“It is not death that a man should fear, but he should fear never beginning to live.”

—Marcus Aurelius¹

“Birds,” said Captain Chesley “Sully” Sullenberger III.

“Whoa,” said First Officer Jeffrey Skiles.

The two pilots, side by side nearly three thousand feet above Manhattan on a cold, clear day in January 2009, both knew that this deceptively simple word – birds – could spell disaster. Sullenberger, age 57, and Skiles, age 49, had met for the first time just hours earlier. Both were highly-experienced pilots, well-versed in the clipped verbal exchanges of cockpit communications.² For the next few seconds they watched as Canadian geese filled the windscreen, heard a loud thudding as the large birds were ingested into the Airbus' engines, and then smelled burning feathers and flesh. The lives of 150 passengers and five crew, including their own, would depend on how the two pilots, the crew, and the air traffic controller handled the next three minutes. What would become a miraculous, zero-fatality landing on the Hudson River drew on aviation training, navigation skills, old-fashioned luck, and that extra, less tangible quality that knowledge workers today must acquire: the ability to team by communicating fearlessly. Fearless communication is vital input into making complex decisions, often quickly, that have no precedent and bring serious consequences.

Use Your Words

We have many examples of how even brief verbal exchanges can be thwarted by a lack of psychological safety. The nurse who hesitates to speak up to a surgeon about a possible procedural error because past exchanges led her to think this would bother him; the new engineer on a project who doesn't ask a question because she fears looking stupid; and the boss who doesn't listen to ideas from employees because he thinks it will make him appear weak. We have fewer examples of the nuanced exchanges that occur in situations of high psychological safety, especially those with high stress, and of the positive outcomes that ensue. But those excruciating few minutes of cockpit conversation, recorded that January afternoon, are worth deconstructing. Each of the small team of key participants felt safe enough with one another to become heroes together.

The bird strike took place about 90 seconds after Flight 1549's takeoff from New York City's LaGuardia airport. The immediate problem: dual engine failure. The next problem: dual engine failure was classified as a “non-normal situation,” and was not included in the automated systems that warn pilots of system failures and display instructions on the monitor for handling the failure.³ In short, dual engine failure from bird strikes was exceedingly rare – bordering on unheard of. Airline policy asked captains “to use common sense and good judgment, especially in those situations not specifically covered.”⁴ In other words, they were on their own.

Immediately, Sullenberger, or “Sully” as he has been immortalized in the eponymous Hollywood film, who had been serving as copilot, took over the controls from Skiles. “My aircraft,” said Sullenberger, using aviation coded shorthand, as he put his hands on the controls.

Although almost instinctive, the decision was driven by good reasoning: Sully had logged far more hours flying the A320 than had Skiles. Perhaps most important, from where he sat, Sullenberger could see the cityscape and George Washington Bridge out his left viewing window, while Skiles could not. Also relevant: Skiles was the pilot who was more familiar with emergency procedures and could thus better manage the landing equipment.

“Your aircraft,” replied Skiles.

That was all it took. There was no hesitancy, fear, apology, or disagreement from either man.

Sullenberger had long played a major role in training other pilots in Cockpit Resource Management (CRM) at US Airways.⁵ Passionately committed to the program, which emphasizes interpersonal communication, leadership, and decision-making under pressure, it's hard to imagine any pilot with a better understanding of the need for crew members to feel able to speak up than Sully. Both he and Skiles felt they were operating in a psychologically safe environment. But the cockpit pilots were not the only members of that intensely high-performing team that day.

Next, Sullenberger informed Patrick Harten, the air traffic controller who worked out of the large Long Island center that controls arrivals and departures out of the greater New York area, that they'd hit birds and were turning back to LaGuardia. “Mayday, mayday, mayday,” said Sullenberger, citing the universal message for life-threatening distress. Harten took the necessary measures, which included calling the LaGuardia control tower to tell them to prepare for an emergency landing.

