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Institute for Healthcare Improvement Blog Post. Access at
How to Use Supervision to Create Psychological Safety
This blog post shares survey results which indicate that conversations between leaders and their direct reports too often do not address concerns and challenges.
This is in stark contrast to research which shows that addressing what is important to each person and his/her pain points significantly improves performance, learning, and innovation. The article defines action steps supervisors can take to promote a psychologically safe work environment which enhances speaking up about concerns.
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For more information about getting support in strengthening your practice, see Adaptive Sprints.
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In this article, you will learn from a real-life situation how to enable the right start in tackling hard relational problems at work.
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(1) Edmondson, Amy C. et al Psychological Safety: The History, Renaissance, and Future of an Interpersonal Construct Annu. Rev. Organ. Psychol. Organ. Behav. 1: 23 – 43, 2014
(2) Perlow, Leslie et al Is Silence Killing Your Company? Harvard Business Review May 2003
(3) Raemer, Daniel B. et al Improving Anesthesiologists’ Ability to Speak Up in the Operating Room Acad Med. 91:530– 539, 2016
(4) Salazar, Marco J. Barzallo et al Influence of Surgeon Behavior On Trainee Willingness to Speak Up: A Randomized Controlled Trial J Am Coll Surg 219:1001-1009, 2014
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In this article you will learn what psychological safety is and why it is simple, important, and fragile.
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This article addresses a question I’m asked frequently by leaders: How can I foster an environment of empowerment when I have to make decisions at times which may cause some people to feel disempowered and distressed?
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Whitmore, John Coaching for Performance Nicholas Brealey Publishing 2009
Questions Tool for Coaching
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In this article you will learn why coaching is so important to effective leadership and how to coach when it feels like there is No Time.
Video (4 min. 39 sec.)
Links to brief articles
Having trouble motivating others?--a quick diagnostic
Active telling--the art of assuring people listen to you
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It is nearly automatic to feel that resistance is about the people resisting—that resistance is IN the resistors.
When caught in this perspective, we tend to focus on our “messaging” (the content of what we are saying) in order to convince them or motivate them or get them to buy-in. This approach creates substantial risk that people will feel we are trying to change them leading to push back or passive compliance with a negative impact on results.
There is a more effective way but it requires a shift in perspective. We need to see that it is not true resistance is IN others.
A common concern of even very successful leaders I work with is lack of sufficient confidence about giving and receiving feedback in the midst of day-to-day work.
This is not surprising because feedback is inherently uncomfortable and risky. But, providing timely, effective feedback is essential if we are after the highest team capacity for transformation. Confidence in taking this on is enhanced by working with the following five barriers.
1. Lack of a motivating, compassionate purpose for feedback.
To counter discomfort, it helps to have a motivating, compassionate purpose. For example: “Feedback is not about correcting bad behavior. Under stress, everyone will, at times, act in ways counter to norms. The purpose of feedback is to help everyone be at their best.”
2. Lack of sharing and assuring mutual understanding of different perceptions.
Relational problems usually set off the nearly automatic tendency to leap from limited data to strong but often flawed conclusions. Effective, respectful feedback depends on stepping back from such certainty. Instead of just “giving feedback,” the initial aim should be to stay open and elicit and assure mutual understanding of each person’s view even if in disagreement.
3. Lack of exchange of information specific enough to enable problem solving .
Feedback is too often given in global generalizations. Then, the chances are high for provoking defensiveness and not getting to specific information which enables problem solving. For example, a client of mine was told by a colleague: “You are a very negative person.”
Resisting her impulse to react, my client asked for a specific example and was told: “When I asked you for help yesterday, you said ‘No’ and walked away.” Such “negativity” had not happened before. My client apologized and they agreed not to use quick hallway conversations to ask for help.
4. Lack of shared norms for feedback.
Shared norms promote helpful feedback. Examples are: (a) Avoid global generalizations; (b) Use "I" statements and offer feedback as perceptions, not as The Truth; (c) Give descriptions of words and behaviors from specific work situations; and (d) Seek each person’s perception.
5. Lack of sufficient leadership engagement in giving and receiving feedback.
A key objective is to develop feedback-rich team interactions. To do so, leaders have to model giving and receiving feedback--especially receiving it. Do you often ask how others have experienced interactions with you? All leaders make mistakes at times. Do you acknowledge them?
