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Transcript of the video:

I’ve spent a lot of time and have done a lot of research thinking about this notion of a climate of what I call psychological safety, where you take for granted that or you remind yourself that it's okay, in fact it's required that I ask questions, that I admit mistakes, that I offer ideas, and so on because that's the nature of the work we do. The world is always changing, and so on and so forth.

Real data this time; these are from a study of ICUs in 26 different hospitals. Ingrid Nembhard, a former doctorate student, now a professor at Yale at the Medical School, and I, studied 1,100 different clinicians in these three categories; physicians, nurses and respiratory therapists.

And they were they were asked to fill out a survey, a validated measure of psychological safety. It doesn't use the term psychological safety. It tries to assess their propensity to speak up, to ask for help when they need it. And these were the results in the whole population and these were statistically significant. And what it says is that hierarchy or medical status is a pretty good predictor of psychological safety.

But Ingrid and I didn't stop there. We looked more carefully, unit by unit. And what we found was that this pattern, this downward sloping pattern, was not always present. In some units it was flat. And that meant flat and high, which of course meant in other units it was far steeper than what we see here. And what made the difference?

And, by the way, Ingrid stuck around long enough to really take this all the way through. So three years later we could say that the places where it was flat and high engaged in more deliberate learning activities, improvement activities, and that they had an 18 per cent reduction in mortality, relative to those where people felt less comfortable; lower in the hierarchy, where they have valuable information about patients, and so on, but need to be able to express themselves.

And so, this really matters. What was the difference, right? What explains those where it was flat and those where it was steep? We called it inclusive leadership. We asked others to rate the leaders. Well, actually, they rated themselves but we threw those data out because they always rate themselves well no matter what. Actually, maybe the inclusive leaders don't. But nonetheless, those who had medical directors, bosses of these units, where the leaders were seen by others as accessible, as asking for their input, as essentially aware of their humble, aware of their own fallibility, made it possible for others to feel safe.

And if you think about it, inclusive leadership does what poor Rodney Rocha did not have which is it lowers the cost of speaking up. And interestingly, simply because of the proactively inviting input, it raises the cost of silence.

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This video was filmed as part of the Organizational Learning Experts Speaker Series on June 17, 2013.