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)