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I Mark Raven, here, my upcoming 
book, the mistakes that make us 

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in the book, I share insights 
and strategies for cultivating, 

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a culture of learning 
Improvement and Innovation a 

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place where mistakes are 
embraced as opportunities for 

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growth and punishment is 
recognized as counterproductive 

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to learn more about the mistakes
that make us. 

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Visit mistakes, book.com, hi, 
it's Mark. 

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Gray been here. 
This is episode 3, 30 of lean 

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blog. 
Aw Audio. 

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Today, I'm reading a post that I
wrote and published May 9th 

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2023. 
It's actually not published at 

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lean blog dot org. 
This is a post that was 

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published on the value capture 
website at Value capture 

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llc.com. 
You can look for a link in the 

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show notes or you can go to lean
blog dot org, slash audio 3:30 

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and that will actually forward 
to the value capture site. 

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And the blog post, it's titled 
organizations cannot solve 

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problems. 
Unless the leaders admit them 

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and help others feel safe. 
Speaking up, This is post number

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two in a series that's being 
published this week at the value

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capture website in collaboration
with DeAndre award owl. 

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It's a new hashtag root cause 
racism series and we invite you 

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to check that out. 
So here's the post as we explore

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Concepts, like psychological, 
safety and diversity, equity, 

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and inclusion, and 
accessibility, or D EI in this 

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blog post series, I'd like to 
kick things off with a look at 

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some serious problem, statements
that we must address. 

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Yes, I'm thankful for the 
organizations, including value 

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capture clients, who aim to 
close these performance gaps and

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systematic and sustained ways in
2023. 

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Healthcare organizations face, a
number of serious problems. 

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For one patients, continue to be
harmed at unacceptably. 

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High rates not because of quote 
unquote bad providers but as the

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result of preventable errors 
that are caused by process 

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problems and miscommunications. 
Additionally, Healthcare 

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professionals are injured at 
rates far higher than in 

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industries that are perceived as
dangerous. 

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Such as mining or manufacturing.
As to chart in the blog post, 

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shows driven by OSHA data. 
There's quite a gap or hospitals

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are as dangerous. 
If not more dangerous nursing 

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care and skilled nursing 
facilities, the same. 

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They are both more dangerous 
than the average of what's 

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called all private. 
History by OSHA for measures 

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such as various types of patient
harms including pressure, ulcers

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Falls, and hospital-acquired 
infections, and employee 

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injuries and lost work days. 
We need to define the measurable

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gaps between the current levels 
of performance and the 

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theoretical limits. 
Meaning, zero harm. 

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It's not just the averages that 
matter but the variation. 

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Nobody should get hurt at work. 
But how can we identify 

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inequities in health outcomes? 
Outcomes and employee safety 

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data. 
With the aim of providing 

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equally safe conditions for all 
if organizations and their 

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senior leaders cannot openly 
admit serious problems, like a 

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patient or employee harm. 
How can they expect Healthcare 

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professionals to speak up about 
the problems and causes of harm 

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that they see and experience? 
If people are going to choose to

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use their voice, we need to 
eliminate the two primary 

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barriers as discussed by Ethan 
Burris PhD, from the University 

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of Texas at Austin. 
Often these two primary barriers

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are fear and futility. 
If people fear punishment, they 

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won't speak up. 
Even if the Fear Factor is 

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reduced, people will stop 
speaking up if they think doing.

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So just isn't worth the effort 
that's futility. 

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Now, others in the series will 
discuss this concept and it's 

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practical implication. 
So let's start with the 

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definition of psychological 
safety. 

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To get us on the same page. 
One such definition is by 

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Timothy our Clark PhD author of 
the book. 

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The four stages of psychological
safety. 

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He defines it as being 
psychological. 

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Safety is a social condition in 
which you feel included, safe to

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learn safety contribute, safe to
challenge the status quo, all 

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without fear of being 
embarrassed, Most marginalized 

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or punished in some way, you can
take a deeper dive in the 

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psychological safety, through a 
value captures resources page, 

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that's linked to in the blog 
post. 

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Research by Amy Edmondson. 
PhD from Harvard, Business 

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School has demonstrated that 
teams with the highest levels of

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psychological safety improve 
more and perform better. 

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Whether that's within a tech 
company like Google or a 

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healthcare organization and 
Healthcare teams, having a 

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higher feeling of psychological.
Safety means individuals are 

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more likely to speak up about 
risks problems, mistakes, 

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near-misses? 
Or or harm? 

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We cannot solve problems unless 
we know what they are. up about 

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a near-miss means that future 
harm can be prevented When 

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leaders can reduce fear, people 
will feel safer about speaking 

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up. 
That's the Fear Factor that must

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be followed up then with 
effective problem solving. 

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So speaking up about a mistake 
means it won't be repeated. 

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We reduce the futility Factor as
well how do leaders create 

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conditions for people to feel 
psychologically safe? 

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Well, they cannot declare in 
organization or some part of it 

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to be a safe space. 
They must demonstrate that it's 

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actually safe to speak up 
without the fear of or the 

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Reality of punishment. 
It's neither Fair nor effective 

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to demand that Healthcare 
professionals, be brave, or 

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courageous or that. 
It's their professional 

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obligation to speak. 
Truth to power, when fear 

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exists, people will protect 
themselves by choosing to stay 

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silent. 
That's their right. 

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And it's understandable, that's 
why L must work to reduce the 

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level of risk. 
Shifting from punishing, those 

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who speak up to instead 
rewarding and celebrating them 

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for doing so. 
As Clark teaches leader, set the

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tone through, not just their 
words, but their actions, those 

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actions include two high-level 
countermeasures one modeling? 

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Vulnerable acts and to rewarding
vulnerable ads as Clark says, a 

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vulnerable Act is one that 
exposes us to the risk of harm 

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or loss personally or 
professionally writing a blog 

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post. 
Like this is a vulnerable act in

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the sense that an author might 
say the wrong thing that pens 

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and they might hurt their 
professional reputation by 

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writing something that's 
unclear. 

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Any human interaction is on some
level of vulnerable act. 

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If we don't feel a low level of 
risk or zero risk, then our 

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leaders and colleagues can work 
to help us feel safer over time.

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Other examples of vulnerable 
acts mapped to Clarks. 

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Four stages model are shown in a
table stage. 

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One inclusion safety sharing a 
personal problem or challenge is

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An example of a vulnerable at 
stage 2, Learners safety. 

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Sharing past mistakes is also an
example of a vulnerable act 

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stage, three contributors safety
communicating. 

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Bad news, is also an example of 
a vulnerable act and stage four 

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Challengers safety. 
Inviting others to challenge. 

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Your opinion is an example of a 
vulnerable Act. 

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Now because of their leadership 
position, these acts are 

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generally less vulnerable or 
less risky to a more senior 

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leader leading. 
By example, gives others 

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permission to follow some acts 
such as actively. 

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Inviting disagreement, debates 
or dissent, directly give people

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permission to use their voices, 
but people might still be 

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afraid, especially if speaking 
up, was punished by previous 

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leaders telling people, they 
should now feel safe. 

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Doesn't mean they will 
immediately Feel safe. 

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If a leader has admitted a 
mistake or close disclose that 

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they don't know. 
Something team members might 

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test the waters in a small way 
that doesn't feel horribly 

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unsafe when employees mirror. 
Those vulnerable acts are 

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respond to the invitation to 
speak up leaders, must reward 

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them for doing so. 
And Clark's model teams and 

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organizations. 
Generally progressed through the

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four stages of psychological 
safety, the ultimate level the 

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most difficult for a team to 
achieve would be stage for 

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Challenger safety. 
Where people feel safe 

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challenging, the status quo, 
this is where Improvement and 

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Innovation happen, but it's hard
for people to feel safe 

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challenging, the status quo if 
they don't feel first included, 

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accepted and respected by their 
colleagues and leaders. 

