one surgeon repeatedly told his team, “I need to hear from you because I’m likely to miss things.”80 Another surgeon would say, “I screwed up. My judgment was bad in this case.” What made these messages effective was their repetition. Entrenched behaviors don’t change with one impassioned speech. As team members heard these messages over and over again, they felt psychologically safe to speak up—even in an environment as hierarchical as an operating room. “There are no sacred cows,” a member of one surgery team explained. “If somebody needs to be told something, then they are told—surgeon or
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