Translator: Gabriela Imhoff
Reviewer: Peter van de Ven A nurse on the night shift
in a busy urban hospital notices that the dosage
for a particular patient seems a bit high. Fleetingly, she considers
calling the doctor at home, to check the order. Just as fleetingly, she recalls his disparaging comments
about her abilities, last time she called him at home. All but certain
the dose is in fact fine – the patient is, after all,
on an experimental protocol, which justifies the high dose – she hits for the cart, gets the med
and goes towards the patient’s bed. Quite far from the urban hospital, a young pilot
in a military training flight notices that his senior officer
might have made a crucial misjudgement. He lets the moment go by. Far from both of those stories, a senior executive
who has recently been hired by a very successful
consumer product’s company to join the top management team, has grave reservations
about a planned take over. New to the team, feeling like an outsider, everyone else is so
enthusiastic about the plan, he doesn’t say anything. These are three episodes
of workplace silence when voice was necessary. Voice would have been helpful. Now, you may think, “If I were in their shoes,
I wouldn’t do that.” Or you may be aware, as I am, of just how often this happens
in the modern workplace. I’ve been fascinated
by this problem for a long time. Why does this happen? It’s quite simple, actually. It turns out that no one
wakes up in the morning and jumps out of bed because they
can’t wait to get to work today to look ignorant, incompetent,
intrusive or negative, right? (Laughter) No, on average we’d prefer
to look smart and helpful and, you know, positive and helpful. So the good news about all this
is that it’s very easy to manage. Don’t want to look ignorant?
Don’t ask questions. Don’t want to look incompetent?
Don’t admit weakness or mistake. Don’t want to look intrusive?
Don’t offer ideas. And if you don’t want
to look negative, by all means, don’t criticize the status quo. Now, this strategy – The good news about
this very successful strategy is that it works for self protection. The psychologists
call this “impression management,” and there’s a great deal of evidence
that we’re quite good at it. We learn how to do this
sometime in grade school. By the time we’re working adults,
it’s all but second nature. Have you ever had a question, and you look around,
and you don’t ask it? No one else seems to be asking. Maybe you’re supposed to know. You think, “I’ll figure it out later.” So why does this matter? It matters because
every one of these moments, everytime we withhold, we rob ourselves and our colleagues
of small moments of learning, and we don’t innovate. We don’t come up with new ideas. We are so busy, unconsciously,
for the most part, managing impressions that we don’t contribute
to creating a better organization. The nurses don’t call,
the pilot doesn’t speak up, the executive doesn’t say anything. The good news is that not
every workplace is in fact this way. There are some workplaces where people absolutely
wake up in the morning, if not eager, at least willing and ready to take the interpersonal
risks of learning. I call these special workplaces
ones that have psychological safety. I’ll define psychological
safety as a belief that it’s absolutely okay,
in fact it’s expected, to speak up with concerns,
with questions, with ideas, with mistakes. I got into this, I got interested in this,
actually, quite by accident. Let me tell you how it happened. I joined a team of mostly
physicians and nurses, and the job of that team
was to find out, to asses, they hoped conclusively, what the actual
rate of medication errors was in, let’s say, some modern
tertiary care hospitals. So their job was to set out
to collect data on drug errors, human related drug errors. My little part was very simple: I was going to ask the question,
and answer the question, “Do better teams, better hospital
patient care teams make fewer mistakes?” I used a standard team survey measure
to asses the team effectiveness, and trained nurse investigators
visited a number of units in two hospitals every couple of days for six months. These were the data
that they came up with. These are adverse drug events, errors,
let’s just call them medication errors that were deem to be based on human error, expressed in terms of
errors per thousand patient dates. Now, here’s where the story
gets a little weird. I got the data, waited patiently, I got the data on the teams,
I got the data on the errors, and I ran my analysis. And what did I find? The results were exactly the opposite
of what I had expected. It appeared that better teams
were making more mistakes, not fewer. From the point of view
of a young researcher wanting to publish a paper,
this was a real problem. Never mind the other problems, right? So this was a problem.
