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Helen Sanderson, founder of Helen Sanderson Associates, co-founder of Wellbeing Teams, and author of Psychological Safety in Practice, explains how health and social care leaders can bring more voices into the conversation.
Think about the last time you reached the end of an item in a team meeting, a case review or a handover, asked “Any thoughts?” and heard nothing back. You might have taken that silence as agreement and moved on, although the people in the room may have been unsure whether it was their place to speak. You had invited them to contribute, and the discussion needed a structure that let everyone respond.
Amy Edmondson, professor of leadership at Harvard Business School, describes four interpersonal risks that make people hesitate before speaking at work: appearing ignorant when they ask a question, incompetent when they admit uncertainty, negative when they raise a concern and disruptive when they question direction. The review by Elizabeth Morrison, ITT Harold Geneen professor in creative management and the vice dean of executive programs at the NYU Stern School of Business, of research on employee voice and silence identifies fear and futility as the most consistent reasons people stay quiet about ideas and problems.
This evidence suggests that silence in a meeting is a rational response to the conditions around it, and leaders can change those conditions.
Psychological safety
The five foundations for psychological safety – mattering, clarity, voice, connection and learning – each ask their own question. Mattering asks “Do I matter here?”; clarity asks “Do I understand what is expected of me and how I contribute to decisions?”; voice asks “Can I speak up and will it be taken seriously?”; connection asks “Do we know what is expected in how we behave together?”; and learning asks “Do we use experience to improve how we work?”
Each foundation has its own practices for teams, and each one depends on the others.
Leaders can strengthen voice through inviting contribution, one of its four practices, by making it explicit that they expect to hear from everyone. A structured round gives leaders one of the simplest ways to do this. Everyone responds to the same substantive question, in turn and without interruption, anyone may pass, and the team opens the discussion once everyone has had a turn.
Rounds work because each person knows when their turn will come, so speaking up stops being a competition for airtime. Research by Anita Woolley, professor of organisational behaviour at Carnegie Mellon University’s Tepper School of Business, and colleagues found that groups perform better when their members share speaking turns more evenly. When people know their turn is coming, they also take on responsibility for contributing and stop assuming that someone else will raise the issue.
In a round, the leader speaks last, because where hierarchy is strong, a leader who speaks early can set the direction of thinking and make other perspectives feel unnecessary, even during a structured round. By speaking last, the leader uses positional power deliberately, so the round widens the team’s thinking before authority shapes the decision.
Some people think best before they speak, and Nancy Kline’s Thinking Pairs give them time to do that before a round begins. Two colleagues each have the same uninterrupted time, commonly two to five minutes, to think aloud about one question while the other listens with full attention and makes no comment. The pairs then return to the group and share their freshest thinking in a round. Thinking Pairs especially help reflective thinkers, people lower in the hierarchy, and anyone still working through uncertainty.
The question a leader asks in a round tells people what kind of contribution they want. Purpose-framed questions, such as “What impact will this have on patients?”, link each contribution to its impact, and they often bring forward views from people who find positional debate harder and care deeply about purpose. Dissent-inviting questions, such as “What are we missing?” or “If this went wrong, what would we wish we had questioned earlier?”, name disagreement as legitimate before anyone has to risk being the first to raise it. Both kinds of questions make challenge an expected part of the work.
Structured rounds
The first few times I introduced structured rounds, people rolled their eyes and talked about “creeping death”. That reaction usually means the structure has felt mechanical, and it tends to change once people understand why the round exists and trust the leader to run it well.
Rounds work well with groups of up to around 12 to 15 people, and larger groups can run rounds in smaller breakout groups first and then bring the key themes back to everyone.
An invitation opens the conversation, and people decide whether to speak again based on what followed the last time they did. Leaders can use making voice count, another practice in the Voice Foundation, to close the loop, so people can see how the team considered their contribution and why it made the decision, including when the outcome stayed the same. Morrison’s work on futility shows why this matters, because people who can see what happened to their views have a reason to offer them next time.
At your next team meeting, handover review or case discussion, choose one agenda item and use a structured round with a single question, with the leader speaking last.
Then notice what you hear that you might not have heard before.
