Open now? Open later? As debate rages about restarting economies, one critical element is absent from discussion. The predictor of our success or failure will have less to do with when businesses open their doors and more to do with how often people open their mouths. Decades of research suggest that the heart of a high reliability culture is immediate peer accountability.
A few years ago, John Noseworthy, CEO of the Mayo Clinic in Rochester, Minnesota, proudly told me about a nurse who confronted him when he forgot to use hand sanitizer as he exited an elevator. He said, in effect, “If everyone in our system will speak up to forgetful colleagues, no matter their level or position, we can avoid most incidents of preventable harm.” And he was right.
And yet, in late April, at the peak of the Covid-19 pandemic, Vice President Mike Pence entered the Mayo Clinic to learn about their research efforts. During his tour, provided by Mayo leaders who all wore masks, Pence proceeded barefaced. While the vice president has since said that he should’ve worn a face covering, the incident is an obvious — and public — reminder of how hard it can be to speak up to people in power.
I’ve heard about similar incidents in recent weeks. A nurse who refused to wear appropriate PPE for four days before finally being reprimanded by her supervisor. Shoppers entering big box stores without masks, while the clerk they pass upon entry says nothing. And a boss of a team of essential workers who gave high fives in a meeting to people who’ve worked hard in recent weeks and none of his eight direct reports said anything until after the meeting.
As businesses begin to reopen, great attention is being given to the measures required to keep employees and customers safe. And many of those measures are simple behaviors: washing hands, wearing masks, etc. But those measures won’t succeed unless they become norms. And at the end of the day, the speed with which norms change is the speed with which it becomes normal to give correction. If noncompliance is rarely addressed, healthy behavior becomes a joke.
Keeping employees and customers safe and healthy while doing business in an ongoing pandemic will not only hinge on behaviors like wearing masks, performing temperature checks, washing hands, and staying six feet apart. It will rely on getting all of us to do these things, every time, for however long it takes. And that doesn’t happen unless those who see someone drop the ball speak up and remind them.
Inherently, we’re very bad at speaking up. In a recent VitalSmarts study of 1062 respondents, 3 out of 4 admitted to being nervous about infection risk when interacting with others. And yet, 7 out of 10 people admit to saying less than they think they should to keep themselves and others safe.
My colleagues and I have spent 30 years studying what it takes to create rapid, profound, and sustainable behavior change. Our central finding is that a robust influence plan must engage all of the six sources of influence that shape human behavior. These include:
- A compelling moral frame
- Deliberate practice
- Peer and leadership pressure
- Social support
- Environmental cues, tools, and resources
When all six sources of influence are present in robust form, we’ve seen in our research that the likelihood you will see positive change goes up tenfold. Below are five best practices that collectively engage all of these sources of influence. Unless all five are practiced in combination, the odds of meaningful change drop substantially.
Five Practices for Creating Safe Workplaces
Require please and thank you. The only way to create and sustain change is to have 200% accountability: Employees must understand that they are not simply responsible to follow safe practices themselves (the first 100%), they are also responsible to ensure everyone around them does as well (the second 100%). Instruct employees that when anyone sees anyone violate safe practices, they are to remind them of proper protocol with a polite, “Please.” For example, “Please wear a mask when you’re in the office.”
But this isn’t enough. My firm has worked with dozens of hospitals to improve patient safety by developing norms of reminding as well. It’s a challenge to get front-line nurses to remind testy physicians to wash their hands, unless you create an enabling norm. Leaders must be instructed that when they’re reminded of a safety guideline, there is only one permissible response: an immediate “Thank you” followed by compliance. Period.
Spectrum Health in West Michigan worked for months to encourage caregivers to issue reminders. When they asked reminder recipients to say thank you and comply, hand hygiene practice improved by more than 60% within a matter of weeks. When doctors were trained to “show gratitude, not attitude,” reminding became a low-risk norm rather than a terrifying ordeal.
Hold a Covid boot camp when you return to the office. The idea of a “boot camp” is to break down old patterns and introduce new ones. The easiest time to reset norms is when no one knows what is normal. As employees reenter the workplace, take advantage of their unformed expectations by holding a boot camp. This can be as short as 30 minutes or as long as a few hours, depending upon how many new norms you need people to practice. The meeting should include the following:
- Leaders as facilitators. This can’t be turned over to HR, or fobbed off to a consultant. Leaders must stand in front of employees and demonstrate their sincerity and commitment to the new policies.
- Moral messaging. Make the moral case for changing behavior by telling stories of affected friends, family, or clients to bring the risks of noncompliance to life.
- Deliberate practice. Leaders must not simply instruct people on new safety behaviors, people must go through the actual motions so they begin to develop muscle memory and the practices feel comfortable, normal, and compulsory. For example, at Spectrum Health, we developed a boot camp where everyone in a unit would go through the motions of walking into and out of a patient room. In one condition, they would wash in and wash out as required. In another, they would fail to wash in, and another caregiver would practice reminding them. After which the one reminded would practice saying, “Thank you” and then complying. The entire experience took no more than 20 minutes. This seems simple but compliance with the new norms was substantially higher in units that did the boot camp over those that didn’t.
Practice with fire drills. Hold daily fire drills in the first week, where you ask people to stop what they are doing and practice the new behaviors. In the weeks following, twice a week is sufficient. Effective fire drills also require leadership. Leaders must walk all employees through the motions of each new safety behavior, including saying please and thank you. Fire drills require much less time, but are critical to sustaining change because they remind employees of how important the behaviors are.
Perform daily rounds. As the saying goes, “you don’t get what you expect, you get what you inspect.” Just like in a hospital, leaders must use a checklist to do “rounding” and measure compliance results. They can walk the work area and observe the degree to which proper behavior is being practiced. They should score it every day for the first 30 days and do their observations at unpredictable times of day. After that, rounding can happen every other day.
Keep score publicly. Leaders should then post the rounding scores publicly, every day. Above the score they can place a large circle with colors denoting the organization’s level of compliance: Green = 95%+. Yellow = 80-90%. Red = <80%. They must commit to post the results no matter what they are and make sure they are visible to clients and customers. Embarrassment is a powerful motivator for improvement and the more public the embarrassment, the greater the motivation.
These practices may feel awkward for many employees and leaders, especially those who haven’t been part of concerted workplace safety efforts before. But these are unusual times and if we want to keep everyone safe and healthy, people have to do things outside of their comfort zones.
If leaders take these practices seriously, they will be able to inculcate new norms much more quickly. Doing so is not only important for employee safety but for the health of your business. Adherence to these critical behaviors will make it possible for business to reopen — and to stay open.