Cultivating Spirited Voices and Welcoming Minds In the Workplace

Ron A. Carucci

June 09, 2021

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Getting people to be open and cooperative and tell the truth is hard enough under routine conditions. But when things get rough, you can expect people to reflexively shut down. This is a big problem in a world defined by continuous change and technological disruption. But even companies facing major challenges can beat the odds.


Michael Abraham Shadid was born in 1882 in what is now known as Lebanon. He was the twelfth child born to his poverty-stricken parents; nine of his eleven siblings died of dysentery caused by contaminated food and poor hygiene. A few months after his birth, his father died, leaving his mother a one-room house, two mules, and the equivalent of about US $1,000, which lasted the family 10 years.[1] In 1893 his mother moved their family to Beirut, where he received a scholarship to the Syrian Protestant College (later the American University of Beirut). His dream of a better life for his family had begun to form.

Shadid knew of the college because Dr. George Post, a physician from the college, occasionally visited Shadid’s village to treat the poor, sparking his desire to study medicine. In 1898, he and his sister moved to the United States and peddled jewelry for four years, earning enough money to pay his way through medical school. Within two years they sent for his mother and brother to join them.[2] Despite several family financial setbacks, Shadid entered Washington University medical school in St. Louis in 1903.

Shadid’s early life experience of poverty and not having access to quality medical care shaped his values as he trained to become a doctor. In his autobiography, he reflects, “Among my earliest memories, many have to do with poverty. Why was I barefoot? Why were my clothes shabby and my lunch meager compared with that of other children? Why was my mother menial?”[3] These values, so strongly implanted, would stay with him as he began to build a practice of his own.

Shadid continued his medical training beyond Washington University, and eventually settled in rural Oklahoma to practice. For the next 20 years, Shadid became the veritable horse-and-buggy country doctor. He traveled from town to town, performing surgeries by candlelight. He trekked through dust storms and blizzards to reach ramshackle shanties occupied by poor farmers and their families. They were dying from preventable ailments like ruptured appendixes, and their wives and children were helpless against the havoc wrought by pneumonia, diabetes, and tuberculosis. By his own estimation, he delivered more than 3,000 babies. He was appalled to discover the lack of access to quality medical care, and even more disheartened by the frequency with which he saw farmers sell their entire group of livestock, sacrifice their crops, or even lose their homes just to pay for medical treatments. And he was deeply troubled by how frequently he saw fellow doctors exploiting these farmers’ vulnerabilities by pushing for unnecessary surgeries and treatments just to bolster their fees.

Around this time, Shadid had become fascinated by the farming community’s natural ability to collaborate to form agricultural cooperatives. Several farming groups near him coalesced in 1906 as the Oklahoma Farmers’ Union, which earned financial capital for farmers through group-owned entities such as cotton gins or wheat elevators, thereby sharing the burden of rising farm equipment costs. Shadid wondered if a similar cooperative model could be applied to healthcare.

In October 1929, as the country was on the brink of financial collapse, Shadid called together a group of farmers in the basement of the Carnegie Library in Elk City, Oklahoma. There he presented a plan for improving the quality of available healthcare by sharing the costs through a cooperative like the ones they’d created in their farming operations. Because he framed his proposal through a model they already understood, the farmers were predisposed to trust him. He told the farmers that if 2,000 people invested $50 per share as an annual fee, something they could afford, they would have enough money to build and furnish a community hospital in Elk City, staff it with specialists, and offer quality medical services at a significant discount. He offered payment plans to allow cash-strapped farmers to opt in. By May of 1930, Shadid had sold 700 memberships, and construction on the Elk City community hospital began.

The threatened reaction from the traditional medical community was predictably swift. They spread rumors that Shadid’s plan was a scam and took out ads in newspapers claiming that the hospital would inevitably go bankrupt and that the quality of care would be inferior. They made viciously racist public comments about him, and there were even threats on his life. Some professional medical associations even tried to revoke his license to practice medicine.[4] But Shadid was undeterred, despite having to pause construction on the hospital due to the controversy it was stoking.

Rather than focusing on refuting the naysayers, Shadid patiently but tenaciously focused on the farmers—the patients—he so deeply cared for. In August of 1931, the hospital opened its doors, and 3,000 members of the community attended the ribbon-cutting ceremony.[5] For the next 10 years, doctors and officials from all over the country came to witness the success of the hospital. Newspapers wrote stories about its impact on the farming community.

