The surgeon was renowned. At the hospital the researchers called Chelsea, he was the new chief of cardiac surgery, and he had already used a new heart operation, done through a small incision between the ribs instead of a split breastbone, in numerous cases elsewhere. The company behind it estimated that teams would need about eight operations to match their usual times.
“It was not a matter of training myself,” he explained. “It was a matter of training the team.” The team was assembled by seniority, and he didn’t take part in its dry run. Nor would his style change: “Once I get the team set up, I never look up.”
But the new operation had moved the information. The balloon clamping the aorta was beyond the surgeon’s sight and touch; the anesthesiologist guided it by ultrasound. People below him in the operating room’s hierarchy now had to tell him things. After almost 50 cases, he said, “It doesn’t seem to be getting that much better.”
Sixteen hospitals in the study adopted the procedure, all with the same three-day training. One of the two that learned it fastest was a community hospital whose team was led by a relatively junior surgeon.
Two fears in the same room
Edgar Schein, the MIT psychologist, had names for what was going on in rooms like this. In a 2002 Harvard Business Review interview with Diane Coutu, he described two kinds of anxiety. Learning anxiety is the fear, when trying something new, “that it will be too difficult, that we will look stupid in the attempt, or that we will have to part from old habits that have worked for us in the past.” Survival anxiety is “the horrible realization that in order to make it, you’re going to have to change.”
Learning, he said, “only happens when survival anxiety is greater than learning anxiety.” That leaves two levers. You can threaten people “with loss of jobs or valued rewards,” or you can create “a safer environment for unlearning and new learning.” Most companies pull the first one because it is easier, he said, and that “is where organizations have it absolutely wrong.”
People change when the fear of standing still outweighs the fear of learning, and the second fear is the one you can shrink.
Why the threat can backfire
In a 1995 MIT working paper, Schein explained why turning up the threat can fail. Learning anxiety, he wrote, can rise “in direct proportion to the amount of disconfirmation,” his term for the bad news. Unless people feel safe enough, that information “will be denied or in other ways defended against,” and nothing changes.
Someone who moves abroad knows they need the language. What keeps them pointing at the menu is the waiter’s face when they get a word wrong. Reminding them how much depends on it doesn’t remove the waiter.
Schein listed ways to lower the second fear: working in groups, “providing practice fields in which errors are embraced rather than feared,” breaking the learning into manageable steps, coaching while the work is happening.
That is close to what the fastest cardiac teams did. At that community hospital, Mountain Medical Center, the junior surgeon said a surgeon had to allow himself to become “a partner, not a dictator.” The researchers, Amy Edmondson, Richard Bohmer and Gary Pisano, wrote that on a team, people “risk appearing ignorant or incompetent when they suggest or try something new,” and the teams whose members felt comfortable doing it learned faster. Their academic paper adds that successful hospitals designed practice sessions and early trials to create that safety.
The other dial
The first lever is on the urgency page, where John Kotter names too little urgency as the first error of change efforts, and reports that in a few successful cases, a group manufactured a crisis. Schein didn’t dismiss threat. Real change, he told Coutu, does not begin until the organization feels “some real threat of pain.” But if people accept the need to learn, the process “can be greatly facilitated by good training, coaching, group support, feedback, positive incentives.” ADKAR splits change into five hurdles; learning anxiety can stall someone who already knows why and how.
What it rests on
Schein drew the idea from his studies of American prisoners of war in Korea, Kurt Lewin’s change theory and decades of consulting, for Digital, Shell and BP among others. It is a framework from practice; neither the 2002 interview nor the 1995 working paper puts the two-anxiety framework itself to a controlled test. The cardiac study fits it, but its researchers didn’t measure Schein’s two anxieties, and safety was only one of three traits of the fastest teams.
There is field evidence for the safety half. In a 1999 study of 51 work teams in a manufacturing company, Edmondson found that team psychological safety was associated with learning behavior. There are limits. Schein himself said safety is “usually very difficult” to create while pushing for productivity and goes “dramatically missing” during downsizing. And Edmondson noted in 2008 that when people feel particularly close and the manager’s hand is weak, “performance standards can slip.”
The spreadsheet at home
Imagine a payroll lead, the person everyone asks about the old spreadsheets, whose company switches to a new HR system. At the training she asked one question and felt the room wait. Weeks later she still runs each payroll in her spreadsheet first and types the results in. Her manager announces that the spreadsheets will be locked at month’s end. She keeps a copy at home.
Now imagine a test copy of the new system loaded with last month’s payroll, an afternoon set aside, and someone from IT beside her while she makes mistakes no paycheck depends on. The deadline hasn’t moved. The fear of looking slow in front of the team could shrink.
One surgeon in the study, a team member reported, told his team again and again: “I need to hear from you because I’m likely to miss things.” Said only once, the researchers noted, a message that contradicts old norms tends not to be heard or believed.