She introduced new terminology (âwords to work byâ) that altered the meaning of events and actions in important ways; for instance, instead of an âinvestigationâ into an adverse event, the hospital would use the term âstudy;â instead of âerrorâ she suggested people use âaccidentâ or âfailure.â In subtle but important ways, Morath was trying to help people think differently about the work â and especially about what it means when things go wrong. These leadership actions comprise what I refer to as framing the work.
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The study [on what made the best teams] examined several possibilities: Did it matter if teammates have similar educational backgrounds? Was gender balance important? What about socializing outside of work? No clear set of parameters emerged. Project Aristotle, as the initiative was codenamed, then turned to studying norms; that is, the behaviors and unwritten rules to which a group adheres often without much conscious attention. Eventually, as Duhigg wrote, the researchers âencountered the concept of psychological safety in academic papers [and] everything suddenly fell into place.
When I studied top management teams with action scientist Diana Smith, we analyzed detailed transcripts of their conversations to show how a psychologically safe climate for candid discussion of strategic disagreement can be created, even in high-level teams confronting strategic challenges, and how this can enable productive decision-making.
Framing the work is not something that leaders do once, and then it's done. Framing is ongoing. Frequently calling attention to levels of uncertainty or interdependence helps people remember that they must be alert and candid to perform well.
To reinforce a climate of psychological safety, it's imperative that leaders â at all levels â respond productively to the risks people take. Productive responses are characterized by three elements: expressions of appreciation, destigmatizing failure, and sanctioning clear violations.
âUse Systems Thinking to Change How We Think about Error âŚ
Rely on inquiry
So Morath faced a challenge: How to help people to see and accept their hospitalâs failures? Rather than doubling down on her logicâYou work in a complex error-prone system, donât you see? Things will go wrong!âshe instead invited clinicians to reflect on their experiences that week with their patients, then prompted, âWas everything as safe as you would have liked it to have been?â Her aspirational question opened the floodgates. Most people had been in what Morath called âa health-care situation where something did not go well,â and
once they reflected on the many problems they had noticed, they became eager to talk about what had happened and how they might improveâŚ
New language
Another element of the patient safety system was what Morath called Words to Work Byâa roster of suggested terms designed to help shift mindsets from blaming to learning. Morath substituted neutral-sounding words such as study for the more threatening word investigation, which put people on the defensiveâŚ
SynergyâŚ
As with the system at 3M that supported peopleâs intelligent failures in ways that encouraged product innovation, and the system at Toyota that made quality improvement second nature, Childrenâs Minnesota built a robust learning system that turned everyone into an active participant in patient safety. Morathâs approach reminds us that system design is more than simply coming into an organization and flipping a single switch. Itâs flipping multiple switches understanding how they work as a system.