Abstract
Psychological safety at work means that you can be yourself at work and speak up with a dissenting opinion without fear of reprisals. I’m lucky to have worked more often than not in cultures predominantly defined by respect and with colleagues who not only make me feel safe but who also routinely inspire me to bring my best self to the office. Can the same be said for most workplaces in America? If you study this question, you will find that all roads lead to the extraordinary scholarship of Harvard Business School’s Amy Edmondson. This editorial reviews the advantages of building a fearless health promotion profession and argues that we need to substitute some natural, understandable tendencies with some unnatural but powerful traits.
Does health education work? This reads as a nonsensical question to me, given my vantage point as an editor who, every week, gets to review some of the best research in health promotion. I’m mindful that many studies that fail to prove a hypothesis don’t cross my desk; nevertheless, ours is a discipline undergirded by decades of science proving its effectiveness. That’s why I’m discomfited to admit that an extensive literature review article I wrote early in my career was titled “Does Health Education Work?” 1
In retrospect, I’ll also admit that the article was motivated by a feeling that the health education department I managed, not to mention my ego, was getting bruised by a workplace pecking order. I worked in a large health system at the time, and now, a quarter of a century later, I still recall a meeting attended by about a dozen physicians with whom I was collaborating to plan a continuing medical education calendar for that year. I proposed some sessions relating to patient education, and a psychiatrist who chaired the planning committee, turned to me and said. “Well, is there really any evidence that health education works?” I came to realize in the years that followed that the medical profession was fraught with long-standing pecking orders. Psychiatry was one of those subspecialties that got more than its share of disparagement from other, ostensibly harder, science-driven subspecialties. In me and my profession, the psychiatrist likely felt, consciously or not, an opportunity to have the upper hand for a change.
In recent months, it was my pleasure to organize a think tank meeting focused on psychological safety at work. Collaborating with a preeminent psychiatrist and other mental health experts who served as faculty on this topic is no doubt what resurfaced my outmoded pecking order story. Outmoded, that is, in my experiences at work since. Although I remain conscious of the slights and misunderstandings extant in any workplace, I’m lucky to have worked more often than not in cultures predominantly defined by respect and with colleagues who not only make me feel safe but who also routinely inspire me to bring my best self to the office. Can the same be said for most workplaces in America? If you study this question, you will find that all roads lead to the extraordinary scholarship of Harvard Business School’s Amy Edmondson. Her newest book, among seven, is “The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation and Growth.” Building on her expertise in teaming, Edmondson chronicles the ways that creating an environment where you can be yourself at work, without fear of reprisals when you speak up, fosters business success. 2 If you review Edmondson’s portfolio of books on her Amazon author’s page, you’ll see that those who read Edmondson also read Edgar Schein and Brené Brown, 2 other must-read authorities helping us understand the high stakes behind getting cultures right. 3
When you dig in to Edmondson’s latest writing, you may find it instructive, as I did, to reflect on how her current work may have been informed by her early career experience with the renowned “Bucky” Fuller, an expert in the geometry of thinking and the mathematics of geodesic domes. Edmondson’s first book, “A Fuller Explanation: The Synergetic Geometry of R. Buckminster Fuller,” translated Fuller’s famously obscure technical work that combined the study of architecture with his abiding fascination for the uniformity of nature. 4 A surprisingly generous amount of this explanatory book is available free, by the way, if you click on Amazon’s book sample of the Kindle edition. 5 Harken back to these early explorations by Edmondson, and you find her reflecting on conch shells and honeycombs and asking questions about “what accounts for nature’s magnificent orderliness?” Where Fuller was mostly known as “the dome guy,” Edmondson deciphers his calculations and drawings to show how “every identifiable experience is an energy event,” and she eloquently explains why Bucky’s work was more transcendent than symmetrical design. His was “a sort of philosophical geometry.”