One for All and All for One

What does a leading provider of kidney dialysis services for 200 000 patients around the world have in common with a nineteenth century historical novel?¹¹ Answer: a swashbuckling hero who brandishes a sword and lives by the motto “one for all and all for one.”

At DaVita Kidney Care, the swashbuckler is CEO and Chairman Kent Thiry.¹² Thiry is known to leap about the stage brandishing a sword while wearing full musketeer regalia in front of hundreds of frontline employees – patient care technicians, nurses, and social workers – in attendance for the regularly offered two-day DaVita Academy program, one of the foundational seminars for new employees put on by the DaVita University. Thiry's unusual choice of persona and costume, along with frequent high-fives and other high-intensity interactions, seem to reflect his comfort bringing his whole self to the workplace, so as to signal to others that they can do so too. The program offers many team-building and socializing activities for attendees that include songs, skits, games, storytelling, refreshments, music, and dancing and is intended to introduce employees to the DaVita culture. Thiry also leads a town hall question and answer session, where he is willing to be vulnerable (often admitting, for example, that he doesn't know the answer to a question) and open, entertaining direct questions about wages and promotions. The “One for All and All for One” slogan conveys a company core value – the idea of shared obligations and responsibility. All Davita workers are called upon to contribute their best to the company; likewise, the company is responsible for helping individuals develop and succeed. Attendance at the Academy program is voluntary, but the company's data shows that people who do attend have a turnover rate of about 12% compared to the 28% who do not attend.¹³

Hired in 1999 to rescue the company from the brink of ruin, Thiry is credited with having turned it around by building a set of values and a culture that combine to create a high level of psychological safety. Much like Bob Chapman at Barry-Wehmiller, discussed in Chapter 5, Thiry believes in fostering a community where people on every level of the organization have a voice and are developed as leaders. As part of giving people a voice, Thiry decided to involve them in creating a list of core values, which were then voted on by 600 of the company's clinician-managers. Employees (called teammates) were asked to vote to find the new name, DaVita, when Thiry wanted to rename the company, previously called Total Renal Care. To help prepare frontline employees for their responsibilities as teammates, and to support them in taking on administrative roles, DaVita University provides many leadership development programs, with an emphasis on management and team skills, along with programs on quality improvement.

Thiry refers to himself as the “mayor” of DaVita “village” and emphasizes that “building a successful company is a means to the end of building a healthy community.”¹⁴ Also in support of a healthy community, the DaVita Village Network fund exists to help teammates who may encounter unexpected medical expenses or have other financial difficulties. This is part of the “all for one” philosophy. The company matches donations teammates make into the fund. Although the majority of teammates are low-skilled, hourly workers, DaVita offers comprehensive health and welfare benefits, including provisions for healthcare, retirement, tuition reimbursements, and, most surprisingly, stock options and profit sharing. These incentives help support Thiry's demand that teammates come to work “intending not only to do a solid day's work, but also to strive to make DaVita a special place.”¹⁵

Kidney dialysis patients, the majority of whom are suffering from end-stage renal condition, are especially in need of the combined efforts of a medical team that is “all for one.” Patients typically visit a local clinic three to four times per week and are hooked up to the dialysis machine for about four hours at a time – for the rest of what they know is likely to be a shortened life. They must endure the poke of needles and sit quietly while the machine draws out and cleans the blood that their failed kidneys can no longer process. They must adhere to a strict diet and often suffer from other chronic conditions, such as diabetes and heart disease. Unsurprisingly, some become depressed, or worse, stop coming to the clinic for treatments, which leads soon to death. It's emotionally difficult to care for dialysis patients. Up to 25% will die each year. Given these morale-lowering conditions, the excessively upbeat tone of the DaVita Academy sessions begins to make more sense.

