Messy Moments: Feeling safe enough to speak up

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One MD says nothing during your practice meeting to discuss a major workflow change. She’s relatively new to the practice. She is also the only black person.

You worry that something is wrong.

What would you like to happen? You want this MD to feel safe speaking and to know that the practice values her because the practice needs her.

Having a voice is critical to MDs being satisfied in the work. You want everyone to feel they have a say, even when it may surface a problem, so they’ll stay.

You also depend on this MD to support this change or it won’t work! You don't yet know what she thinks.

What can you do so she feels safe to contribute to all-hands meetings? Arrange to talk with her privately when it’s convenient for her and soon. She may be fearful. She may feel deep distress about how she has been treated in the practice. Or she may worry about voicing something negative. Speaking her with privately (at first) can build a trusting relationship. Ask her:

1. How was the meeting for her?
2. How is her practice going? Sincerely invite her to talk. What can the practice do to make her work easier or more effective? Discuss how that might be done.
3. What do you think of the process change we discussed? What suggestions does she have so that it works for her and improves the practice?

Tell her that it’s important to you that it works for her. Listen. Ask clarifying questions, including any underlying issues or emotions. Then summarize so she knows you heard and understand her.

Suggest you create a committee to solve any problems so that you can improve the work. This clearly communicates:

• You take her contributions seriously.
• Raising a concern does not make the messenger responsible for fixing it. If that is the perception, no one will ever say anything negative again! Assure her that this is a practice problem, not hers alone.

Also acknowledge what else if missing to make this a successful change for everyone. More resources? Data? Other voices? Tell her how you’ll remedy that.

End your discussion with action [see below]. Also agree on a date for a follow-up conversation about how she’s doing.

Announce a task force of at least 4 people to address this and any other concerns about making the change successful. Include her in the task force if she wants that. Set a deadline for committee recommendations for solutions.

AND: Take tasks and time off participants’ plates. No one should think that saying something will add to their workload!

Check with this colleague a few times during the committee’s work if she participates:

• Is everyone participating?
• If not, what’s happening that stops people from contributing?
• Ask her how those obstacles might best be reduced?
• Ask how you might help? Offer to join the next meeting to improve the inclusiveness.

Why make time that you don't have for this?

• Most MDs want more say in their practice and their professional development. Your making space for all clinicians communicatesthat you value them and want their involvement. They’ll enjoy working there more and will be more willing to stay at a moment that many are quitting.
• This MD will know that you heard her concern. She saw you then act to address it. You are standing behind her. She feels less invisible or excluded. You show that she belongs to the practice and its success.
• You’ve improved the tone of practice conversations by showing others positive ways to express difficult information. You explore with them – How can we make this a success for all of us?
• We all have unconscious bias. It continues to silence women, people of color, LGBTQ+ people, remote workers and introverts. The more they contribute, the more information and insights you’ll have to make better decisions and patient outcomes.
• You model how you support your colleagues. You show what you expect of everyone. If you continue to support these norms, more people will contribute, and more people will help others to speak in the future. Repeat comfortable phrases: Let’s hear from everyone on this. What we want is to get better. Let’s talk candidly about how to do that.

A significant evidence base shows that diverse groups offer their differing experiences – geographic, military, education, problem-solving approaches, as well as race, economic, gender and sexual preference lenses, and create better solutions most of the time. Research shows in measurable terms that organizations with more diverse decision-makers create better outcomes. Interrupting and excluding Others are pervasive. The behaviors will continue unless they’re stopped. And you’ll lose valuable people.

Your actions and expectations here will improve the participation of everyone because you are communicating that everyone’s voice adds something and leads to better care decisions and better cooperation. People of all stripes will want to work with you because you listen to them and expect them to contribute.

What have you done to bring everyone into the conversation? Email me to tell me how it worked out. Nance.goldstein@post.harvard.edu

RESOURCES

Edmondson, A. 2018. The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth