Messy moments: When one colleague silences another

In a meeting of clinical staff and supervisors, an MD makes an observation about a potentially unsafe practice and suggests how to prevent it in future.

The meeting moves on - as if no one heard the comment. A few minutes later a white male MD makes the same comment. The group discusses it and decides the next step.

The original contributor is a Latinx woman physician. She says nothing else after her initial comment.

No one mentions what happened.

What - if anything - can you do? What would you like to happen here?

You wonder what the Latina clinician thinks and feels about it. You’re worried that she feels ignored. She may not risk speaking again.

Here one person in the group insulted and humiliated another. This sends a strong signal to everyone lower in the pecking order. If the situation above goes without response, others who feel “lesser” in the group may stay silent to protect themselves from those with higher perceived rank or privilege.

But you need them to speak up so you get critical information for safe care.

ACT Attend to and motivate the injured individual

Arrange a confidential one-to-one conversation with the Latinx woman MD to attend to and welcome the mistreated person back into your care group

You might say: ‘I’ve thought about your contribution at our meeting today. Can we find some time to talk?’

1. A: ASK: Ask focused questions that invite her to talk. Your attention shows you saw the aggression. Your tone communicates you truly want her to feel comfortable contributing. [Avoid questions that can be answered with one word]

• What happened for you today in that conversation?
  Give her time & space to think and respond
  Sketch the trajectory you intend with the first 3 things you say
  Clarify you really understand her:
  • What leads you to think that?
  • Would you give me an example of that?
• Tell me about when and how this may have happened before (with whom/what kinds of situations)
  Listen to the feelings behind the words, what she is not saying
• What do we need to do to create a workplace where you feel safe to speak and feel our group listens? It matters to me.
  Listen carefully, paraphrasing what you understand to be sure you understand what happened and her perceptions/concerns.

2. C: CREATE NEXT STEPS TOGETHER:

• Brainstorm together what each of you might do to support her voice, her belonging, her success.
  • Let’s brainstorm possibilities that support your voice. Crazy ideas are allowed! Let’s take 2 minutes.’
  • So how might you respond now if it happens again…knowing that I support you?
• Choose and tell her what you will do this week to support her and others’ safe participation. This dials down the threat of rank: you stand beside her.

3. T: THANK HER:

• Appreciate the value she brings to the care group - even in a small way
• Arrange a follow-up conversation - soon.

You always act on two levels: the individual and the group.

For the group: Set the scene of norms and expectations and strengthen them with structures for the group’s future performance.

Construct a safe crucible

Set the stage for psychological safety for all whenever the care group gathers – meetings, pre-shift huddles, debriefs, etc.

Meetings are the most powerful place to change expectations and behaviors. Choose 1 or 2 below and bake them into meetings to produce inclusivity and safety from retribution or disrespect.

• Start each meeting by inviting – indeed, expecting – everyone to contribute and everyone to listen to all contributions. Say this while looking directly at people. Then ask everyone to say their name. It brings their voice into the room.
• Appreciate each person after their first contribution in the meeting:
  • Thank you for raising that.
  • That’s an idea/or perspective we need to hear (or haven't heard before). I’m glad you said that.
• Acknowledge the idea without judging its value. This makes people feel visible and valued. It declares they belong in the group and discussion.
• Consciously wait to let others respond to comments in meetings.
  • This invites everyone to think and shows you want to learn from them.
  • Support debate with your body language and affect.
    [When you weigh in, it’s harder for others to comment.]

In the messy moment above:

• Stop the action: Ask what others think as soon as you notice a contribution that’s ignored.
• Give the voiced idea “air time” so everyone hears it and gains space to respond.

There are countless ways to do this. Create something that works for your intentions and style.

Always look forward AT THE SAME TIME that you deal with the present moment. Always be constructing (ABC) the culture of psychological safety and belonging.

So you get critical care information. And your group creates safe quality care together.

Want to create psychological safety for your group before silence swallows something critical? Let’s talk: nance.goldstein@post.harvard.edu