The Fearless Organization

1The Underpinning

“Psychological safety was by far the most important of the five key dynamics we found. It's the underpinning of the other four.”

—Julia Rozovsky, “The five keys to a successful Google team.”¹

The tiny newborn twins seemed healthy enough, but their early arrival at only 27 weeks' gestation meant they were considered “high risk.” Fortunately, the medical team at the busy urban hospital where the babies were delivered included staff from the Neonatal Intensive Care Unit (NICU): a young Neonatal Nurse Practitioner named Christina Price* and a silver-haired neonatologist named Dr. Drake. As Christina looked at the babies, she was concerned. Her recent training had included, as newly established best practice, administering a medicine that promoted lung development as soon as possible for a high-risk baby. Babies born very prematurely often arrive with lungs not quite ready for fully independent breathing outside the womb. But the neonatologist had not issued an order for the medicine, called a prophylactic surfactant. Christina stepped forward to remind Dr. Drake about the surfactant and then caught herself. Last week she'd overheard him publicly berate another nurse for questioning one of his orders. She told herself that the twins would probably be fine – after all, the doctor probably had a reason for avoiding the surfactant, still considered a judgment call – and she dismissed the idea of bringing it up. Besides, he'd already turned on his heel, off for ...