Most importantly, DaVita consistently delivers top clinical outcomes in its industry. That's because good clinical outcomes in large part depend on the quality of care delivered by the staff at the outpatient dialysis clinics where most patients are treated. Although a technician's job is ostensibly practical – to connect and disconnect the patient to the machine and monitor the ongoing treatment – much can also depend on the relationships technicians establish with both the patient and other caregivers. Patients who feel comfortable and trusting – psychologically safe – with the clinic staff are more likely to comply with a rigorous treatment plan. To encourage these positive feelings, DaVita centers are often decorated with photographs of patients and their families, as well as by drawings made by them, their children, and their grandchildren. As one DaVita administrator said, “it's important that the teammates like their jobs and smile and relate in a compassionate way to patients, because that makes the patients feel better about being here.”¹⁶ In other words, clinic staff who themselves feel supported by high levels of psychological safety are able to support and bond with patients, which contributes to positive clinical outcomes.

As we have seen in other healthcare settings, speaking up and feeling psychologically safe enough to communicate across boundaries and well-established medical hierarchies also contributes to positive clinical outcomes. In 2017, DaVita successfully participated in a pilot program run by the Centers for Medicare and Medicaid Services (CMS) to institute integrated care for dialysis patients – specifically for nurses, social workers, and technicians to communicate regularly with nephrologists about individual patients. As Roy Marcus, a medical director and participating nephrologist put it, “DaVita's integrated care team regularly communicates with nephrologists to better address gaps in care that extend beyond dialysis. This frequent communication means I have the time and details I need to provide better, more holistic care to my patients.”¹⁷

Kidney dialysis treatment is especially well suited to follow the Institute for Healthcare Improvement's triple aim for healthcare: improving patient experience, improving population health, and reducing cost per patient.¹⁸ Here, as in other industries, making dramatic, systemic change happen is highly-dependent on building the psychological safety that allows employees to speak up with their concerns and ideas for improvement, as well as to experiment in small ways to figure out what works best.

Speaking Up for Worker Safety

By now you're well aware that speaking up is easier said than done. There's no switch to flip that will instantaneously turn an organization accustomed to silence and fear into one where people speak candidly. Instead, creating a psychologically safe workplace, as we'll explore in depth in Chapter 7, requires a lot of effort to alter systems, structures, and processes. Ultimately, it means that deep-seated entrenched organizational norms and attitudes must change. And it begins with what I call “stage setting.” Let's look at how Anglo American, one of the world's largest mines, headquartered in South Africa, prepared for and then institutionalized speaking up.

When Cynthia Carroll was appointed in 2007, with much fanfare, as the first female CEO of an international mining company, she was appalled by the number of worker fatalities been occurring in the company – nearly 200 in the 5 years prior to her arrival.¹⁹ Realizing that she was “in an unprecedented position to influence change” as both an American/outsider in a foreign country and as a woman where “until very recently women hadn't been allowed to visit underground at mines in South Africa, let alone work there,”²⁰ she immediately used her position to speak up and demand a policy of zero fatalities or serious injuries.

At first, others in the company, especially members of the old guard who saw themselves as upholding tradition, refused to take Carroll seriously. At least one executive responded by saying that zero harm “will never happen in our lifetime.”²¹ Likewise, when Carroll visited individual mines, the local managers tried to make her understand that while safety was important, her demands were unrealistic. Serious injuries and deaths were considered an inevitable hazard, part of mining's dangerous physical demands. Furthermore it was not uncommon to blame errors on the workers themselves. The prevailing attitude in South Africa, according to Anglo American's chairman, Sir Mark Moody-Stuart, who was instrumental in hiring Carroll, was that workers who suffered injuries “took shortcuts, did not always follow the rules; they were stupid.”²²

Carroll's response to the resistance could not have been more unambiguous. She shut down one of the most problematic and dangerous mines. Rustenburg, located about 60 miles from Johannesburg, was the world's foremost supplier of platinum and generated about $8 million in revenue per day. Shutting down the mine was both bold and unprecedented. It immediately got everyone's attention. Even more shocking, Carroll insisted that before the mine could restart, she wanted to find out what the workers were thinking, and she intended to get input from every single worker about how to improve safety. This, she knew, was a direct challenge to Anglo American's strict hierarchical culture and rigid, top-down management style, which had begun with the mine's founding in 1917 and was further strengthened by South Africa's apartheid history.