In the hospital’s early years—which occurred during the Dust Bowl era and the Depression—Oklahomans suffered as drought and other weather conditions ruined crops and killed livestock. As always, patients struggled to pay their membership fees and medical bills. But Shadid persevered and continued to enroll new members. Between 1934 and 1949, the hospital was expanded seven times, and from 1932 to 1937 surgical procedures rose from 121 to more than 1,000. By 1949, there were more than 2,500 members. It was clear: Shadid’s progressive model of cooperative health was succeeding, even in the face of enormous adversity.

In hopes of spreading the co-op model further, Shadid traveled to many states to educate interested communities on the basic principles and benefits of the model: 1) lowering medical costs for patients; 2) staffing hospitals with salaried physicians, incentivizing quality care without unnecessary medical procedures; and 3) prepayment, encouraging patients to seek care early and preventatively.

Shadid’s pioneering work set the stage for future co-op organizations like the Group Health Association in Washington DC, The Kaiser Foundation Medical Care plan, and the Group Health Cooperative of Puget Sound. The Elk City Community hospital’s legacy remains vibrant and continues to be carried out by its successor, the Great Plains Regional Medical Center in Elk City.[6]

While Shadid’s efforts took place at a very particular time and within a specific field (medicine), his story offers universal lessons to anyone, and any organization, striving to make meaningful change. Every day, organizations face dilemmas they have attempted to resolve multiple times with conventional solutions that repeatedly fall short. We have to wonder, then, how many Michael Shadids are roaming the hallways of our organizations, attempting to have their novel ideas heard, or worse, have given up trying? Rather than acquiescing to the irritating squeaky wheels or dominating voices, what if we actively sought out the voices of our Shadids: voices with thoughtful, and yes, unorthodox ideas, measured approaches rooted in sound convictions, and the resilience to see their ideas through. Of the many exemplary ways Shadid used his voice and wisdom, one of the wisest was not wasting his time merely speaking against established medical practices. Instead, Shadid focused his passion and talents on speaking for patients, advocating for ways to improve the quality of their lives.

What if our organizations had more voices like that?



The concept of employee voice, the behavioral science term for the conditions under which people in organizations will readily speak their minds about problems like misconduct, someone’s bad behavior, or impending problems, as well as freely offer ideas, has been the subject of researchers for decades. Most of the research has focused on dissecting horrific disasters that could have been averted had someone spoken up or, if someone did speak up, someone had actually listened. These include catastrophes like the Challenger Space Shuttle in 1986 and the Columbia in 2003, which were the result of known issues that had been raised and dismissed within NASA.[7] Or BP’s Deepwater Horizon oil spill in the Gulf of Mexico in 2010. The recent groundings of 387 of Boeing’s 737 Max airplanes due to mechanical issues, beginning in 2019, is another example.

In each of these cases, those in a position to act upon what they knew and prevent disaster chose not to. Was the way the information was brought forward ineffective? Or were leaders so driven to achieve their goal that they denied the potential consequences? Because as is too often the case within our organizations, somewhere between the offering and reception of employee voice, things broke down, with tragic consequences.

An alternative to silence is the concept of “speaking truth to power.” A tried-and-true ideal of activist, political, and human rights groups, the idea describes courageous citizens delivering harsh and/or inconvenient truths to political leaders about things in need of change that they may be blind to, perhaps willfully.

The term itself is attributed to the Quakers in their book Speak Truth to Power: A Quaker Search for an Alternative to Violence published in the 1950s, though there are countless examples of this behavior throughout history. But sadly, the stories of those speaking truth to power often have horrendous endings—people sacrificing careers, reputations, and even their lives in an attempt to draw attention to injustice, misconduct, and even criminal misdeeds only to have those in power retaliate, dismissing or deflecting their newly spotlighted bad behavior.

When you see voices emerging en masse, however, safety in numbers can result, and things can sometimes improve. Consider the power of the recent #MeToo movement where women’s voices revealing prolonged sexual abuse have brought down Hollywood, industrial, and political titans. In Czechoslovakia in 1989, the negotiations and protests of groups made up largely of students forced a peaceful transition of power from a single-party communist regime to Czechoslovakia’s first non-communist government in four decades, and in just under six weeks, an event known as the Gentle Revolution. But under many circumstances mass activism, especially within organizations, is less effective, and frankly, shouldn’t be necessary if we are designing governance systems that invite the spirited voices and views of those within our organizations.

