# Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interdisciplinary Action Teams

*Edmondson · Team Learning, Voice & Silence, Power & Equity · Journal of Management Studies · 2003 · Open access*

A mixed-methods field study of 16 cardiac surgery operating-room teams learning a new minimally invasive technology in the late 1990s (165 interviews across surgeons, anaesthesiologists, nurses and perfusionists), testing whether ease of speaking up predicts successful adoption of a new practice, and more centrally, what team leaders do to make speaking up possible in the first place. Introduces 'interdisciplinary action teams' (IATs) as a category combining two demanding features at once: the fast-paced, improvisational coordination of action teams like cockpit crews (Weick and Roberts, 1993), and the status, training and language differences that come with interdisciplinary composition. Confirms that ease of speaking up correlates with successful technology implementation (rho = 0.55 and 0.47, both p < 0.05), but the paper's more useful contribution is identifying two distinct, empirically separable leadership strategies behind it, laid out in a table that pairs each with its barrier, its behaviours, its mechanism and illustrative quotes. The first is providing a motivating rationale for change — explaining why the new behaviour matters, typically by anchoring it to patient benefit or framing innovation as simply how cardiac surgery works — which operates through motivation: people understand why the effort is worth it. The second is downplaying power differences: leaders disclosing their own fallibility, actively elevating other disciplines' input, and, the paper's most vivid illustration, under-reacting to error. In one hospital, a nurse dropped a freshly harvested vein graft on the operating room floor mid-procedure; the surgeon said nothing, simply went back and harvested another, and the near-universal retelling of this incident by other team members across the hospital shows how powerfully a single non-punitive response to a real, costly mistake can travel and shape a team's shared sense of what is safe to admit. This second strategy operates through psychological safety rather than motivation, and the two are conceptually and empirically distinct: a leader could in principle provide a compelling rationale while still running a punitive, high-power-distance team, or vice versa. Team leader coaching, the composite of both strategies, was strongly associated with both ease of speaking up (rho = 0.70) and boundary spanning (rho = 0.77), and boundary spanning (communication with cardiology, ICU and ward nursing outside the immediate OR team) turned out to be the single strongest predictor of implementation success of any variable measured (rho = 0.66, p < 0.01), a finding somewhat overshadowed by the paper's headline focus on speaking up. A genuinely counter-intuitive result: organisational-context variables (management support, resource availability, information infrastructure, innovation history) showed no association with implementation success at all, which the paper attributes to how self-sufficient and insulated from senior management cardiac surgery departments typically are. Conceptually, the paper also pushes back on how the voice literature had mostly studied speaking up as extra-role behaviour (discretionary organisational citizenship, going beyond the job); here, as roles shift under a genuine technology transition, speaking up becomes part of doing the job adequately at all, blurring a distinction the field had treated as clean. Explicitly frames its own correlational findings, given the small sample of 16 sites, as tests of plausibility for future research rather than conclusive evidence.

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