Here's where things get interesting. After shutting down the mine, Anglo American executives gathered 3000 to 4000 workers at a time in a stadium and spoke about the importance of safety. Because the workers spoke a range of languages and literacy rates were low, the company used visuals to illustrate safety and hired a theater group to role-play safety interactions between workers and supervisors. Employees were then divided into groups of 40 to 50 and asked to speak up about their safety concerns and opinions. Understandably, the workers were reluctant to do so, having historically had no say. As Carroll observed, “I wondered how much authority someone who is underground for hours on end, with a shift supervisor right behind him, really has. I questioned whether a line worker had the power to put up his hand and say, ‘I'm not going to do this, because it is unsafe.’”²³ In other words, the workers had to feel psychologically safe in order to speak up about their physical safety.

Psychological safety had to be created in the mines by finding a culturally appropriate approach. With help from the unions, Anglo American leadership adopted a traditional South African method of conducting village assemblies, called lekgotla. As you will see, lekgotla seems to echo tenets and practices of psychological safety. Traditionally, in these assemblies (somewhat like meetings at Eileen Fisher), everyone sits in a circle and has a chance to speak without being interrupted or criticized; conversation continues for as long as it takes to reach consensus on whatever issue is at stake.²⁴

During Anglo American's lekgotla, senior managers reframed the initial question. Instead of asking workers to give their opinions directly about safety issues, they asked, “what do we need to do to create a work environment of care and respect?” That was when workers started to feel safe enough to speak up about specific concerns. One group said that they'd like hot water at their work site to clean up and make tea. (Management complied with this request.) The dialogue continued until each group had developed a contract stating what specific actions were needed to maximize safety. In a powerful symbolic gesture of shared commitment, workers and Anglo American executives both signed the contract. As Judy Ndlovu, an Anglo American executive said about this process, “the real change was listening to the workers…Cynthia challenged management to understand what the employees were thinking, what they felt when they went into the mine each day.”²⁵ Previously, for an individual miner to speak up would have taken courage but might very well have been a foolish act if not well received by management. Once psychological safety started to take root in the culture, miners could then speak up to help insure physical safety.

When the mines reopened, more than 30,000 workers were retrained to comply with the newly agreed-upon safety protocols. Top leadership met with managers to discuss compliance with the new rules and to emphasize that employees now had the right to stop work if safety standards were not being met. New policies were instituted to insure regular review of safety procedures and to schedule times when management and executives continued to solicit input from workers regarding safety operations. Guiding values were established. Executive meetings were now required to begin with lengthy updates and discussions on safety. Although fatalities fell considerably – from 44 in 2006 to 17 in 2011, a reduction of 62%²⁶ – they did not reach zero. The company honored any worker who died with memorial services and by posting their photographs in all buildings. The supervisor of the deceased visited the worker's family and village to convey respect and sympathy. All these measures helped to institutionalize not only the safety protocols but also a psychologically safe culture built by care and respect.

A year after the shutdown, Carroll chose to speak up yet again, this time to people outside the organization – the National Union of Mineworkers and the Minister of Mines – to ask for their help in working together to achieve zero harm. Again, she was rebuffed. However, in April 2008, a Safety Summit was held in Johannesburg between Anglo American, the South African Department of Minerals and Energy, and the National Union of Mineworkers. It was the first time the three major stakeholders had come together. As with the mineworkers, it took time for representatives from the three governing entities to build trust and respect. The catalyst for working together was the shared goal of dramatically improving physical safety in the mines. And process was instrumental. By visiting different mines together and continuing to convene, the three groups developed a growing sense of respect and trust for one another. The stakeholder partnerships that eventually developed helped spread of the passion for safety ignited at Anglo American into the rest of South Africa's mining industry.

Although production and revenues fell in the year following the mine shutdown, in both 2008 and 2011, during Carroll's tenure, the company achieved the highest operating profits in its history. Share price rose commensurably. Carroll realized that increasing physical safety in the mines was as much about transforming old attitudes about worker safety and changing the culture to make it safe to speak up as it was about technical or process improvements.

