Building a culture of full disclosure
How does a work place culture allow people to speak up, highlight important issues and opportunities to improve?
The underlying theme of 10x Curiosity is one of continuous improvement. In all disciplines how do you make sure that the work you are doing tomorrow is always better than the work today?
Organisations are frequently placing barriers in the way of innovation and improvement. Whether through explicit policy’s requiring approval of a higher level leader or more subtle organisational cues around what is celebrated and promoted, the way people work is an outcome of the systems that are put in place .
These systems frequently get in the way of people being able to achieve their best work.
I have previously looked at aspects of this via the blog “Blackbox Thinking”.
There has been much work in recent years on the benefits of creating a culture with high psychological safety. Much of it stems from the groundbreaking book “ The Fearless Organisation” by Amy Edmondson.
Edmondson describes psychological safety as (p32):
“the belief that the work environment is safe for interpersonal risk taking. The concept refers to the experience of feeling able to speak up with relevant ideas, questions, or concerns. … In psychologically safe environments, people believe that if they make a mistake or ask for help, others will not react badly. Instead, candor is both allowed and expected.
Psychological safety exists when people feel their workplace is an environment where they can speak up, offer ideas, and ask questions without fear of being punished or embarrassed.”
A key part of this is developing systems where there is a culture of full disclosure, one where reporting and learning from mistakes is expected and celebrated. Edmondson and Singer explore why this is important in a post on “The System Thinker”:
Where catastrophic failure is possible, mistakes are inevitable, or innovation is necessary, learning from failure is highly desirable. Yet research suggests that few organisations dig deeply enough to understand and capture the potential learning from failures. Why this resistance to learning?
More generally, the human desire to “get it right” rather than to treat both success and failure as useful data greatly impedes learning.
Individuals prevent learning when they ignore their own mistakes in order to protect themselves from the unpleasantness and loss of self-esteem associated with acknowledging failure.
Two notable areas demonstrating the benefit of a culture of full disclosure are the airline and heath care industry’s.
An interesting case study is provided by Julie Morath, RN, MS, chief operating officer and vice president of care delivery at Children’s Hospitals and Clinics of Minnesota in Minneapolis.
The system introduced by Morath is modeled on the type used in the airline industry starting with:
a new incident report the form of a “safety learning report” that is mostly text, rather than a series of questions or boxes to check off. Morath notes that forms asking a person to check off boxes are good for data management, but not so much for learning. It’s a different kind of data analysis that is needed for improving patient safety, she adds.
“You mostly learn about systems through the stories, what happened, what the conditions were at the time, and what you think could have prevented this,” she says. “One thing we learned was that near misses or vulnerabilities that are not dealt with can reconfigure at another time in a way that actually harms the patient.
So we started asking “Have you ever seen this before?’ to help us become aware of recurrent problems.”
Another important part of the disclosure philosophy at Children’s is the blameless reporting system. Simply promising employees that will not be punished for reporting accidents is not enough, Morath says. They must see over time that you mean what you say.
“We don’t name names in the disclosure process by pointing the finger at someone like the nurse who just happened to be last person in a long line of system failures that made the accident possible,”
… “We indicate what has happened, what the consequences to the patient are as we know them today, that an analytic review will take place, that the family will know the results of that review, and what changes will be made to reduce the probability that this will ever happen again.”
Moving towards this culture is a critical step in developing groups that can work fluidly and independently across projects and organisational boundaries. This is critical to the success of many of the projects in today’s organisations. Edmondson refers to this as “teaming” and outlines the following important steps to achieve it:
Frame the work
- The first leadership task is to frame the work for others. A frame is a set of taken-for-granted assumptions that powerfully shape how we see a situation.
Make it safe
- The second leadership task is to recognise and combat the subtle ways in which a lack of psychological safety can inhibit teaming when caregivers are reluctant to ask questions or challenge others. Leaders play a critical role in creating such environments in health care by emphasising the risky and uncertain nature of the enterprise and by asking thoughtful, probing questions.
Build facilitating structures
- Finally, leaders must create structures that make teaming easier, including systematic communication tools like SBAR (situation, background, assessment, and recommendation) that structure clinical interactions in ways that improve hand-offs and lower the risk of crucial omissions related to a patient’s care. Implementing structures can also mean redesigning facilities to force cross-disciplinary collaboration in the care of complex patients.
Edmondson again (p165)-
Leaders in a volatile, uncertain, complex, and ambiguous (VUCA) world, who understand that today’s work requires continuous learning to figure out when and how to change course, must consciously reframe how they think, from the default frames that we all bring to work unconsciously to a more productive reframe.
As previously written, It is great to be confident of your views of the world but care needs to be taken to ensure your confidence doesn’t stop you from being open to alternate points of view and possibly realising that confidence is misplaced. You especially need to be sure that your confidence is not preventing others from speaking up and highlighting important issues and opportunities to improve.
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