Our organization’s governance systems gather countless employees every day into meetings on video screens or in conference rooms to solve problems, share ideas, learn new concepts, make critical decisions, and exchange important information. If you hope to create governance systems in which people show up to these conversations with their whole voice and bring you their best ideas, critiques, challenges, and warnings, then you have to start by creating an environment in which people freely have spirited exchanges up and down the hierarchy and across organizational boundaries.

It’s important to always remember, however, that at the other end of those spirited exchanges, welcoming minds and hearts must be waiting. That doesn’t mean agreement or acquiescence—it means openness. Your job as a leader is to de-risk truth telling so that people don’t need to fear the implications of telling it. Without those two foundations in place, even the best-designed decision-making governance will fail.

The most-cited reasons for employees not speaking up are a fear of retribution and a sense of futility. When weighing the cost of speaking up, employees consider the questions “What are the risks to my career or wellbeing if I speak up?” and “Why should I bother if nobody’s really going to care?”[8] Sadly, the answers are usually not encouraging— for them or for you, their leader. Employees fear being labeled, retaliated against in some form, ostracized, or worse. All of these concerns are rooted in a loss of a strong sense of belonging. If a relationship or status within their community feels like it’s at risk, people are far less likely to bring their true voice. Your job is to take away that risk.

Not surprisingly, if an organization with poor communication and relationships hits a major setback, the natural fragmentation will intensify, heightening the risk of ruptured community. When I interviewed social psychologist Jonathan Haidt, he offered this perspective on humanity’s ability to both cooperate and to pull apart:

We’re tribal. We’re really good at groupish stuff. That’s why we will always have conflict and war, but it also means that we can cooperate with people that are not our kin. You have to see our minds as really operating on a dimension of open versus closed. There are certain things that make us open and then we’re brilliant and cooperative, and there are certain things that make us closed. The more things feel threatening, the more closed we are.

Getting people to be open and cooperative and tell the truth is hard enough under routine conditions. But when things get rough, you can expect people to reflexively shut down. This is a big problem in a world defined by continuous change and technological disruption. But even companies facing major challenges can beat the odds.

Guidant Corporation, now a division of Boston Scientific and Abbot Labs, offers an illuminating example of an organization that went from communicating poorly to one making employee voice an integral part of its culture. This story begins in 1993, when Ginger Graham was named President and CEO of Advanced Cardiovascular Systems (ACS), then a division of Eli Lily, and spun out as Guidant Corporation in 1994. When Ginger took over, performance was declining and divisional warfare among key groups was at an all-time high. R&D and manufacturing weren’t even talking to each other. Management had broken many promises and morale couldn’t have been lower. She was the company’s fourth CEO in five years.

Shortly after Graham’s hiring, she was tasked with addressing the US salesforce who, like so many others at the company, were deeply unhappy. She knew the people she was about to address didn’t trust her, and by all accounts had no reason to. She decided that rather than trying to rally them, they needed to hear the truth from her: despite ACS’s impressive history of innovation and reputation as one of the crown jewels in the medical device industry, this was not the same company. And everyone knew it. Her words shook the room. “I’ve always heard about what a wonderful company ACS is, but frankly, that’s not what I see,” she began. “What I see is deteriorating morale, disillusioned customers, and finger pointing. I see a place where R&D and manufacturing are practically at war. You folks in sales blame manufacturing. R&D blames marketing. We’re all so busy blaming each other that nothing gets done. No wonder our customers are furious with us.”[9] Believe it or not, the tough medicine worked. Once she realized her audience was relieved to know that she was willing to admit the truth, she realized she had earned their goodwill, at least for the time being. She took advantage of the moment, committing herself to “create a culture that would allow everyone in the company to feel free to tell the truth, from top managers to the people on the loading dock.”[10]

Graham was aware of how information starved the company was, and how employees had almost no visibility into what was going on up and down the hierarchy. Knowing how frustrated employees were with the poor communication they’d been receiving from management, and realizing the futility of an expensive study asking them for even more feedback about their frustrations (which nobody believed would be acted upon, anyway), she decided radical action was needed to reverse things quickly. Every executive at Guidant was assigned a coach… not a superior, but a rank-and-file employee. These coaches were trained to collect and offer candid feedback and expected to gather and deliver it to their assigned executive about the accessibility, clarity, and reliability of their communications; credibility of their decisions; and their ability to listen to and act upon the concerns of employees. The coaches gathered this information throughout the year, and then brought that feedback to their executive during their regularly scheduled meetings. Executives’ behavior changed quickly as they received actional feedback on how employees in the organization experienced it.

