When asked what makes a high-performing team, what would you say? I’m sure many people would say that having the best skills or most talented individuals on the team would lead to the best performance.
However a massive study conducted by Google in 2015 showed that:
“who is on a team matters less than how the team members interact, structure their work, and view their contributions”[GOO19].
So in the veterinary context, our clinical skills and combined IQs can only get us so far in terms of performance as a practice. We hit a metaphorical performance glass ceiling.
The study at Google demonstrated that 5 key factors set the most successful teams apart from the others.
1. Psychological safety – can team members take risks without feeling insecure or embarrassed?
2. Dependability – Can team members rely on one another to do high quality work on time?
3. Structure and clarity – Are goals, roles and execution plans clear for our team?
4. Meaning of work – Is our work something that is personally important for each of us?
5. Impact of work – Do we believe that the work we’re doing matters? [GOO19]
So the number one factor present in a high-performing team? Psychological safety. And furthermore, this factor underpins each of the subsequent four factors.
WHAT DOES PSYCHOLOGICAL SAFETY MEAN?
Psychological safety is the creation of an environment in which all team members are safe, and feel safe, to take interpersonal risk to speak up without fear of judgement or animosity from colleagues.
This may be with a new idea, halting a process that may be dangerous, admission of a need for help, offering constructive feedback or adding opposing opinions to a discussion no matter what level of the team hierarchy the contributor is, amongst myriad other things. Data from Gallup [GALL17] polls show that in the US, only 3 out of 10 workers feel it is safe to speak up at work. But there is hard data showing that productivity and turnover increase (12% and 27% respectively) and safety incidents drop (by 40%) simply by increasing how many workers feel their opinions matter. As a high-performance workplace and as a business we are losing enormous value if our team don’t feel psychologically safe.
“If we’re not hearing from people we may be missing out on a game-changing idea…or we might miss an early warning…that someone saw but felt unable to bring the bad news to their boss.” [CRE18]
So how does a team create an environment of psychological safety? Is it as simple as being led by someone who is nice, kind, humble, helpful and authentic? Well in short, no. Building psychological safety and trust in a workplace isn’t as simple as just being the ‘nice guy’. Research has shown that there is greater trust when we identify with people in the same group, particularly if the purpose of the group is something we care about fundamentally. Hence the way that points 4 and 5 above underpin the level of psychological safety in our own veterinary workplaces. Do our team members feel that the work they do as individuals is personally important to them? Do they believe that the work they are doing matters? If as a team we are all feeling the same about these issues, then an environment of psychological safety starts to build.
The following statements were used by Prof Amy Edmondson (who coined the term psychological safety) to survey how employees felt about the psychological safety in their team. What would you answer?
[TDT19]
HOW DOES PSYCHOLOGICAL SAFETY RELATE TO JUST CULTURE?
Just Culture refers to a workplace culture that recognises that competent professionals make mistakes and can also simply develop unhealthy norms. This is normal and can be treated as something to learn and grow from as a whole team. However, it is not a culture that allows for things like reckless behaviour or destructive acts. Team members are rightly held accountable for this sort of behaviour. But unlike a blame culture, a Just Culture focuses on systems-based issues that could lead to a genuine mistake. It does not just focus on the individual and their ultimate error. There is a shared accountability between the organisation (practice) for the systems in place that have contributed to the error and the employee who is accountable for his/her choices and equally for reporting their error. A psychologically safe workplace with a Just Culture is one in which team members can safely speak up about their errors or even practice/systems issues that could or have led to error, knowing that the situation will be dealt with fairly and justly. We must recognise all humans will make mistakes and often it is systems that lead to that human erring. A workplace where people feel psychologically safe will be a workplace where error is reported. In a Just Culture, that report is then dealt with in a just and fair manner and lessons are learned by the whole organisation not just the individual involved.
In all our practices there will have been a time where a client walked out the door with the wrong drug. It would be easy to point the finger at an individual and consider the situation dealt with. The vet must have pulled the wrong drug off the shelf, and should have taken more care to get it right. But on unpicking the situation we see that that day consults were full and some had been double booked. There was chaos in the dispensary because the drug order had arrived late so there was no time to fully unpack before afternoon consults. The label printer often spills labels out onto the floor if lots are printed at once. And a new SVN who was trying to help ease the load on the vets by labelling dispensed drugs, had only arrived that morning and hadn’t had a proper induction yet. A blame culture points the finger at an individual (vet or SVN) and considers the matter closed.
