For foundation doctors, speaking up about risks and errors is one of the biggest challenges we face. Sir Robert Francis famously called junior doctors “the eyes and ears of the NHS”, but we can only step up to that challenge if we speak out about what we are seeing and hearing.
In her brilliant keynote speech at LIH2018, Megan Reitz, Professor of Leadership and Dialogue at Ashridge Executive Education outlined results of her research into how speaking up works. For Reitz, speaking up is only half of the story; it must be matched by listening up. I love this model because, although Reitz didn’t use these terms, it shows how leadership, particularly for junior doctors, is so closely entwined with followership.
Reitz says followers need “courage to speak up” and leaders must develop “wisdom to listen up”.
She challenged followers to reflect on how we silence ourselves and used the term Speak Up Traps to describe three key barriers to speaking out. Self-doubt can stop us from believing in our instinct that something needs changing. Abdicating responsibility can mean we let somebody else take responsibility for it. Even when we do speak out, our concerns can be lost in translation as we explain a problem in ways that might persuade us, but not other people.
On the flip side, Reitz outlined Listen Up Traps. These are the things that stop leaders from hearing the concerns of the people they are leading. Sometimes silence is interpreted positively when leaders have forgotten how scary they are. Sometimes leaders can’t avoid holding authority over colleagues, but an awareness of that improves the interpretation of silence. Leaders should therefore avoid inadvertently sending shut up signals, rather than speak up signals. Body language is a major culprit here. Shut up signals might be a manifestation of our internal lists of who is worth listening to and who isn’t. Discernment is both sensible and natural, but leaders need to be aware of whose opinions we are taking less seriously that others’ and appropriately reflective.
Speak TRUTH To Power
Reitz described key factors using the acronym TRUTH.
Followers need to trust themselves; they need to trust their own judgement. For leaders, trust means valuing followers’ opinions.
All parties must recognise that speaking up can be risky. The risks can be dramatic and career changing, but speaking up can also upset people or cause awkward social situations. Leaders have got to be empathetic.
Leaders also need to understand that followers will want to tell them what they think they want to hear: particularly in rigid, steep hierarchy. The politics of speaking up should also inform the follower: what is the appropriate way to deliver this information?
Again, roles, identities and power all influence whether and how the speaking up relationship works. These demand conscious awareness.
Effective speaking up from followers should be at the right time, with the right person, and in the right way. There is practical wisdom involved. At the same time, leaders must use skilful questions to discover how to elicit difficult information.
Speaking up doesn’t have to mean whistleblowing. In a previous post I suggested that leadership – getting results through people – can be difficult to distinguish from effective teamwork. On this basis, every act of speaking out is an act of leadership and of effective followership. But a deliberate and reflective approach to speaking up, such as Reitz’s TRUTH approach, will help create patient advocates who speak up and who become leaders who listen up.
Speaking Truth to Power took place on November 16th 2018 and was part of Leaders In Healthcare 2018 held at the ICC, Birmingham.