1: Back in 1991, Amy Edmondson, a first-year Harvard PhD student, began visiting two Boston hospital wards.
She was studying organizational behavior and was “on the prowl for a dissertation topic,” Charles Duhigg writes in Smarter Faster Better: The Transformative Power of Real Productivity.
Her idea was that good teamwork would reduce medical mistakes. That “the units with the strongest sense of teamwork,” Charles notes, “would have the lowest error rates”
“I figured it would be pretty straightforward,” Amy recalls.
The only problem? “The data kept saying she was wrong,” Charles writes.
Amy visited recovery rooms, spoke with nurses, and analyzed hospital error reports. “She measured the satisfaction, happiness, and self-motivation of different groups and hired a research assistant to observe the wards for two months,” he shares.
What did the data say?
“The wards with the strongest team cohesion had far more errors,” Charles observes. “It didn’t make any sense. Why would strong teams make more mistakes?”
Amy continued to study the data. There was one question which provided a clue: “If you make a mistake in this unit, it is held against you.”
She looked at the responses to that question vs. error incidence.
Voila! “She realized what was going on: It wasn’t that wards with strong teams were making more mistakes,” Charles writes.
“Rather, it was that nurses who belonged to strong teams felt more comfortable reporting their mistakes.”
One specific “norm,” whether people were punished for errors, impacted whether they were honest when they messed up.
Some leaders “have established a climate of openness that facilitates discussion of error, which is likely to be an important influence on detected error rates,” Amy wrote in The Journal of Applied Behavioral Science in 1996.
2: But there’s more.
“It wasn’t simply that strong teams encouraged open communication and weak teams discouraged it,” Charles explains.
Certain teams encouraged admitting mistakes, while others—also strong—made nurses hesitant to speak up.
“People would say things like, ‘This is one of the best teams I’ve ever been on, because I don’t have to wear a work face here,’ or ‘We aren’t afraid to share crazy ideas,’ ” Amy reports.
With these teams, norms of enthusiasm and support encouraged team members to voice their views and be comfortable taking chances.
One nurse said: “People feel more willing to admit to errors here, because the nurse manager goes to bat for you.”
“Other teams would tell me,” Amy remembers, “my group is really dedicated to each other and so I try not to go outside my department without checking with my supervisor first”
Or, “We’re all in this together, so I don’t like to bring up an idea unless I know it will work.”
On those teams, loyalty was the norm, making people less willing to offer suggestions or take risks.
“Measurements of group cohesion on this ward were still very high,” Charles shares. One nurse told Amy’s research assistant that the ward “prides itself on being clean, neat and having an appearance of professionalism.”
Yet, a different nurse said that when she admitted hurting a patient while drawing blood, the nurse manager “made her feel like she was on trial.”
Another said doctors “bite your head off if you make a mistake.”
Takeaway: Enthusiastic, supportive norms make teams effective. Loyalty-driven norms hinder effectiveness.
“Managers never intend to create unhealthy norms,” Amy says. “Sometimes, though, they make choices that seem logical, like encouraging people to flesh out their ideas before presenting them, that ultimately undermine a team’s ability to work together.”
3: Building on her initial findings, Amy continued her dissertation research, this time expanding beyond hospitals into technology companies and factory floors.
She identified a small set of norms that consistently led to higher productivity across industries.
“On the best teams,” Charles writes, “leaders encouraged people to speak up; teammates felt like they could expose their vulnerabilities to one another; people said they could suggest ideas without fear of retribution; the culture discouraged people from making harsh judgments.”
Underlying these norms was a single attribute: “They were all behaviors that created a sense of togetherness while also encouraging people to take a chance,” he notes.
“We call it ‘psychological safety,’ ” Amy says.
Which is defined as a “shared belief, held by members of a team, that the group is a safe place for taking risks.
“It is a sense of confidence that the team will not embarrass, reject, or punish someone for speaking up,” she wrote in a 1999 paper.
“It describes a team climate characterized by interpersonal trust and mutual respect in which people are comfortable being themselves.”
More tomorrow!
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Reflection: Do the teams and relationships in my life make it safe for people to admit mistakes, ask questions, and share ideas without fear of embarrassment or criticism?
Action: Pay attention to how I respond when someone makes a mistake or offers an unconventional idea. Look for one opportunity to reinforce trust and psychological safety.