No, this was a puzzle. So I sat down to think: why else? I thought about the need for coordination
between physicians and nurses. I though about the need
for team work on the fly, for speaking up, for double checking. And I thought, “Maybe” – in a kind of blinding flash
of the obvious – I thought, “Maybe the better teams
aren’t making more mistakes, maybe they’re more willing
to discuss them.” What if the better teams
have a climate of openness that allows them to report and even get to the bottom
of these things? Now, having that insight
was a far cry from proving it. So what did I do? I sent out a young research assistant
to study these units very carefully. He had to have no preconceptions,
he didn’t know the error rates, he didn’t know how they scored
on the team survey, he didn’t even know my hypothesis. And I said, “What did you learn?” And you know what he found? He found that these units,
these eight units were wildly different in terms of whether they
were willing and able and did in fact talk about errors. Some of them were actually
actively talking about them all the time and in the process of trying together
to work together to find new ways of reducing them. Much later, I called this
psychological safety. Now, you might want to know,
What was the sorting rule in this chart? It looked at first like I was trying to get it
from highest error rates to lowest, and I’m just not very good at math
and got mixed up in the middle. No. These are sorted by the research assistant’s ratings
of the openness of the climate. As you can see, the correlation
is very high indeed. Okay, so how do you build it?
What do you do? If you’re a leader and you say, “Wow, I want to have psychological safety
in my workplace”? Let me just suggest
three simple things you can do so that that nurse does make the call, the pilot does speak up, the executive even reveals
his concern about the takeover. First, frame the work
as a learning problem, not an execution problem. Recognize, make explicit
that there’s enormous uncertainty ahead and enormous interdependence. Given those two things,
we’ve never been here before. We can’t know what will happen. We’ve got to have everybody’s brains
and voices in the game. That creates the rationale
for speaking up. Second, acknowledge your own fallibility. You know you’re fallible. Say simple things like, “I may miss something
I need to hear from you.” This goes, by the way, for subordinates
and colleagues, peers alike. That creates more safety for speaking up. And third, model curiosity.
Ask a lot of questions. That actually creates
a necessity for voice. And so, these three simple things
can go a long way towards creating the kind of workplace where we can avoid
the catastrophes you saw coming in those three opening vignettes. Now, at this point in describing
and teaching about these things most managers I talk to
start to get a little nervous. They say, “I get it, I understand
how this could really help people learn. I understand, and I don’t want
to hear about errors. But are you saying I have to dial back
a little on excellence? Is it not longer possible to hold people accountable
for great results? To hold their feet close to the fire?” And I say, “No, in fact,
I don’t think it’s a trade-off. I think it’s two separate dimensions. Two dimensions
that you have to think about.” In fact, when I’m talking
about psychological safety, I’m essentially talking
about letting up on the breaks. I’m not talking about … the gas. I’m not talking about motivation. There’s a lot out there on motivation, and it’s really important,
and it’s important to understand it. But I’m talking about
it’s equally important to free people up, to really engage
and not be afraid of each other. So if you don’t do either, by the way, that’s the apathy zone
and that’s quite sad, so let’s move on. If you only do psychological safety,
yes, well, it’s possible, you’re creating a comfort zone,
leaving money on the table. But this is the one
I’m more worried about, and I wish more managers
were worried about it too. If you’re only talking about
people’s accountability for excellence and not making sure
they’re not afraid to talk to each other, then they’re in the anxiety zone. This is were the nurse was,
this is were that young pilot was, even the senior executive
was in this place, and that’s a very dangerous place to be. Of course, where do I want you to be? I want you to be high, high
in the learning zone. And let me just say,
in case it wasn’t clear yet, that this is also one and the same
as the high performance zone as long as there’s uncertainty
and interdependence. If you have no uncertainty
and no interdependence, it’s fine. You don’t need psychological safety. It’s fun to have, but not necessary. But if you have both
uncertainty and interdependence, it’s absolutely vital
that you have psychological safety. So the workplace out there,
the complexity, the interdependence, it’s not going to go away any time soon. We need people to bring
their absolute full selves to the challenging jobs ahead, and I hope you will help me
create those kinds of workplaces so that they can learn and become
their full and most contributing selves. Thank you. (Applause)