For the full editorial, the complete interview with Dr. Amy Edmondson and editorial references go to the American Journal of Health Promotion (open access).
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?”
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 sub-specialties that got more than its share of disparagement from other, ostensibly harder, science-driven sub-specialties. 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 re-surfaced my outmoded pecking order story. Outmoded, that is, in my experiences at work since. Though 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 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.
In describing the fearless organization Edmondson explains the attributes of a healthy “interpersonal climate” and how safety is transcendent in business when it “lives as a property of a group.” Her practical applications of concepts has made her an 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. 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.” 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. Though 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. 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:
Question: You wrote in your book about the “anxiety zone” that is created when people don’t feel psychologically safe at work. It is the zone that keeps you up at night. It relates to the fear people have about confronting conflicts. Our first webinar poll results show that 42% of our audience are undecided or disagree that people in their organization are eager to share information about what doesn’t work (i.e. mistakes) as well as information about what does work.
Dr. Edmondson: It suggests we as a society are moving in the right direction and that we’re coming to understand the importance of bringing up problems. Your webinar likely attracts those who already understand the value of this, but my heart goes out to the 42% who don’t work in that kind of environment. In some organizations, leaders are going out of their way to let people know that it is okay to speak up. I spoke with one leader who would routinely begin conversations by acknowledging what he got wrong about something, he would admit failure so that his colleagues could admit failure. And then he got to his own performance review and his supervisor said, “I heard you made some mistakes,” and he got dinged for it on his review. How ironic! He is this extremely perceptive manager doing all the right things in this volatile, uncertain, complex world, but his boss doesn’t get it.
For the full editorial, the complete interview with Dr. Amy Edmondson and editorial references go to the American Journal of Health Promotion (open access).
Thoughts on Teaming 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.
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 re-telling 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.” 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.
Paul E. Terry, Ph.D., Senior Fellow, The Health Enhancement Research Organization (HERO), Editor in Chief, the American Journal of Health Promotion.
