"Can You Hear Me Now?" Why Speaking Up is So Critical

Those of us who work in Biopharma, work in an industry where we can make a real difference in people's lives. We work hard every day to advance therapies for serious medical illnesses and to develop treatments that we hope will have a major impact on patients' lives. Sometimes these patients are our own relatives and friends, which makes our mission personal. It's also a privilege and a responsibility - we need to get it right! When a drug doesn't get approved or approval is delayed or doesn't cover all patients who need it, the consequences can be extreme for the patients we want to serve.

There are other industries where the employees carry a tremendous responsibility for looking after customer's wellbeing – one of these is air travel. The airline industry has learned the hard way that failing to speak up can have severe consequences, something that Malcolm Gladwell also talks about in his book The Outliers.

In 1978, a United Airlines DC-8 crashed in Portland, Oregon. The crew of Flight 173 was making an approach to the Portland International Airport when they experienced a landing gear abnormality. The captain decided to enter a holding pattern so they could troubleshoot the problem. He focused on the landing gear problem for an hour, ignoring repeated hints from the first officer and the flight engineer about their dwindling fuel supply. Only when the engines began flaming out did he realize their dire situation and they crash landed over six miles short of the runway. In 1990, Avianca Flight 52 fell out of the sky over Long Island leading to 73 fatalities. The reason for both tragedies was a communication failure, according to Gladwell. At the end of the 1990s, Korean Air had more plane crashes than almost any other airline in the world culminating in Flight 801 crashing into a hill while on approach to an airport in Guam. Gladwell reports that after assessing the causes of these crashes, it was determined that a main factor was that the communication in the cockpits of Korean Air was overly polite and hierarchical. Junior pilots were not willing to point out imminent danger due to pilot error to someone who they perceived was senior to them. US airlines responded to these kinds of disasters by developing CRM or "crew resource management" - mainly focused around direct communication. CRM has been extremely successful in reducing pilot errors and allowed Korean airlines to create an excellent safety record since the nineties. In case you think that these lessons only apply when flying a plane, CRM has been used to reduce errors in medical teams performing surgical procedures, another area where hierarchy and politeness has been shown to cost lives.

You may think that learnings from these kinds of disasters are not relevant to what we do in Biopharma, but I disagree. Where I work, communication and speaking up is just as vital and potentially lifesaving. When we miss the mark, it can affect tens of thousands of patients. We need clear and courageous communication to develop new treatments for patients in need and to put our best science forward. Centuries of experience have shown that great science emerges when people share ideas, challenge established ideas, and are ready to accept great ideas wherever they come from.

If you are someone who is uncomfortable with direct communication or being questioned, ask yourself: How would I feel if I was getting on a plane knowing that no one in the cockpit would speak up even if they saw an obvious mistake? Would it be OK if the crew decided someone's feelings were more important than challenging their judgment to preserve the safety of everyone on the plane?

Of course not! If someone is messing up by forgetting to put the wheels down, you want the crew to tell your pilot in the most efficient and impactful way possible. Now imagine your workplace is a cockpit and the same rules apply. Do not obscure your concerns with overly polite, mitigated speech that could be interpreted as vague. Get to the point and be clear. Make sure our wheels are always down as we seek to advance global health.

One of my early mentors in my pharma career once told me about two different extremes of behavior. She said there were people with ideas and a point of view and people with nothing to contribute. On another axis, there are people who are just easy to work with and others who are quite difficult. We all prefer to work with easy people with great ideas but life isn't that simple. She told me to always pick the people who may be difficult to work with but add value with their ideas over those who are easy to work with but don't. Don't let your natural desire to be a team player and get along stop you from sharing your ideas. Your company hired you for your intellect – they want to hear what you have to say and they also want you to be comfortable debating your own ideas with others.

This isn't an argument for being rude or insensitive, just an admonition to speak up and be clear.