In describing the fearless organization, over a quarter of a century later, Edmondson remains fascinated by energy events, although today she explains the architecture that supports a healthy “interpersonal climate” and how safety is transcendent in business when it “lives as a property of a group.” In describing her early work teaching about Fuller and building model tetrahedrons, she would quip that her work then combined “kindergarten games and mathematical torture.” It’s no wonder that Edmondson is now an international expert to whom business leaders turn to solve for “VUCA,” today’s climate of volatility, uncertainty, complexity, and ambiguity. In this troubling context, one where the title of a bestselling book about our nation’s president is titled “Fear,” it is noteworthy that Edmondson’s book offers comprehensible calculations about the connections between anxiety, hierarchy, and a company’s ability to innovate. To wit, it’s not merely embarrassing when someone essentially opines that you or your profession has it wrong; if unaddressed, it is performance quicksand for both the purveyor and the receiver of such abuse.
I’m lucky to work with colleagues who not only make me feel safe, but who routinely inspire me to bring my best self to the office. Can the same be said for most workplaces in America?
We are “constantly assessing our status”—largely without conscious attention—according to Edmondson, and my pecking order story above relates to her findings that those deemed to have lower status are those who experience more stress. Where Schein taught about “learning anxiety in organizations,” Edmondson builds on this premise by detailing why fear is not an effective motivator and why psychological safety is essential for learning and growth. Look up the antonyms for fear, and you’ll find those attributes that make a company as strong as a geodesic dome, such as confidence and calmness, curiosity, and courage. In short, the opposite of fear is acceptance, and Edmondson’s book offers a tour de force exposition on how personal humanity and workforce productivity are mathematical equivalents. Had I, or others on our medical education planning committee, understood those many years ago, the merits of what Edmondson describes as “situational humility,” I could have saved myself the nuisance of writing a superfluous literature review on the effectiveness of our profession.
Teaming and Collaboration to Create Something New
When considering the advantages of a fearless organization and applying these principles to a fearless health promotion profession, I’m persuaded that we need to substitute some natural, understandable tendencies with some unnatural but powerful traits. We should not spend time fretting about our status in the eyes of critics or defending our profession to those who operate through fear. Similarly, we should not be stymied by seemingly inevitable professional culture clashes. Instead, we should invoke our right to psychological safety and spend much more of our professional capital on teaming. As Edmondson explains in her prior books and in a popular TED Talk, teaming, goes beyond well-established work teams, requires reaching across professional boundaries and collaborating in ways that enable the creation of something new. 6 Edmondson uses the seemingly unsolvable plight of the 33 miners in Chile who were trapped half a mile underground to illustrate how brilliantly teaming can work when professional boundaries are safely traversed. The fearless health promotion profession is one that spends less time extolling the merits or our team and more time teaming, that is, forging alliances that bring in altogether new ideas, resources, and solutions.
As much as health promotion describes itself as a multidisciplinary profession, consider how many cases you can name of health promotion initiatives that are co-designed by interdisciplinary teams and that intentionally cross departments, sectors, or other professional boundaries? In a recent article entitled “Cursed by Knowledge,” Rosenbaum, a physician, relates her experiences of feeling blamed by other medical specialists if she made mistakes, while, fatefully, these same specialists were ever wary of sharing their expertise. Rosenbaum understands the value of specialization but notes that “it comes at the cost of integration.” Rosenbaum cites examples of how “specialists essentially develop their own language” and “they lose the ability to play well together.” 7 And it’s not only professional turf that foils teaming. Add competition over budgets, the quest for credit and the crush of competing organizational or community priorities, and it seems clear that teaming is an outright act of courage.
That motto, “don’t bring me problems, bring me solutions,” is foolish in today’s business climate of ambiguity and volatility.