Effective, timely feedback is not easy. It requires reformulating what feedback is all about. It reqiures universal respect and compassion. It requires constant practice. Working with the five barriers increases confidence and helps to embed feedback in daily leadership practice.
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When facing difficult relational problems at work, it is natural and nearly automatic for us all to want to diagnose what is wrong and come up with THE right solution as soon as possible.
It is very common to leap quickly to strong but faulty conclusions. One example is attributing relational problems to personality issues or lack of skills. Actually, situational issues are far more often the primary cause of difficult behavior.
Situational complexity and stress are inherent in organizational life. These factors easily provoke differing viewpoints and experiences among the people involved. Relational problems arise most frequently when these differences have not been adequately heard and understood. Pushing for a solution prior to such understanding runs a substantial risk of negative reactions and push back.
Resisting the rush to diagnoses and solutions and taking the time for “dialogue and discovery” usually leads to much more success. By engaging in dialogue, a process of hearing and understanding different viewpoints, new perceptions and solutions emerge surprisingly often.
While there are no recipes or scripts, the following three steps provide guidance.
1. Reflect—recognize and manage leaps to conclusions in yourself
2. Dialogue—first, set aside finding solutions in order to build mutual understanding
3. Decide—seek agreement to meet again (expect multiple conversations for resolution)
The first step can be the most difficult. When the stakes feel high, at times we all have unproductive habits of reaction. These take practice to change and, sometimes, coaching.
The productive habit we need to continuously strengthen is counter-intuitive: we need to slow down the rush to solutions and take one small step at a time through dialogue and discovery. This enables the chances for the best success for both task and relational goals.
Subscribe for free monthly articles and obtain links to articles and tools for subscribers only including the Resource Guide for In-the-Moment Leadership Strategies and the reference list Books That Inspire A “Dialogue and Discovery” Mindset. Click below.
Not only are there hundreds of thousands of books on leadership and associated topics but they offer a bewildering variety of frameworks, models, and terminologies.
On the one hand, this is a very good thing. Having served as a leader for many years, I have been deeply appreciative of many great approaches.
But, as a leader, I usually faced a huge number of issues every day. It was hard to recall more than a few strategies in the moment.
So, all through my career I have sought one short list of strategies for easy reference that would be powerful in problem-solving across many types of situations.
Could it be possible to create such a list? Find out more in the Resource Guide for In-the-Moment Leadership Strategies available for subscribers only. Click on the button below to subscribe for free monthly articles and obtain a link to the Guide as well as other resources.
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The worst mistakes I made over 24 years as an organizational leader were how I told things to people.
I know excellent leadership depends on great listening—I was a natural with that. Each moment of listening is a step forward in building commitment.
But, early in my career, my way of telling too often led to pushback or withdrawal into silence—it was like three steps backwards with commitment.
A recipe for people not really listening
At that time, I was driven by a need for success which led to a need to convince people of my ideas. So, I worked hard to present ideas in a powerful and inspirational way, minimizing weaknesses and flaws. I was well-prepared and could quickly counter any perceived limitations or risks.
The trouble was that people almost always had concerns—few organizational actions are risk-free. Too often, my quick retorts made them feel not listened to. This would provoke debate we could not resolve well or silent discontent which slowed or blocked the actions I wanted.
A paradox of skillful telling
As I sought research and advice about telling, I discovered that even the most inspirational speech is lucky if it gets even 20% of people on board! (1) The large majority of people have to talk their way toward commitment over multiple conversations.
Paradoxically, people are more likely to pull together around an idea if they are able to freely express and explore concerns. Also, people need to be able to talk things over to figure out how an idea connects to what is important to them.
I even had to face the humbling reality that my best ideas had holes and flaws. In complex systems, no one person has the full picture and everyone has a perspective to learn from. It was very hard, but I gradually learned to link success with actually seeking out negative reactions.
A method for skillful telling
To tell effectively I first prepare myself by remembering “My best ideas are just theories to be tested and improved upon.” Then I proceed with a cycle of Ask-Tell-Ask (2):
Several cycles of Ask-Tell-Ask get a lot out on the table. People are more likely to feel taken seriously. Concerns can get then converted into issues for problem solving and action.
Risks and traps in active telling
I call this approach active telling because, like active listening, it is two-way—the goal is to assure mutual understanding and exploration of ideas even if there is disagreement.