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Stage one of inclusion, safety 
is closely connected to 

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diversity equity and inclusion 
accessibility or D eia, and 

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belonging goals practices and 
initiatives. 

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If all employees don't feel 
equal levels of inclusion, 

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safety due to gender race, 
ethnicity sexual, orientation, 

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or other distinguishing 
characteristics, then we can't 

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expect them to feel equally safe
to learn, contribute and 

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challenge the status quo. 
If employees from different 

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demographic groups, don't feel 
equally included, they would 

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feel less welcome to ask 
questions unless safe to 

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challenge the status quo. 
This means that staff safety and

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patient, safety and their 
departments will suffer as an 

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article. 
I've linked to says the main 

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stressor, many black women face 
is a lack of psychological 

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safety as a Forbes article. 
That I've also linked to says 

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frustratingly black women also 
ranked dead last in their 

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experience of manager support. 
manager showing interest in 

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their career, checking in on 
their well-being, and promoting 

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inclusion as compared to survey 
results that were grouped by 

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other identities, including men 
all women, lgbtq women women 

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with disabilities, white women, 
Asian, women, and Latinas, And a

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healthcare organization if 
leaders are committed to equity 

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and employee safety and in 
health outcomes. 

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I suggest asking the following 
questions, one are there 

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disparities in patient safety 
measures or other health 

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outcomes based on these 
demographics to are there 

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disparities and employees. 
Safety metrics, including lost 

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workday incidents based on 
demographics. 

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Three our employee safety 
disparities caused to what 

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degree by the type of Of work 
being more physically demanding 

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or caused by some employee 
groups, feeling less safe to 

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speak up and I'll add like the 
work being more physically 

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demanding is not an excuse for 
higher injury rates, that would 

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be part of our challenge. 
Question 4. 

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What can we do to reduce gaps in
the feeling of psychological 

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safety across teams or 
demographic groups and 5. 

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What hypotheses can we test? 
And how would we gauge our 

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progress? 
So as we kick off this blog 

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series, I look forward to the 
contributions from our varied 

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and diverse contributors. 
I'm also eager to hear thoughts 

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comments questions and 
experience from our audience 

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here in the blog here, listening
to the podcast and on social 

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media. 
So, thanks for reading. 

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And this case, thanks for 
listening. 

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Thanks to Value capture and 
their leaders for sponsoring 

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this series. 
Thanks to Geo and reward Del for

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her guidance and collaboration 
and thanks to everybody who has 

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contributed. 
I'm so again, you can go to lean

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blog Dot orgs. 
Audio 330 it will forward you to

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this blog post. 
And you can also find a link at 

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the bottom of the post on to 
register for a panel discussion 

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webinar that I'm going to be 
part of the other five blog 

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series writers are going to be 
contributing to this panel 

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discussion to be held on May 
16th 1:00 Eastern. 

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It's titled getting 20 harm for 
patients and staff with DEA and 

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psychological safety Concepts. 
Again, it's a free panel 

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discussion format webinar for 
about 90 minutes. 

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Hope you'll come register again.
You can find the link at lean 

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blog dot org, slash audio 330 or
you can go to Value capture 

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llc.com slash webinars. 
It's titled getting 20 harm for 

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patients and staff with DEA and 
psychological safety Concepts. 

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Again, it's a free panel 
discussion format webinar for 

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00:12:00,200 --> 00:12:04,200
about 90 minutes. 
Hope you'll come register again.

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00:12:04,200 --> 00:12:08,500
You can find the link at lean 
blog dot org, slash audio 330 or

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00:12:08,500 --> 00:12:12,300
you can go to Value capture 
llc.com slash webinars.