Transparency Saves Lives
Transparency is one of the three pillars of Empiricism, and a core concept in Scrum. It refers to the state of an object, artifact, or process in which all relevant aspects of it are readily visible and observable by all parties who have an interest in it.
Psychological Safety has been a hot topic in the Scrum and Agile community lately, and is a key factor in Transparency among team members. Psychological Safety refers to the freedom that an individual feels in the team to publicly make mistakes, take risks, and voice unpopular opinions. Google’s recent re:Work project found that Psychological Safety is the key differentiator of high performance teams, and essential to innovation.
A paper published this week in Health Affairs by global health policy researchers Veronica Toffolutti and David Stucker of Bocconi University in Milan examines the impact of Transparency and Psychological Safety in the health care field, with startling results.
In the study, Toffolutti and Stucker performed a multivariate regression to investigate any connection between the degree of “openness” experienced by staff in 137 hospitals in England, and the mortality rate at those hospitals. They define openness as “an environment in which staff freely speak up if they see something that may negatively affect a patient and feel free to question those with more authority”, a definition that’s notably similar to what we mean by Psychological Safety.
They designed a standardized openness score, derived from staff surveys — a numeric value expressing the overall openness of a particular hospital.
Two major results were found by these methods. First the study found that across the 137 hospitals, openness is increasing over time. The average overall score was 13.63 in 2012, and climbed to 16.49 in 2014.
Second, they found that a one-point increase in openness is associated with a 6.48 percent decrease in hospital mortality rate.
“These findings have important policy implications,” Toffolutti and Stucker write, “They offer empirical evidence to support further efforts to increase openness in the English hospital system, since doing so has improved health care quality.”
The researchers point to a very Agile concept, the power of learning from mistakes, as one of the key drivers of this finding. “The single component of our indicator that most affects mortality rates is good hospital procedures for reporting errors, near misses, and incidents”, they write
What can those of us in the software field learn from this? The key takeaway here is: Culture matters.
A team can operate in the cadence of Scrum for years without doing the honest, real, hard work of creating a culture that fosters openness and safety, and the difference is night and day both in team member experience and customer outcomes.
And when it comes to results that are the next step beyond predictable, best-we-can-do results, a culture of openness — of transparency, honesty, and safety — is a free force multiplier.
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