A Just Culture recognises that there were many issues at stake here and ultimately a mistake was made. It was largely systems error that was involved. A psychologically safe workplace means that the vet and hopefully even the brand new SVN can speak up and talk about what happened and why perhaps it happened without fear of retribution. The aims of dealing with an error are restoration not retribution. All parties can discuss how they have been affected with the aim of mitigating against a “second victim” where the individual involved also suffers through guilt, shame or blame.
A practice where it is safe to err will ultimately perform better in terms of patient safety, staff wellbeing, client care and much more. As a result there is better client satisfaction, lower staff turnover, reduced disciplinaries and greater dissemination of learning across the practice. In one NHS trust (NHS MerseyCare) where a Just and Learning Culture was implemented, within less than three years disciplinary cases amongst staff members were reduced by 75%, there was a significant increase in patient safety and a positive increase in staff satisfaction survey results.
This surely forms the foundations of a workplace we would all want to be in.
WHAT CAN WE DO TO FOSTER PSYCHOLOGICAL SAFETY IN PRACTICE?
Amy Edmondson, Novartis Professor of Leadership and Management at Harvard Business School.
1. Frame the work as a learning problem, not an execution problem
2. Acknowledge your own fallibility.
3. Model curiosity and ask lots of questions (all levels of team hierarchy)
Any surgical or medical procedure is easily viewed as a set of fixed problems (that we may or may not anticipate) to be met and executed. But framing the procedure or work up as a learning problem which the team all work through together changes our mindset altogether. If we are all approaching the case as a learning activity, then when issues arise it is far safer for any member of the team to speak up/make suggestions/ask a question.
- We need a team commitment to openness and safety in speaking up, not just with error and mistakes but with ideas and questions too. “We are all going to commit to being open with one another no matter who we are in the team. This is a group commitment not just theoretical thinking.”
- We need colleagues who are willing to hear from their team-mates. “I may have missed something so I need to hear from you”
- Questions can be from any member of the team to another regardless of position. Be curious about one another’s roles. “Why do you do it that way? What have you tried before that led you to doing things this way?” Model questioning with curiosity, not condemnation.
WHAT IS REQUIRED FOR PSYCHOLOGICAL SAFETY TO BECOME PART OF OUR WORKPLACE?
Leaders at all levels of the organisation need to recognise where they could make it easier for team members to approach them. This takes some humility. It is important for the leader in that environment to go first and do what they can to create psychological safety.
“What could I do to make you feel you can come to me with ideas, problems, opportunities and dangers?”
As an employee it’s often not easy to speak up is it? No-one goes to work wanting to look incompetent, ignorant, intrusive or negative. So how to avoid this? Well, keep quiet. Keeping quiet works to protect you, at least in the short-term. But it doesn’t protect or develop the team. The problem comes back – workplaces where teams don’t speak up/offer ideas/ask questions are lower performing, less successful, and are less profitable! Furthermore, not speaking up stalls learning, development and innovation in the team.
Take an example from human healthcare. Do better hospital teams make fewer medication errors? Research by Amy Edmondson [BUI14] showed initially that better teams made more mistakes, the opposite of what she had been expecting. It became clear on further research though that the better teams are not making more mistakes, but have a culture where they are more willing to admit and are open to discuss their mistakes…and as such are a better performing team.
Is it worth developing our workplace psychological safety? Absolutely.
Better team. Better environment. Better results for patients. Better bottom line.
It’s a no brainer.
REFERENCES
[GOO19] Rozovsky J (2015), The five keys to a successful Google team https://rework.withgoogle.com/blog/five-keys-to-a-successful-google-team/- Accessed 15/11/19
[TDT19] http://teamdevelopment-training.co.uk/psychologicalsafety/- Accessed 15/11/19
[GALL17] https://www.gallup.com/workplace/236198/create-culture-psychological-safety.aspx - Accessed 15/1//19
[CRE18] https://www.youtube.com/watch?v=KUo1QwVcCv0– Accessed 15/11/19
FURTHER READING
Rozonovsky (2015) The Five Keys to a Successful Google Team
Guide: Understand team effectiveness https://rework.withgoogle.com/print/guides/5721312655835136/
Edmondson (2016) Why Psychological Safety Matters and What to Do About It
Herway (2017) How to Create a Culture of Psychological Safety https://www.gallup.com/workplace/236198/create-culture-psychological-safety.aspx
Edmondson A (2018) Creating Psychological Safety at Work in a Knowledge Economy - video
Edmondson A (2014) Building a psychologically safe workplace - video