Building Psychological Safety: The Question Formulation Technique

As the modern workplace changes, having an inspired and engaged team is more important than ever, and as dental practice owners and leaders, it is our responsibility to spark innovative thinking and create a work environment that encourages the free flow of ideas. It might sound like a lofty goal, but it is possible.

According to the U.S. Bureau of Labor Statistics, more than 4 million Americans quit their jobs in October 2021. On top of staff shortages, our practices are busier than ever and many of us, including our teams, are feeling burned out.

So, what can practice owners and leaders do to change the energy in their offices and make coming to work worthwhile and rewarding for their teams? Focus on a few crucial factors to improve team satisfaction and productivity.

A survey from 2013 showed that transparency was the top factor for employee engagement. In addition, team play and collaboration ranked as top traits employees enjoy about their coworkers. Some other contributing factors included appreciation and recognition at work, ample opportunities to share suggestions and ideas, and strong relationships with peers and leaders.

Understanding the Question Formulation Technique

In articles I've written about psychological safety in the dental practice, I emphasized the importance of fostering open communication to create a psychologically safe and exciting workplace for your team — but there is more to it than that. It's also about creating a safe and trusting environment where co-discovery and co-creation flourish.

One way my practice created this environment was by adopting the Question Formulation Technique (QFT)®, developed by authors Luz Santana and Dan Rothstein, founders of the Right Question Institute and coauthors of the Harvard Press best-selling book, Make Just One Change. Read more about this technique in “Creating Psychological Safety in the Dental Practice – Three Key Considerations.”

Each step of the QFT process is designed to stimulate three distinct types of thinking:

• Divergent thinking refers to the way the mind generates creative ideas by exploring as many different solutions as possible. In this step of the process, you tap into the group's divergent thinking by having them produce questions spontaneously without imposing limitations or modifying them before writing them down.

For instance, if your area of concern is case acceptance, possible questions might be, “How are we working as a team to create value for what we do?” or “Are we consistently using patient education videos?”

This type of thinking is commonly avoided because creativity comes with a certain amount of vulnerability. As a facilitator of QFT, it's crucial to enforce the rules during this stage and avoid analyzing or second-guessing the questions that come up.

• Convergent thinking relies on logic and reasoning. In this step, team members engage in a different way by analyzing and categorizing questions as closed-ended or open-ended. Together they discuss the value of each question as it is written and rewrite them as the opposite type.
• Metacognitive thinking is the awareness of your own thoughts and the processes behind them. In other words, it's thinking about how we think. In this final step, the team prioritizes questions and selects one or two that represent the overall message.

Building Team Trust and Respect in the Dental Office

All organizations benefit from diverse thoughts and opinions. Teams made up of people with diverse thinking patterns are better able to brainstorm ideas, identify problems, and offer creative solutions than groups with similar life experiences and perspectives. Feeling comfortable voicing opinions that may differ — and being able to effectively communicate these diverse thoughts boils down to psychological safety.

Encouraging your team to practice authentic communication with their coworkers can improve productivity, build trust, and strengthen relationships within the practice. It will also empower your team to know they can speak up when needed.

As the practice leader, you set an example for your entire team. Begin by embracing vulnerability and demonstrating humility. This demonstrates to your team that you are trusting, which means you are more likely to be trusted in return. Regularly asking questions also primes the group for activities that utilize QFT, which relies on a climate of respect and interpersonal trust.

So, how can you use the Question Formulation Technique to improve psychological safety with your team? Start by being open-minded and facilitating an environment where everyone is encouraged to speak up and be supported.

This is especially important in Step 1 of QFT, when everyone is expected to contribute their questions. Some individuals might not feel comfortable speaking up if psychological safety isn't a priority among the team. By encouraging creative expression, reasonable risk-taking, and the free flow of questions, you promote a space to share mistakes and lessons learned from failures openly. Doing so will inspire innovation, creativity, and productivity among the entire team.

In addition to utilizing QFT to enhance your team meetings, there are a few exercises you can do to reinforce trust and transparency in the group.

Check in with your team regularly

Demonstrating a genuine interest in how your team is doing will go a long way to promote engagement, trust, and overall satisfaction in the office. You can do this as a warm-up exercise for your meetings to improve mindsets and focus your team's awareness, or in less formal and one-on-one situations. The goal here is to find out what's holding the team's attention, what is their current state of mind, and give them an opportunity to share their thoughts.

Embrace constructive conflict

Once team members feel empowered to challenge ideas and express themselves, you may find conflicts arising more often. While it is unhealthy to attempt to prevent them from occurring altogether, it's your role to help team members engage in productive debate, clearly communicate their concerns or expectations, and work together to resolve issues in a productive and positive way.

Take turns during conversations

Ever notice that a few people seem to do all the talking? Be mindful about allowing everyone to share their thoughts and have ample time to participate during conversations. If you want to improve your team culture, you first need to improve your conversations.

Powerful Questions to Discuss as a Team

While you play an essential role in guiding your team's vision and success, ultimately, it's up to each member to contribute to the culture and commit to creating a psychologically safe environment.

Each step of the QFT is designed to be a learning experience for your team. To jumpstart the process, it's important to begin with a meaningful Question Focus (QFocus)® statement. There aren't any rules for creating a QFocus. It can be a phrase, a single word, an image, or video. There are no limits!

I strongly encourage you to come up with statements that are unique to your practice; however, I've provided suggestions below to help you start utilizing QFT with your teams.

Team Building/Practice Culture Focused:

• Teamwork
• We are an inclusive and supportive team

Clinical/Practice Management Focused:

• Case acceptance
• The ideal patient experience

Final Thoughts

Question formulation is a learned skill that can be strengthened over time. The willingness to ask questions and engage in personal and professional development are invaluable traits for any successful team.

As you and your team continue to ask questions and challenge the status quo, you'll become more confident, and your ideas will be more innovative. I implore you to embrace your team's creativity and continue to feed it through ongoing collaboration, co-discovery, and co-creation opportunities within the practice.

Ricardo Mitrani, D.D.S., M.S.D., is a member of Spear Resident Faculty.

References

1. Rothstein, D., Santana, L., & Puriefoy, W. D. (2017). Make just one change: Teach students to ask their own questions. Harvard Education Press.