In previous chapters we saw how people up and down and across an organization can contribute to creating a climate of silence and fear. Similarly, people up and down and across the organization can contribute to creating a climate of voice and safety. A leader can be the driving force and catalyst for others to speak up; but ultimately, the practice must be co-created – and continuously nurtured – by multiple stakeholders. As we have seen, commitment to doing this is particularly vital for preventing or managing a crisis.

Transparency by Whiteboard

When people think of leadership in a crisis, all too often they think of someone like General George Patton, issuing decisive orders to his soldiers and commandeering them to victory with toughness. But that isn't always the case, especially when the enemy is technology or natural forces, or both.

Let's look at a less obvious example of heroic leadership in a crisis: Naohiro Masuda, the plant superintendent of the second Fukushima nuclear plant when the giant earthquake struck in March 2011. Like Patton, he inspired life-saving teamwork from his followers. However, Masuda did so by adhering to key principles that build psychological safety: honesty, vulnerability, communication, and information sharing. And his key weapon was a whiteboard.

Fukushima Daini, less than five miles down the coast from its sister plant, Daiichi, also suffered severe damage from the earthquake and tsunami waves.²⁷ In stark contrast to Daiichi, however, Masuda and his 400 employees managed to safely shut down all 4 of the plant's reactors, thereby averting the ultimate disaster of releasing nuclear material into the air and sea. They managed to lay 5.5 miles of extremely heavy cable in 24 hours – a job that under normal circumstances would take a team of 20, with machinery, at least a month. And they worked for over 48 hours without sleep, in a state of tremendous uncertainty, with fear for their lives and those of their families.

How did Masuda motivate his men to stay under such tough conditions? From the beginning, Masuda chose to issue information rather than orders. After evacuating his workers to the Emergency Response Center (ERC), and having heard from operators in the control rooms that three of the plant's four reactors had lost all operative cooling systems (the operators had bravely weathered the tsunami from their posts), Masuda knew the situation was “extremely serious.”²⁸ If the reactors could not be cooled, they would overheat, resulting in a nuclear breach.

Masuda and his team unfortunately lacked information about the physical condition of the plant. They didn't know what was broken or what resources they might have. To find that out, workers would need to venture outside to assess the damage and figure out what could be done to restore power to the reactors and stabilize the plant. And, for Masuda, that meant helping the workers – already shaken by earthquake and flood – feel psychologically safe enough to act.

Instead of grabbing a megaphone or commanding his men into action, Masuda began writing things down on a whiteboard: the magnitude and frequency of the earthquake's aftershocks, calculations, and a rough chart that demonstrated the decreasing danger of the quakes over time. In other words, he armed his men with data. “I was not sure if my team would go to the field if I asked, and if it was even safe to dispatch people there,” Masuda later reflected.²⁹ Indeed, he allowed the men to make their own decisions about whether they wanted to assist in what might be a dangerous mission. At 10 p.m., when Masuda finally asked the men to pick 4 groups of 10 workers to go out and survey the damage at each of the 4 reactors, not a single one refused.

Having begun his career at Daini in 1982, when it was still under construction, Masuda was intimately acquainted with the plant. That knowledge allowed him to give each group detailed instructions about where to go and what to do. Concerned that fear might interfere with workers' ability to remember his instructions, he made the groups repeat the instructions back to him before they left. The point was not to command action but to assist them in acting quickly should the situation change, and their safety be compromised.

By 2 a.m. on March 12, all 40 workers had safely returned to the ERC with information. One of the reconnaissance teams reported a crucial break of good luck: there was still power inside the radiation waste building behind Reactor 1. That meant the men could potentially get power to the cooling systems. But they would need to lay heavy-duty cables – and a lot of them.

By dawn, Masuda and his team had drawn up a route to run cables from the building down to the reactor units by the water. However, team leaders calculated that they lacked sufficient supplies to do the job. Masuda, in turn, quickly contacted TEPCO headquarters and the Japanese government to request additional supplies and the calculated 50 spools of cables.

