Silence hurts, and sometimes it kills | Mike Cook

By Mike Cook
Contributing writer 


You ask a question to the group assembled in front of you, your team, and the response is silence.

“Any questions?” you ask. Again, silence.

The meeting is over and you leave with an expectation of, what? The thought running through your mind is familiar, “I know they don’t agree with what I have asked them to do, I know they had questions. How will they make me pay this time?”

Hours, maybe days later, work comes back to you that clearly indicates that your team had questions and they did not ask, they had opinions they did not express. And then the rework begins.

There is a cost to silence and you know it well, yet you never really tally the bill. That’s part of why the pattern continues.

What if the results of silence and the associated costs were right there in front of you every day? Things might be a little different. You might be less likely to end that meeting without hearing those opinions and questions.

How can you make the cost of silence visible and urgent?

For healthcare professionals, it is a different game. The costs of silence are immediate and visible. But are they doing better than you?

The statistics will probably surprise you—they are both startling and unacceptable.

Each year, one in 20 in-patients at hospitals will be given the wrong medication, 3.5 million will get an infection from someone who didn’t wash his or her hands or take the appropriate precautions, and 195,000 will die because of mistakes made while they’re in the hospital.

Here is both an amazing and tragic truth about these statistics. Many of the key problems that contribute to these errors are often known far in advance, and yet few people talk about them.

Every day, many health care workers observe colleagues who cut corners, make mistakes or demonstrate serious incompetence. Only a small percentage of workers speak up and discuss what they have seen.

Listen to these words from professionals gathered by the Vitalsmarts Inc. organization as they surveyed healthcare professionals.

“A group of eight anesthesiologists agree a peer is dangerously incompetent, but they don’t confront him. Instead they go to great efforts to schedule surgeries for the sickest babies at times when he is not on duty. This problem has persisted for over five years.” (Focus group of physicians)

“A group of nurses describe a peer as careless and inattentive. Instead of confronting her, they double check her work—sometimes running into patient rooms to retake a blood pressure or redo a safety check. They’ve ‘worked around’ this nurse’s weakness for over a year. The nurses resent her, but never talk to her about their concerns. Nor do any of the doctors who also avoid and compensate for her.”(Focus group of nurses)

Vitalsmarts conducted this survey in collaboration with the American Association of Critical Care Nurses. In the study, researchers conducted dozens of focus groups, interviews and workplace observations representing more than 1,700 nurses, physicians, clinical-care staff and administrators.

The following findings were reported:

-Regarding issues of peer competency, 50 percent of nurses and 80 percent of physicians describe somecolleagues as missing basic skills, using poor clinical judgment or being out of date.

-Only 12 percent of nurses and physicians indicated that they would confront a nurse with concerns of this nature, and almost none would confront a doctor.

– Remarkably, the study indicates that in almost half the cases, these problems have existed for more than one year, some for as many as three to five years.

The costs are clear: unacceptable error rates, high nursing turnover, reduced productivity due to “workarounds” and low morale.

The research indicates that about 10 percent of healthcare workers are willing to confront the types of issues that we have cited here—when they feel as though they have the permission and the skills to do so.

Over the past 12 years, my colleagues and I have worked with healthcare professionals in institutions like Strong Memorial Health System, Via Health and Healthquest. The work we have done with their employees has assisted in giving them both the motivation and the skills to hold the critical conversations that have been missing: the dialogue confidence required to confront the issues posed in the study.

This has translated into significant improvements in measurable outcomes for these institutions. We have also enjoyed working with clients in other industries and realized similar outcomes, though maybe not so dramatic.

In healthcare, the stakes are in plain site every minute of every day, and still silence takes its toll. How about where you work, where it is not a life and death game?

So, how can you make the cost of silence visible and real for people?

Mike Cook is a management developer who lives in Anacortes, Wash. His columns appear on every other Tuesday. He also publishes a weekly blog at

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