I have experienced first-hand several risks and traps. Watch out for the inevitable lure back into convincing others. Also, I have learned to be careful that helping others feel heard does not lead to premature abandonment or revision of my ideas. The reverse can happen--dealing with negativity can easily pull us all, at times, into getting more rigid and discounting feedback.
Human affairs are never perfect. There is no guarantee these methods mean people will really listen to you. But, the chances for getting to true commitment are much higher.
(1) Baker, Neil The Impact of a Visionary Speech.
(2) Adapted from multiple sources including Miller, William R., Rollnick, Stephen Motivational Interviewing The Guilford Press 2012. See the tool on active telling for full list of references.
Success sometimes depends on where you look.
Results from my survey of 420 healthcare leaders published in the Physician Leadership Journal in March 2016 suggest that relational barriers to improvement are very common but are all too frequently overlooked or inadequately addressed.
(If you wish to read the article, contact me and I will send you a copy.)
Since publication, a follow-up survey of 293 additional healthcare leaders adds to the story.
New data suggests an opportunity for action.
80% of the leaders in the new survey reported their organizations specify norms and values to guide behavior and communication. But, it appears that the norms and values are not used as often as needed--such as to give feedback to address problematic communication getting in the way of collaboration. In these situations, only 10% of the leaders indicated feedback happens very frequently and only 30% of the leaders indicated it happens even half of the time it is needed.
One likely cause is that giving and receiving feedback is quite uncomfortable—even for people with advanced communication skills. It is very easy for anyone, at times, to not take action.
Also, it is quite easy to fall into thinking of norms as correcting “bad” behavior which further inhibits feedback. Stress and complexity will cause everyone at times to act in ways inconsistent with team norms. Feedback is not about scolding bad behavior but giving necessary reminders to help everyone more consistently act at their highest level of relational skills.
How do you move beyond the discomfort of feedback?
You can’t--feedback just is uncomfortable.
But you can decrease discomfort by steady practice. This takes courage, determination, and hard work. You could act now by creating or revisiting norms with teams and protecting time in meetings to review what is and is not working.
Or, more simply, you could start by reading about relational issues (see references below) and reflecting about what you believe makes for good work relationships--i.e. get clear on your own norms. Practice watching for inevitable times you do not act consistently with your own norms. Test giving and receiving feedback with trusted colleagues.
If you find yourself not moving forward, consider getting consultation and coaching. Our task is to keep relational issues from becoming hidden in plain view. Achieving the highest quality of teamwork and the best results are at stake.
Resources for team norms and feedback.
Eliciting and managing different perspectives is very important.
In complex systems, no one person or group has sufficient information and perspective to accurately define problems or to design the most creative and effective solutions.
One right answer rarely exists. Different perspectives must be brought together through high quality communication.
Also, the best results arise when people decide to do work out of desire and interest, or intrinsic motivation, as opposed to compliance. Intrinsic motivation arises not through being convinced but through being able to talk about the work and its rationale and contribute to solutions.
But, such open and widely distributed talk about different viewpoints and concerns is very hard to do.
The complexity, pressures, and high stakes of daily life in organizations result in a strong drive to quickly come up with answers to problems. This can shut off adequate communication and cause misdirection, errors, conflict, and passive compliance all of which can hurt results.
Dialogue is a method to elicit different perspectives and manage them skillfully.
Definition of dialogue
Open, honest conversation which elicits commonalities and differences and manages them skillfully to:
Key practices for dialogue:*
You can start to use these practices right now. Every conversation is an opportunity to advance mutual understanding and problem solving. The most important enabling factor for dialogue is the first practice—setting aside, on a temporary basis, the push to get to solutions in order to really listen to people.
Example 1: In complex systems, slowing down simply to ask questions is likely to progressively lead to more accurate definitions of problems, better solutions, and higher motivation. It is helpful to think of one dialogue about one issue as potentially spreading out over multiple interactions including even a 5 minute hallway conversation.
In your next hallway conversation or in a meeting with an individual or team, consider these questions:
Example 2: If you are in the middle of a conflict, ask if others could set aside the attempt to resolve it just to explore what each person is observing and experiencing. Being able to elicit and explore disagreements rather than debate them not infrequently leads to a whole new understanding of an issue entirely different from what was originally expected.
Make every conversation count toward involving people in identifying and solving problems that they care about.
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