An Interview With Amy Edmondson
Dr Amy Edmondson is the Novartis Professor of Leadership and Management at the Harvard Business School. She has been recognized over many years by Thinkers50 as one of the top management thinkers in the world. Although Dr Edmondson was not able to join us for our think tank on psychological safety, we provided her book to all in attendance, and I was able to host her in a webinar that is publicly available on the webinar archives page of the HERO website. 8 In addition to a presentation on key concepts from her book, the webinar afforded time for an interview with Edmondson where she took questions from me and from the webinar audience and reacted to polls of our listeners’ opinions. Here is a lightly edited excerpt from the interview segment of the webinar:
That’s very interesting and it raises many possibilities. Some of the people in the comfort zone feel comfortable speaking their mind but they’re not fully engaged, so they may need more motivation and feedback on their performance. But their own behavior may be making it difficult for others to speak up. So the challenge for this manager is to be appropriately engaging in a tough love sort of way for those in the comfort zone and let them know that she’s confident that they have more to offer. Conveying that you believe someone is capable of more is a compliment. Managers needs to keep moving people toward the learning zone in a dynamic way. Most people need to be reconnected to a motivating goal or purpose, to stay motivated. Similarly, we are dependent on small signals that the environment is safe for interpersonal risks like speaking up.
That is a very thoughtful statement. You know it’s also ironic. If you think about it, his leaders are confusing positivity with caring, loyalty and engagement, and nothing can be further from the truth; it is counter-productive. As one leader I cite says, “if you’re not dissenting, I’m not getting what I’m paying for out of my leadership team.” This is a challenge because we want people to be gung ho and willing to go for it, but that means also being willing to be proven wrong. Exuding warmth and energy is not the same as agreement. In other words, to confuse putting on a happy face with alignment is a grave error. This pressure to put on a positive spin is what so many famous failed business case studies are based on; this covering up what isn’t working all comes home to roost. That motto, “don’t bring me problems, bring me solutions,” doesn’t work very well in today’s business climate of ambiguity and uncertainty. Consider that human beings are very good problem detectors; we readily spot things that aren’t working. But finding solutions that really work for customers is a team sport. So saying “don’t come to me with problems” is counterproductive, because you need to get a team together to come up with a solution for most complex problems – and that cannot happen if people don’t speak up about the problems they see.
That’s interesting because leaders not listening is a more subtle problem than the more explicit fear of reprisals. For those 25% without these concerns, I’m delighted on one hand. They may well be those who can show up and bring their full selves to work. On the other hand, it may mean that there are other things that are preventing them from speaking up.
It’s true that the higher you go in an organization the more you feel is at stake, so it’s a myth that the leaders enjoy all of the psychological safety. It is often the case that as leaders go higher in the organization they get more reluctant to admit mistakes because their failures are more visible. And, yes, research suggests narcissists do rise up in organizations because they’ve mastered getting attention and looking good and making it all about them. But these are not the leaders who we admire most or who create enduring value. There are forces in play that help narcissists get ahead, but I like to think of leadership as a two-by-two table where getting ahead and making a difference are two dimensions you should think about. In leadership development programs at Harvard and elsewhere, for example, we teach things that we hope will help people get ahead, to be in positions where they have more influence. But we also hope that they will learn how to make a difference. That’s the sweet spot in the upper right-hand quadrant of the two-by-two table. Those who get ahead but aren’t focused on making a positive difference for others—it’s about themselves—seem to me less worthy of our respect. Personally, I admire those who toil away making a difference but don’t ever make it into the limelight a great deal more.
Yes, the forty-one percent who agree or strongly agree are in a pretty uncomfortable place. We are human beings, and we make mistakes. We don’t do it on purpose, and we don’t want to create harm. It’s called a mistake for a reason: it’s unintended. I find it painful and important because the main thing these forty-one percent can do in that environment is to hide the mistakes they make, to cover them up because none of us want to have things held against us.
You can take these responses to be about this audience’s belief system, their philosophy of how to work with those who aren’t open to change. This is interesting because many here are saying we really have a lot of agency and they don’t worry too much about those above them. They do what they need to do, look to their peers and get on with making a difference. I believe this is a very healthy perspective. The other half seem to be suggesting this is pretty deterministic; when you’re in a situation with a stuck leader you just have to get yourself out. I’m not sure whether this is their philosophy or just their reporting on their own realities, but it’s clear that sometimes you would counsel people to get themselves out of such situations and find a better work environment.
