Creating a speak-up culture in private practice: a 4-step project to improve psychological safety at work 

As a private practice owner, one of my most important jobs is to remove fear from the workplace. To build a culture where everyone on our team feels safe and free to speak their mind. 

I haven’t always done this well. No doubt, part of the problem stems from my personality defects (e.g. I can be a bit talkative, ‘assertive’ (ahem) and resistant to criticism). But, on reflection, I think a large part of the challenge is overcoming the way I was trained.

When I was a junior employee, speaking up felt risky. I was hesitant to do it. I didn’t want to say something wrong, or make a silly blunder, or get angry or upset. I didn’t want to disagree openly with my supervisor, or challenge the way things were done. I was hyper-aware of my lack of authority and power, and vulnerability. I didn’t want to rock the boat or trigger conflict with my colleagues. Most importantly, in the rocky economic climate of the 1990s, I wanted to stay employed!

My thoughts back then weren’t neurotic or paranoid, and I certainly wasn’t shy. The truth is that, to this day, in some workplaces, speaking up is risky. It can result in social rejection, a damaged reputation, limited opportunities for promotion, or even being fired.

Obviously, a culture of ‘keeping your views to yourself’ is bad news for employees. But it’s also terrible for managers, practice owners and, ultimately, clients. If people don’t feel safe to say what they think, team morale suffers, office politics distracts from the mission, and productivity and client service standards suffer. You miss opportunities to hear great ideas, and to get important feedback you need to improve services and systems. You lose opportunities to identify and unlock your team’s talents and capabilities. You squander chances to improve as a leader, and as a person.

A confession

I need to work harder to support our team to feel safe to speak up. 

It’s a key priority in my personal training plan for the coming year. It’s a key objective for our team business strategy. And it’s a fundamental part of our mission to provide quality care to our clients and families in an hospitable workplace where everyone feels safe.

Another confession

I used to think you could conjure a speak-up culture into existence with words – with slogans in your Code of Conduct and team training like: 

 “We need your voice, we need your opinions. We need your honest feedback”.

I now know this is embarrassingly naive. You can’t tell people to feel safe when they don’t feel safe.

So how are we going to improve psychological safety at work?

First, by identifying our goal and being honest about where we are now. (This article is part of that process.)

Second, by investing in training and research:

• We’ve all just completed accidental counselling training with Relationships Australia. Among other things, this has helped us to create simple optional/voluntary practices in weekly supervision and our day-to-day interactions to check in with each other and to provide additional emotional and other support to team members who need it.
• We’re finalising individual annual training plans that will include professional development goals to reduce known burnout risks. 
• I’ve been reading the work of Timothy Clark, author of “The 4 Stages of Psychological Safety”, and using this work to think about practical things we can do to make everyone feel safer at work. (I have a lot more to learn!)

Third, by communicating to the team and committing publicly (i.e. here!) to the following four key principles (based on Clark’s work):

1. Your rights to respect and dignity at work do not depend on your performance or views: 

• We have deliberately hired a team made up of very different people (including people of different ages, personalities, skills, talents, interests, cultural, linguistic and professional backgrounds), because we value cognitive diversity, including differences of opinion. 
• Everyone on our team is worthy. Simply being human qualifies you for inclusion. But being a team member gives you the right to be included and to belong at work, and to be respected by everyone else on the team. 
• Our respect for you does not depend on your performance, or on the ‘worthiness’ (value) of your input, opinions or views on a given issue. Everyone is entitled to the same dignity based on their intrinsic worth as a person.
• Being a team member gives you the right to speak your mind respectfully without fear of reprisal for speaking up. 

2. Loyalty does not mean agreement

• True team loyalty is about genuine concern for the best interests of the team, our clients and the practice. It is not about agreeing with your supervisor or anyone else. For this reason, we encourage independent thought.
• Respectful disagreement is not disloyal. We do not want to manipulate conformity by using hierarchies, status or power to make it seem like everyone agrees with a view when they don’t – a recipe for unhappiness and poor quality work.
• Rigorous debate and constructive criticism about issues that affect our work, team and clients are encouraged. You can always question systems and processes, and make suggestions to improve them.

3. The value of your opinions does not depend on your title, seniority or power

• To keep improving our services, we need to change how things are done, and not leave things as they are simply because ‘this is the way we’ve always done them’.
• Smart teams harness their collective intelligence by sharing ideas and testing them.
• Thoughtful and respectful disagreement in good faith is encouraged because it can improve ideas, systems, processes and the quality of our work.
• Sometimes, the best ideas come from new voices and outside perspectives. Minority views can sometimes turn into great solutions.
• We welcome your views – including on these principles!

4. Your right to speak up does not mean that we will always agree with you

• Your right to speak up internally does not affect your professional, ethical, and employment obligations to us, our clients, our regulators, and others, including to protect the confidentiality of our clients, staff and our practice, and to abide by our Code of Conduct and other policies and procedures.  
• Running a practice involves lots of trade-offs, choices and compromises. Our resources (including time and money) are not unlimited. We have many stakeholders, including staff, clients, regulators, and risk-takers (i.e. us practice owners and funders) whose interests may not always be aligned. 
• This means we can’t say ‘yes’ to everything. 
• We commit to listening and considering your views with respect and professionalism. But this does not mean that we are obliged to adopt the suggestion.
• We will continue to thank and commend team members who speak up, even when we don’t adopt their suggestion. Even when we say ‘no’ to your suggestion, we appreciate you sharing the suggestion or idea.

Fourth, we will now reality test these principles. 

This means experimenting with different forms and media of team communication to foster a culture where everyone feels free to speak up in ways that make them feel safe and respected. We will ask the team for regular feedback on how we’ve going, and do our best to improve our systems and practices when we fall short. 

If we can hit our goals and put these principles into practice – if our team feels respected and empowered to speak up, and to challenge the status quo – I’m confident we will all find greater purpose and satisfaction at work, and contribute greater value to our practice, which will improve outcomes for our clients and the communities we serve. 

As always, though, actions will speak louder than words. 

Key source:  Clark, T.R. (2023). Building a Culture Where Employees Feel Free to Speak Up. Harvard Business Review, August (online).

This article also appears in a recent issue of Banter Booster, our weekly round up of the best speech pathology ideas and practice tips for busy speech pathologists, providers, speech pathology students, teachers and other interested readers.

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