The data are consistent in this simple but interesting finding: psychological safety seems to “live” at the level of the group. In other words, in the organization where you work, it’s likely that different groups have different interpersonal experiences; in some, it may be easy to speak up and bring your full self to work. In others, speaking up might be experienced as a last resort - as it did in some of the patient-care teams I studied. That’s because psychological safety is very much shaped by local leaders.

When asked why she thought the regulators chose deference even though they possessed this power, her answer was succinct: “they are coming from a place of fear.

In short, psychological safety is reinforced rather than harmed by fair, thoughtful responses to potentially dangerous, harmful, or sloppy behavior.

If she asks her report how things are going and the answer for multiple weeks is “Everything is fine,” she takes it as a sign to prod further. It’s much more likely that the report is shy about getting into the gory details than that everything is consistently rainbows and butterflies.

“Use Systems Thinking to Change How We Think about Error …

Rely on inquiry

So Morath faced a challenge: How to help people to see and accept their hospital’s failures? Rather than doubling down on her logic—You work in a complex error-prone system, don’t you see? Things will go wrong!—she instead invited clinicians to reflect on their experiences that week with their patients, then prompted, “Was everything as safe as you would have liked it to have been?” Her aspirational question opened the floodgates. Most people had been in what Morath called “a health-care situation where something did not go well,” and

once they reflected on the many problems they had noticed, they became eager to talk about what had happened and how they might improve…

New language

Another element of the patient safety system was what Morath called Words to Work By—a 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 defensive…

Synergy…

As with the system at 3M that supported people’s intelligent failures in ways that encouraged product innovation, and the system at Toyota that made quality improvement second nature, Children’s Minnesota built a robust learning system that turned everyone into an active participant in patient safety. Morath’s approach reminds us that system design is more than simply coming into an organization and flipping a single switch. It’s flipping multiple switches understanding how they work as a system.