Yes, the connection is strong and not at all coincidental. Most workplace accidents are multi-causal, they happen due to several factors. When too many factors come together, accidents happen. So the best way to avoid safety incidents is not to be too strict but rather to be super quick about pointing out smaller problems before they spiral into an accident. So psychological safety helps avoid accidents. People have to feel super secure to speak up and say, “wait a minute, something’s not right here.” Psychological safety is what allows us to achieve higher levels of employee or customer safety.
Concluding Thoughts From a Minnesotan
I’m a lifelong Minnesotan and a proud booster of a culture with Midwesterner family values and a strong sense of community. As our late Senator Paul Wellstone said without guile, “we all do better when we all do better.” Still, I allow that we’re not standing on our thickest ice when we tout our “Minnesota Nice” reputation. One t-shirt says “Keep Minnesota Passive-Aggressive: Or not. Whatever you think is best.” Minnesotans can dislike you and you wouldn’t have a clue, such is the depth of our go-along-to-get-along personalities. Edmondson’s book is brilliant in distinguishing between attributes that foster psychological safety and dissimilar traits like being nice or pursuing popular opinion.
How is it that my takeaway from Edmondson’s research is that health promotion needs to be more collaborative but that we also need to voice more dissenting opinions? Increasing collaboration within the context of psychological safety should not be confused with everyone being nice and trying to get along. Indeed, there’s nothing ingratiating about being the one who consistently voices dissenting opinions, but dissent is precisely what defines a psychologically safe workplace. Nor should collaborating across disciplines be felt as an abdication of accountability related to your area of expertise. Being trained in a profession, by definition, means we should still feel duty-bound to share what we know about what is likely to work and challenge ideas we doubt can work. One standard rule in brainstorming is to never criticize the ideas of others. It is a nice idea were it not for research that shows it’s a rule we need to be breaking. Read “minority influence theory” to see evidence showing how brainstorming should be more like barnstorming. The less we challenge ideas, the less originality ensues. Conversely, according to research by Charlan Nemeth, another Harvard scholar, when we’re confronted with consistent opposition, the diversity of opinions blossoms and the quality of ideas improves. 9
Being trained in a profession, by definition, means we should feel duty-bound to share what we know about what is likely to work and challenge ideas we doubt can work.
Unlike the influence of the majority who exert their views in ways that evoke conformity, minority influence, when exercised well, is thought to be the more powerful agent for social change. I’m referring here, of course, to authentic reasoned dissent, not to the scornful babble of truculent naysayers or bloggers. In a “Freakonomics” podcast on “Where Good Ideas Come From,” Conan O’Brien’s comedy team’s writing process is described as one of relentlessly picking apart each other’s ideas. 10 What O’Brien and Nemeth have in common is their appreciation for the role of troublemakers and how dissent sparks new thinking. Airing out dissenting opinions is a prerequisite to raising the bar. For a good writer, painter, or musician, it’s seldom the first pass at a song or painting that passes as their newest masterpiece. Rather, that disciplined process of tinkering over and over is where ideas and execution comingle then wed. Critical feedback from trusted colleagues delivered in a safe environment is how inspiration and perspiration meet.
I am writing this editorial the week that Congress invited Michael Cohen to give testimony that may stand in history as one of the more disturbing examples of someone who, according to his account, deserted a psychologically oppressive workplace. What’s more, it would be hard to replicate a more psychologically inhospitable venue than the House Oversight Committee for retelling his story. New York Times columnist David Brooks posited that the testimony should serve as a warning about the costs awaiting those who blithely desert their morality. Brooks wrote: “Here is the commandment that experience teaches us: Immorality usually bites you in the ass. If you behave in a way that betrays relationship and obliterates the truth and erases your own integrity, you will sooner or later wind up where Michael Cohen has wound up—having ruined your life.” 11 Thankfully, for the majority of us, breaking ranks from a bad boss or acquiescing to a dysfunctional workplace is not going to land us in jail. Still, Brooks’ caution applies to all manner of compromises. Bringing our dissenting views, consistently standing up for our beliefs and inviting collaboration that assumes we’ll meet each other on moral high ground is what we must do to wind up where we want to wind up – with a life well lived.