Given this well-documented tendency for people in the workplace to choose silence over voice, sometimes it seems surprising that anyone ever speaks up at all with potentially sensitive or interpersonally threatening content. This is where psychological safety comes in. A growing number of studies find that psychological safety can exist at work and, when it does, that people do in fact speak up, offer ideas, report errors, and exhibit a great deal more that we can categorize as “learning behavior.”
Learning from Mistakes
For example, in a study of nurses in four Belgian hospitals, a team of researchers led by Hannes Leroy explored how head nurses encouraged other nurses to report errors, while also enforcing high standardsfor safety. The challenge here is one of asking people to perform the highest quality (arguably, error-free) work yet still be willing to talk about the errors that do occur. Leroy and his colleagues surveyed the nurses in 54 departments, measuring a set of interrelated factors. These were psychological safety, error reporting, the actual number of errors made, and nurses’ beliefs about how much the department prioritized patient safety and about whether the head nurse practiced the safety protocols.
Leroy found that groups with higher psychological safety reported more errors to head nurses. That finding was consistent with what I had seen back in graduate school in my study of medication errors. More interestingly, they found that when nurses thought patient safety was a high priority in the department and when psychological safety was high, fewer errors were made. In contrast, when psychological safety was low, despite believing in the department’s professed commitment to patient safety, staff made more errors. In short, psychologically safe teams made fewer errors and spoke up about them more often.What I have found in similar settings is that good leadership (for instance, on the part of head nurses who demonstrate a commitment to safety and to openness), together with a clear, shared understanding that the work is complex and interdependent, can help groups build psychological safety, which in turn enables the candor that is so essential to ensuring the quality of patient care in modern hospitals.
Quality Improvement: Learn-What and Learn-How
Nearly every organization wants quality improvement. Hospitals, especially, constantly pursue efforts to improve the innumerable processes of patient care. Does it make a difference whether a unit supervisor creates the conditions for psychological safety or simply commands staff to work on improvement projects?
With Wharton Professor Ingrid Nembhard and Boston University Professor Anita Tucker, I studied over a hundred quality improvement (QI) project teams in neonatal intensive care units (NICUs) in 23 North American hospitals. By asking the QI team members to report on what they did to improve unit processes, we found that these clustered into two distinct sets of learning behavior, which we called learn-what and learn-how. Learn-what described largely independent activities like reading the medical literature to get caught up with the latest research findings. Learn-how, in contrast, was team-based learning that included sharing knowledge, offering suggestions, and
brainstorming better approaches.
We were intrigued to find that psychological safety predicted an uptick in learn-how behaviors (those that came with interpersonal risk) but had no statistical relationship whatsoever with the more independent behaviors captured by learn-what activities. This result provided a reassuring demonstration that psychological safety does promote learning by helping people overcome interpersonal risk for engaging in learn-how behaviors. Not surprisingly, for the kinds of learning that you can do alone (read a book, take an online course), psychological safety is not essential. The results also offer support for why psychological safety was not as important in days of yore when work might consist primarily of well-defined tasks such as typing letters for the boss, or passing the surgeon the correct scalpel.
“Workarounds,” a phenomenon identified by Anita Tucker in her remarkable ethnographic study of nurses in the early 2000s, are shortcuts that people take at work when they confront a problem that disrupts their ability to carry out a required task. A workaround accomplishes the immediate goal, but does nothing to diagnose or solve the problem that triggered the workaround in the first place.
The problem with workarounds is that well they, work. They seem to get the job done, but, in so doing, they create new, subtle, problems. First, workarounds sometimes create unintended risks or problems in other areas. For example, confronted with a shortage of a needed material input (say, linens in a hospital unit), a worker might simply find a supply of linens in another unit, thereby getting what she needs but depleting her colleagues who will encounter a shortage later. Second, workarounds delay or prevent process improvement. The problems that trigger workarounds can be seen as small signals of a need for change in a system or process. The workaround bypasses the problem, thereby silencing the signal by getting the immediate job done – but getting it done in a way that is inefficient over the longer term. More difficult, because it would require working across silos, would be for nurses to devise a new linen supply system for all units. Workarounds can occur when workers do not feel safe enough to speak up and make suggestions to improve the system. Indeed, in another study of hospitals, Jonathon Halbesleben and Cheryl Rathert found that cancer teams with low psychological safety relied more on workarounds, while teams with high psychological safety focused more on diagnosing the problem and improving the process that caused it so it didn’t happen again. Halbesleben and Rathert gave us additional evidence that psychological safety is important for organizations interested in achieving process improvement. Their work shows that psychological safety makes it easier for people to speak up about problems and to alter and improve work processes rather than engaging in the counterproductive workarounds.
Another study of process improvement projects, this time in a manufacturing company, also found that projects with greater psychological safety were more successful. Here the researchers studied 52 process-improvement teams following principles of total quality management (TQM). They found that even when employing a highly-structured process improvement technique, interpersonal climate matters for success.
Sharing Knowledge When Confidence Is Low
You might think that speaking up with creative ideas is easier than speaking up about errors. Now, imagine you’re at work and you’ve got an idea you’re 95% confident is creative or interesting. You’ll probably have no trouble speaking up. Now imagine that same situation but you’re only 40% confident of your idea. Most people will hesitate, perhaps trying to size up the receptivity of their colleagues. Stated another way, when you feel extremely confident in the value or veracity of something you want to say, you are more likely to simply open your mouth and say it. But when your confidence in your idea or your knowledge is low, you might hold back.
In a particularly compelling study in several US manufacturing and service companies, University of Minnesota Professor Enno Siemsen and his colleagues found an intuitively interesting relationship between confidence and psychological safety. As expected, the more confident people were in their knowledge, the more they spoke up. More interestingly, a psychologically safe workplace helped people overcome a lack of confidence. In other words, if your workplace is psychologically safe, you’re more able to speak up even when you have less confidence. Given that an individual’s confidence and the value of his idea are not always tightly linked, the usefulness of psychological safety for facilitating knowledge sharing can be immense. Communication frequency among coworkers also led to psychological safety. In other words, the more we talk to each other, the more comfortable we become doing so.
Source : Edmondson, Amy C.,.2019. The fearless organization : creating psychological safety in the
workplace for learning, innovation, and growth. New Jersey : John Wiley & Sons, Inc
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