At first the coaches delivered anonymous feedback. But as trust grew between management and employees, open conversations about financial performance, product development progress, and where things were succeeding and where they were falling short, became more common. In town hall-style meetings of large groups of employees, progress against company goals was openly discussed. When a goal was missed, it was discussed until employees understood why it had been missed, what could be learned from the shortfall, and what needed to be done to course correct. All questions were welcomed at these meetings, any concern was fair game, and even feedback for management was invited. When problems were brought up outside of meetings, Graham directed managers to make a direct appeal: tell employees what the situation is, what needs to happen, and ask them to help.

That’s not all Graham did to embed a culture of honesty among Guidant employees at every level. In her decade as CEO, storytelling became another key part of her approach. Like elders siting around a fire, stories of great truth telling were passed along from executives to successive generations of employees, especially new employees, to propagate the culture they wanted to sustain.

To solidify her executives’ comfort with feedback and vulnerability, she instituted a personal feedback process among her team that put each leader on the “hot seat.” While they were on it, the rest of their team would offer the leader feedback on one area they could improve on and some suggestions for how. This kept executives humble, open, and constantly reminded of their need to own their own shortcomings before they’d have the right to ask the organization to own theirs.

The results of Graham’s unorthodox but powerful approach speak for themselves. During her tenure, Guidant grew exponentially, with market share and margins rising along with retention and morale. Innovation exploded, with dramatic breakthroughs in the cardiovascular device field. The company grew from $300 million in 1994 to $2.7 billion in 2001, and to more than 10,000 employees.

Since then, Guidant has certainly had its share of new setbacks. But the decade of transformation under Graham’s leadership provides a blueprint for cultivating a culture of voice with leaders who welcome those voices: flip the hierarchy so that executives are being coached by employees, tell employees the whole truth (even the parts you think they can’t “handle”) and ask for their help solving problems, honor truth tellers in stories and rituals, and hold yourself accountable to honesty through truly open forums and ongoing feedback.

Now that we’ve looked at what fostering spirited voices looks like in action, let’s break down key factors needed to make it happen: safety and skill.



The concept of employee voice has a built-in paradox: the onus is on the voice to speak up, while those with the power to effect change are the listeners (and not always willing ones). The irony of hierarchy is that those with the least amount of authority are in the greatest position to spot opportunities or oncoming problems.

Amy Edmondson has been a pioneer in the field of psychological safety—creating the conditions under which people will feel free to speak their minds, raise concerns, share risky ideas, and offer candid feedback when things are off course or someone’s behavior is unacceptable. An environment of psychological safety is a foundational ingredient to creating cultures of honesty. In each of the four findings I’ve uncovered in my research (clarity in identity, justice in accountability, transparency in governance, and unity across the organization), psychological safety was one of the factors we specifically studied to understand the role it played in each. It accounted for between 20 to 35 percent of each dimension’s impact on truth telling, acting fairly, and serving a greater purpose. In other words, without psychological safety, you are amplifying your risk of lying, cheating, and self-interest by that much more. Edmondson’s initial interest in the topic stemmed from her curiosity about how organizations learn things—or don’t. “The whole idea was, in today’s fast-paced, constantly changing world, organizations need to learn,” she told me. “But they can’t learn if they don’t have access to their own data, experience and ideas. And so, if people aren’t willing to speak up, especially around sensitive or subpar performance, then there is no way the organization can learn.”

One issue, Edmondson notes, is that many people misunderstand what psychological safety actually is:

It’s about performance—about innovation, about quality, about competitive insights. It’s not at all touchy-feely. It’s not easy to create this kind of environment.

