandmother taught me to read the river, she said something I did not understand until I was an adult. “The water does not lie,” she told me. “It only shows you where the ground has already given way.”
I thought of her last week in Johannesburg, standing in a packed room at the Africa Healthcare Indaba, organised by World Health Expo. Hundreds of doctors, nurses, administrators and procurement officers listened to me. Many had travelled far. All of them were tired in the way that only people who carry other people’s lives can be tired.
I had come with one goal: to make us think, and then rethink.
So I began with a question I have learned to ask every leadership team I meet. When a frontline worker reports a near miss, what happens next?
A near miss is the quiet cousin of tragedy. It is the wrong dose caught at the last second, the missed handover that harmed no one by luck alone, the exhausted nurse who nearly made a fatal error at the end of a double shift. It is the river showing you where the ground is about to give way.
The room went still. Everyone knew the answer, because everyone had seen both versions.
In the first, the report triggers a search for systemic vulnerabilities. Leaders ask why the handover process allowed the gap, why staffing was so thin, why the system let a good person stand that close to the edge. The worker is thanked. The system is repaired. Reporting rises, because people learn that honesty is safe.
In the second, the report triggers a search for a scapegoat. A name is found, a file is opened, a warning is issued. The worker is protected by no one. And the lesson, learned instantly by everyone watching, is simple: never report again.
Here is what I have come to believe after years of working with healthcare teams across the continent. The scapegoat does not make a hospital safer. It makes a hospital quieter. And a quiet hospital is a dangerous one, because the near misses do not stop. They simply stop being told.
This is not only a patient safety issue. It is a mental health issue. A workplace where people fear punishment for honesty is a workplace running on chronic vigilance, and chronic vigilance is where burnout, anxiety and moral injury take root. We cannot ask people to heal in the same environment that is hurting them.
Then I turned to a second question, one that made some leaders shift in their seats.
For a long time, patient safety and procurement decisions have been driven primarily by clinical metrics and budget targets. These matter. No one disputes that. But they are not the whole story, and they are certainly not the whole voice. Who is missing from the room where those decisions are made?
The people who live with mental illness. The people who have sat in the waiting rooms, signed the consent forms, taken the medication, and felt what it is like to be on the receiving end of our protocols. They hold knowledge no dashboard can capture, and too often we collect their stories only after the decisions are made.
If we truly intend to turn lived experience into organisational change, it cannot remain a slogan on a conference slide. It needs mechanisms. Here are takeaways I wish every healthcare professional in the room never forgets, and I offer them here:
Seats, not surveys. Place people with lived experience on safety committees and procurement panels, with voting power and fair compensation, rather than inviting them to comment after the fact.
Co-design before you buy. Before purchasing a new system, a ward redesign or a crisis protocol, let patients test it and shape it. Ask what makes a space feel safe, not only what makes it compliant.
Close the loop. Every piece of lived-experience feedback should receive a documented response: what was heard, what will change, and when. Silence is the fastest way to lose trust.
Make near-miss reporting psychologically safe. Separate learning from blame. Reward the report, not just the clean record.
Invest in the people who carry the system. A team that is supported emotionally makes safer clinical decisions. Mental health care for staff is not a perk. It is infrastructure.
Africa has always understood that wisdom lives in community. In the village, no decision about the well, the harvest or the children was made without those who would live with its consequences. Somewhere along the way, our institutions forgot what our elders knew. We are being invited to remember.
My grandmother was right. The water does not lie. It shows us where the ground has already begun to give way, and it gives us a choice. We can build higher walls and look away, or we can listen, learn and rebuild the bank.
Every organisation has a river. Every team has near misses that no one is reporting, and voices that no one is hearing. The question is whether your leadership is searching for scapegoats or searching for solutions.
I am a coaching psychologist, and this is my work: helping leaders and teams build cultures where honesty is safe, wellbeing is designed in rather than bolted on, and lived experience shapes real decisions.
Let’s design a mental health plan for your team. Reach out today, and let’s begin where the water is already showing us the way.
- business a.m. commits to publishing a diversity of views, opinions and comments. It, therefore, welcomes your reaction to this and any of our articles via email: comment@businessamlive.com
Dr. Joshua Awesome is a Coaching Psychologist/Executive and Business Performance Coach who has supported over 100,000 professionals across Africa and the globe. He can be reached via: joshua@africainmind.org
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