A dear friend and colleague, David Naylor has created a wonderful resource if you are interested in psychological safety and what it takes to help people to speak up.
https://www.safetospeak.org.uk
Safe to Speak has handbooks and blog posts. All building on his doctorate and book published in 2023 – Speaking up in a culture of silence.
One of the most important things David taught me recently is that for every person that is trying to speak up there is someone either listening or not listening. It isn’t a one way process.
This is a really important reframing. A lot of the literature on speaking up has focused on the person who remains silent: Why didn’t they raise the concern? Why didn’t they challenge? Why didn’t they ask? But every act of speaking up is actually a relationship between someone taking the risk of speaking and someone else deciding (consciously or unconsciously) how to receive it.
To explore why people struggle to speak up or ask questions is fascinating. There are so many stories and concepts as to why that is the case.
To explore why people struggle to hear is just as important
First, people do not receive information neutrally. We interpret what we hear through our existing beliefs, experience and assumptions. The work of researchers such as Chris Argyris on “defensive reasoning” demonstrated that people often protect their existing understanding of a situation rather than genuinely inquire into another person’s perspective.
Someone says:
“I am worried about this patient.”
The listener may hear:
“This person doesn’t understand the pressures we are under.”
or:
“This is criticism of my leadership.”
or:
“They are exaggerating.”
The words have been heard, but the meaning has not.
Second, leaders in particular often receive information that has already passed through several layers of interpretation. Problems become softened, sanitised or reframed before reaching them. The danger is that leaders may believe they have an open culture because nobody is telling them otherwise.
Third, when we are expert at what we do we believe we already understand a situation, and we are less likely to explore alternative explanations.
A junior colleague says:
“I’m not sure this is the right dose.”
An expert listener might unconsciously respond:
“I’ve been doing this for 20 years; I know what I’m doing.”
Third, we see evidence that confirms our beliefs or thinking – this is called confirmation bias and leads us to stop searching for information once we believe we have found the answer.
Fourth, we are often listening to respond rather than listening to understand or not listening and just waiting our turn to talk.
Psychological safety is often described as creating an environment where people can speak up. But it also requires the ability to receive information, or a challenge without becoming defensive.
A leader who says:
“My door is always open.”
but responds to concerns with frustration, explanations or defensiveness may genuinely believe they are encouraging openness while unintentionally closing it down.
When people repeatedly raise concerns and nothing changes, several things happen:
- People stop speaking
- Leaders receive fewer signals
- Leaders believe there are fewer problems
- The organisation becomes increasingly unaware of risk
PATIENT SAFETY NOW 