Edmondson believes that psychological safety isn’t a silver bullet. It’s a factor in achieving high performance but requires that organizations maintain high standards along with it. Many people invert the relationship, falsely assuming that to have psychological safety, you need to lower the bar on performance expectations, but this couldn’t be further from the truth.

For leaders, fostering a workplace that’s psychologically safe enough for people to feel free to speak up is an important step. When people choose silence over voice, it’s usually because there are systemic factors in play encouraging that choice. But creating an environment that cultivates safe, spirited voices requires far more than just soliciting feedback or people’s input.

Ginger Graham’s story shows the extent to which leaders must go to create systems in which people bring their whole voice. Setting an expectation that employees do speak up, and will not be punished for doing so, is just as important as extending the invitation to do so.

Here’s a classic example of why setting that expectation is important.

Andrea is the CEO of a large real-estate development company I’ve consulted with. As my client, she complained to me about a frustrating executive team meeting she’d just finished. The main topic of discussion was the struggles of one of the company’s historically high-performing businesses. Its leader had been in the job only six months and had made some changes to their marketing plan. She believed this was the problem behind the business’s falling performance and knew everyone else on the team agreed, yet nobody raised this point during the meeting. Frustrated and perplexed, she vented to me, “It’s not like we’re shy about having hard debates. We are capable of being very blunt with one another. So why didn’t anyone offer their insight to help out a struggling peer? If I’m the one that always has to do it, then what good is having a team?”

She was right. In general, people in her organization didn’t shy away from disagreement, and they could comfortably spar with one another when their opinions differed. But when I asked them why they didn’t bring up their concerns about their colleague’s marketing shift, I got consistently bewildered answers. I heard things like, “Why would I have done that? It’s not my business;” “Gosh, that never would have occurred to me to say something, I figured the CMO would be the one to raise it in private;” or “Are you serious? I’d look like a know-it-all if I’d done that!”

Inherent in their responses are some of the most common justifications for choosing silence. Simply put, employees often believe someone else will raise an important issue.[11] Extensive research on the bystander effect, such as the 2018 study from researchers in Copenhagen, shows that people, even in dire circumstances, will remain silent, believing someone else will say something.[12] People also often second-guess their own conclusions, telling themselves they could be wrong about what they are seeing, or self-sooth by justifying their silence with minimization—“it’s not really that bad.” And, as I discussed earlier, the fear of breaking social bonds and shaking up important relationships is often heightened, especially on a team, when people consider raising difficult issues.

While Andrea’s team was comfortable engaging in passionate debate and pushback, the notion of initiating such conversations about each other was foreign. In my experience working with hundreds of leadership teams, it’s not uncommon for leaders to share unspoken agreements not to tread on one another’s territories. And this is true even in environments where speaking up is safe and leaders make a point of welcoming feedback. Think about that for a minute.

But if people only raise issues that matter to them, they are subtlety reinforcing a type of individualism that undermines teamwork and cohesion. If you want people in your organization and leaders on your team routinely raising hot-button issues, regardless of who does or doesn’t benefit, you have to do more than let them know “it’s safe” to do so. You must make having difficult conversations an expectation and back this up with processes and behavior that reinforces this assumption. To that end, here are some ways of doing just that.


A shared sense of collective success helps unite organizations and reinforces the expectation that “issues that affect others are my concern.” Let those you lead know that when they have insights about a colleague’s challenges, you expect them to freely share them in a respectful, constructive way. When this doesn’t happen, the default mode for many groups and teams is to operate on a “hub and spoke” model, whereby the leader becomes the primary source of keeping things synchronized, and everyone else is excused to worry only about their own “spoke.” If leaders reinforce this belief too long, it conveys that the only issues employees must be concerned with are their own. Don’t assume people will see the self-evident need to avoid this. The higher up in organizations leaders ascend, the more pronounced the individualism that distinguished them to get there will be. Help leaders shift from trying to stand apart to advance their career, to joining forces with peers to create collective success. This ensures they set the example for the rest of the organization, which is especially important when rooting out critical silences. If there are factors encouraging people not to speak up, like unfair reward systems, bullying managers, a history of deaf ears, or real examples of retaliation for speaking up, leaders should be on high alert to eliminate those factors.