While the men waited for the cables to arrive – which would not be until the morning of March 13 – they learned about the explosion at Daiichi. Some were in disbelief. Many were afraid. Could the same thing happen at Daini? Might they be endangering themselves by sticking around? Masuda addressed the 500–600 people in the room: “Please, trust me,” he said. “I definitely won't do anything to harm you, but Fukushima Daini is still in trouble, and I need you to do your best.”³⁰

When the cables finally arrived, the men immediately got to work laying them from the waste building to the reactor units down by the water. They began with Reactor 2, because it was at greatest risk of overheating. To power the three disabled reactors, the men would need to lay almost 9 kilometers (5.5 miles) of cable. Each piece of cable was 200 meters long and weighed about a ton. The operators calculated they had only about 24 hours to perform a job that under normal circumstances would take a month or more. And so, 200 workers began frantically laying cables. Working in shifts, they made agonizingly slow progress. It took about 100 workers to move each piece.

As the men raced against the clock, Masuda slowly came to an unwelcome realization: his plan was untenable. Even at the superhuman pace the men were working, they would not have enough time to hook up all three reactors. The waste building was just too far away.

Masuda's strength as a leader was demonstrated by the immediate admission of his mistake. In keeping with Ray Dalio's Principles, Masuda succeeded by virtue of extreme candor – by telling people the worst news, which he believed would increase the chances they could figure out how to handle the situation. Despite its unwelcome nature, the admission increased the psychological safety in the team and bonded the group more tightly. Consulting with his team leaders, Masuda concluded that they had no choice but to gamble by utilizing some of the power from the generator of the lone functioning reactor unit. On the whiteboard, Masuda added in adjustments to the original plan.

The men continued to work tirelessly throughout the day. Yet, as night approached, some engineers noticed that the pressure in Unit 1 was now climbing faster than that of Unit 2. Fortunately, they spoke up to inform Masuda that they now believed Unit 1 to be most vulnerable and suggested to him that the workers refocus their energy. Equally important, Masuda listened closely to his engineers and took their suggestions seriously.

Having seen his team push onward, without having slept in almost two days, Masuda was understandably reluctant to tell them, “redo it! Shift from Unit 2 to Unit 1!” Still, he broke the news. Though some were upset, a climate of psychological safety and a recognition of what was at stake helped them to commit to the new course of action.

Just before midnight, ecstatic applause broke out when the workers finished laying the last of the cable. At 1:24 a.m., they were notified that the cooling function had been restored to Unit 1 – with about two hours to spare. On the morning of March 15, Masuda and his team were notified that all reactors were finally in cold shutdown. Finally, they could rest.

Masuda influenced the workers to act, even as the ground shook beneath their feet. Through his calmness, openness, and willingness to admit his own fallibility as a leader, Masuda created the conditions for the team to make sense of their surroundings, overcome fear, and solve problems on the fly. Although their physical safety was in constant danger, they felt psychologically safe, and this allowed them to come together, try things, fail, and regroup. In the many moments of fear for their lives over the course of those days, interpersonal fear within the group was nearly nil. Masuda's words and actions set the tone and reassured workers that they could – and must – save the plant.

Unleashing Talent

Reflecting on the more than 20 cases included in Part II of this book helps us understand both how challenging and how important it is to build psychological safety to ensure that the talent in an organization is able to be put to good use to learn, innovate, and grow. Speaking up is not a natural act in hierarchies. It must be nurtured. When it's not, the results can be catastrophic – for people and for the bottom line. But when it is nurtured, you can be certain that it is the product of deliberate, thoughtful effort.

Creating a psychologically safe workplace takes leadership. Leadership can be seen as a force that helps people and organizations engage in unnatural acts like speaking up, taking smart risks, embracing diverse views, and solving remarkably challenging problems. And so the chapters that lie ahead in Part III are focused on what leaders can and must do to create psychological safety. They invite you to consider, and perhaps try out, a variety of practices that can contribute to creating a fearless organization.