Building a Psychologically Safe Workplace: Amy Edmondson (Transcript)

Amy Edmondson – TEDx Talk TRANSCRIPT

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 misjudgment. He lets the moment go by.

Far from both of those stories, senior executive who has recently been hired by a very successful consumer products company to join the top management team, has grave reservations about a planned takeover. 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? 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.

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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, every time 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 assess, they hoped conclusively, what the actual rate of medication errors was in, let’s say, some modern tertiary care hospitals.

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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 assess 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 deemed 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 thought about the need for teamwork on the fly, for speaking up, for double checking.

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