In many of the teams I work with, we actually embed the practice of exchanging pointed perspectives and feedback. It’s a bit like speed dating for executives: we spend a few hours in 20-30-minute one-on-one rounds, varying the questions we use to guide the conversations. Some teams do this on a quarterly basis. You could shape the conversation around leadership effectiveness, strategy execution, or the health of each respective relationship. In each round, both leaders exchange prepared views with each other, with commitments to follow up where necessary. This approach has been transformative for some teams, whose comfort with making each colleague’s success their priority has then become the norm for the rest of their company.


High-performance teams regularly include addressing their colleagues’ challenges as part of normal work practices. This approach puts the recipient of the feedback in the driver’s seat. I use this when new teams launch, especially with senior leaders. One member brings up a particular business challenge they are facing, framing the challenge at the outset of the conversation with about 15 minutes of context setting. Then, using a structured process, the rest of the team can ask questions to clarify their understanding. After the questions have been addressed, the team offers ideas, feedback, and even support to help resolve the challenge. I’ve seen leaders discover issues with their own leadership, view challenges from an entirely new perspective, and even resources shifted from one leader’s department to another’s. This approach helps minimize feeling defensive or dismissive as a result of others’ challenging views because you are expressly asking for them.[13]

Any time someone you lead brings their voice to the table, especially if they’re offering feedback about you, no matter how defensive you feel inside, celebrate their courage with gratitude and praise. When people offer unconventional ideas, challenge the views of colleagues during discussions, or raise concerns about behaviors that contradict what you’ve committed to, acknowledge their courage and hold them up as an example. Whose courage have you admired, but failed to acknowledge? Who has offered out-ofthe- box ideas or raised difficult issues within the past few weeks that you could go back and thank, apologizing for being remiss for not saying it sooner?

To create governance systems in which people engage in conversation with their mind, soul, and voice, you have to create an environment in which people can freely and spiritedly exchange feedback, radical ideas, and share concerns up and down the hierarchy and across organizational boundaries.


This extract from To Be Honest by Ron Carucci is ©2021 and has been adapted and reproduced with permission from Kogan Page Ltd. To read another sample chapter, head to



Ron Carucci has a 30-year track record helping CEOs and executives tackle challenges of strategy, organization and leadership in 25 countries at more than 100 companies. He is co-founder and managing partner at Navalent and is based in Seattle, Washington. He serves on the advisory board of Ethical Systems at New York University, previously served as associate professor of organizational behavior at Fordham University Graduate School and adjunct at the Center for Creative Leadership. He is a sought-after speaker, a regular contributor to Harvard Business Review and Forbes, and author/co-author of eight books.


1. Shadid, M A (1956) Crusading Doctor: My fight for cooperative medicine, Meador Publishing Company, Boston, as cited in Haddad, F S (2010) Michael Abraham Shadid: A Lebanese precursor of prepaid and cooperative medical care, Lebanese Medical Journal (archived at
2. Khater, D and Soleim, A (2016) Michael Shadid: A Syrian Socialist [Blog] NC State University, 24 August (archived at
3. Ibid
4. Haddad, F S (2010) Michael Abraham Shadid: A Lebanese precursor of prepaid and cooperative medical care, Lebanese Medical Journal, (archived at
5. Ibid
6. Great Plains Reginal Medical Center, About GPRMC, Great Plains Reginal Medical Center (archived at
7. Park, C (2008) NASA remembers three space tragedies, Space, 27 January (archived at
8. Wharton, J D (2016) Examining employee voice behavior: A systematic review of voice antecedents, University of Maryland University College (archived at
9. Graham, G L (2002) If you want honesty, break some rules, Harvard Business Review (archived at
10. Ibid
11. Milliken, F J, Morrison, E W and Hewlin, P F (2003) An exploratory study of employee silence: Issues that employees don’t communicate upward and why, Journal of Management Studies (archived at
12. Liebst, L S, Philpot, R, Bernasco, W, Dausel, K L, Ejbye-Ernst, P, Nicolaisen, M H and Lindegaard, M R (2019) Social relations and presence of others predict bystander intervention: Evidence from violent incidents captured on CCTV, Aggressive Behavior (archived at
13. A portion of this section originally appeared in Harvard Business Review and is reprinted with permission; Carucci, R (2017) How to make raising difficult issues everyone’s job, Harvard Business Review

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