Why Do the Best Teams Make the Most Mistakes? The Value of Psychological Safety in Access

Why do the best teams make the most mistakes? The answer may not be so apparent. In a ground-breaking study by Google, five factors were identified as characteristics of effective, high-performing teams: dependability, structure/clarity, meaning, impact, and (most importantly) psychological safety. The best teams, it turns out, don’t make the most mistakes – they are simply the ones who reveal them.

Many Patient Access Collaborative members are surprised when they listen to one of our educational sessions. The speakers, you see, are all required to include their challenges, reflect on their mistakes -- or whatever positive spin they want to put on the language of fallacy. In doing so, we are creating psychological safety. The term, according to Amy Edmonson, PhD, a Harvard Professor who recognized the relationship between performance and candor in teams, is a “shared belief that the environment is safe for interpersonal risk taking.”

Psychology safety is critical for patient access. The measures and goals lack uniformity and specificity. The environment is complex and challenging. The potential solutions are untested and novel. The path is uncertain and unclear. The system is built by humans, and thereby, error prone. There is massive pressure to deliver. Lots of expectations in an environment in which candor, vulnerability, and transparency aren’t rewarded.

As we delve deeper into subject matter expertise – templates, contact centers, patient engagement, digital health, and so forth – we must challenge ourselves to remember that effective solutions require a holistic approach, in a structure in which leaders set the stage for access, invite engagement from all stakeholders, and respond productively.

Consider Edmonson’s findings, as I have applied to our field:

  • Cultivate a culture of psychological safety. Don’t take it for granted, as most professional environments aren’t safe, particularly in health care – and even more so in the academic medical center setting. We operate in an environment which naturally discourages the expressiveness. Psychological safety relates to the climate, not individual personality. It’s up to you to build and nurture it.
  • Create the rationale. Since psychological safety is not inherent, it’s important to develop the evidence for it. Openly discuss the complexity and uncertainty with which we are wrestling; draw from the multitude of studies about patient safety wherein silence is our greatest enemy. The default is dropping one’s head and doing what one is instructed to do. Encourage feedback from everyone on the team.  There is not an inverse relationship between ambition and comfort being vulnerable and authentic; encourage both.
  • Acknowledge the power dynamic. Managerial control is inherent; your subordinates naturally defer to you. Proactively create a safe space for critique. Go out of your way to invite them: ask your team (and yourself) probing questions. Validate your team’s efforts; foster the environment by expressly stating that everyone’s opinion matters. Invite candor. Listen. Appreciate the effort. Own up to mistakes.
  • Don’t shoot – embrace - the messenger. Focus on the message, not the person who delivers it. Ask probing questions about concerns expressed by your team. Access requires a diversity of views; the message is the critical element, not the person who delivers it.
  • Recognize the access knowledge explosion. Each of us is gaining more insight into the various aspects of patient access; let us not forget that the importance of the collective intelligence of the team. Access problems don’t – and won’t – line up with the silos we are creating. The team is better than the individual; incent and celebrate the team.  Without direction, the cultivation of deep expertise can lead to fallibility. 

Our field is constantly growing and changing through external forces and internal factors. The Patient Access Collaborative pledges to support your journey by fostering continuous sharing in a learning platform that embraces psychological safety.

Learn more about applying Edmonson’s findings to your team:  https://amycedmondson.com/.

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