It’s not hard to figure out why people are hesitant to speak up at work. Offering a suggestion for improvement or pointing out when you think something isn’t right exposes a person to any number of possible responses—many of them unpleasant.

There’s the sarcastic retort. There’s the deafening silence. There’s the reply, pointing out exactly why you’re wrong, delivered in the nicest of tones but carrying an unmistakable edge of one-upsmanship. Who needs it? Who wants to create waves and risk a good job?

But when we don’t speak up, we put health and happiness at risk. As Doug Bonacum, Kaiser Permanente’s vice president of quality, safety and resource management, says in this issue’s cover story, speaking up “is mission critical for worker and patient safety.”

In addition to the moral imperative of protecting people from injury, there’s a strong economic incentive for speaking up. Improvement doesn’t typically come from a single person’s great idea—it comes from people sharing ideas. And we at KP have to keep improving, finding ways to deliver care as good as or better than we deliver now with fewer dollars per member. Our future depends on it.  

Since we get good at what we practice, we each have to practice speaking up. Practice means starting with lots of baby steps—don’t tackle the high-stakes stuff first! And let’s practice being good listeners, too, providing the space that lets others speak up safely.

The Labor Management Partnership and unit-based teams provide the framework for transforming what Bonacum calls a “culture of fear” around speaking up. But with that framework in place, it’s still up to each and every one of us to find the courage to address the immediate, particular obstacles that keep us silent.

When employees speak up, teams score high on patient safety, quality, service and workplace safety. But it can be hard to speak up when you don’t feel safe or comfortable. Gain the confidence to use your voice with these tips from two frontline workers with the Ambulatory Care Pharmacy team in West Los Angeles. 

Chakana Mayo, pharmacy technician, UFCW Local 770, Workplace safety champion

Practicing speaking up when you feel safe. “When we first began peer rounding, people were comfortable speaking to one another versus speaking with management. Once people were comfortable speaking with one another, then they felt like they could be comfortable speaking with management.”

Your voice can make a difference. “It’s important to speak up early because you can prevent long-term injuries from occurring. If you’re confident enough to speak up to your manager and just let them know what’s going on, they’ll appreciate it more.”

Employees who feel free to share their ideas and concerns help keep our patients safe and make Kaiser Permanente a better place to work. Managers can help team members feel comfortable speaking up by creating a “psychologically safe” work environment—one where no one is afraid they will be embarrassed, rejected or punished for speaking up. Here are four tips from supervisor Nee Tang, Pharm.D., Ambulatory Care Pharmacy, West Los Angeles, on how to help workers make their voices heard.

Follow up and take action. “When an employee brings up something, look for the solution and be accountable. Make sure things are done. Having that accountability is really crucial to employees.”

Be authentic. “Having a manager who is open-minded and who truly, genuinely wants to create a safe environment for everybody, that’s the key.”

Be patient and persistent. “In the beginning, people may not be as comfortable speaking out. But once they see we’re coming every month no matter what [to do peer safety rounding], they’re speaking out. We’re really getting the equipment that is needed and reminding everyone about the proper ergonomic positions. People know we’re serious about making an environment that is safe for everyone.”

Find people who want to share their passion with others. “Another key is to have people who are passionate. Angie Chandler, our labor co-lead, is really passionate about ergonomics. I’m passionate about eating healthy. We have another employee who is passionate about exercise. Everybody wants everyone to be safe and healthy and to work well together. We’re passionate about what we do and want to spread that to everybody.”