Amy Edmondson argues that organizations successful over the long-term are ones that are constantly learning from what they are doing. She calls it "execution-as-learning", and, like GE and Toyota, these organizations have a mind-set and culture that supports continual examination of their systems and processes to understand what works and how things can be improved. One of the major factors that can make or break an execution-as-learning culture is "psychological safety." Reporting on her research in the July-August 2008 issue of Harvard Business Review, she writes:

My research on why people withhold constructive ideas in the workplace suggests that before execution-as-learning can occur, organizations must fulfill one big prerequisite: They need to foster psychological safety. This means ensuring that no one is penalized if they ask for help or admit a mistake...In psychologially safe environments, people are willing to offer up ideas, questions, concerns - they are even willing to fail - and when they do, they learn.

You'd think that in teaching hospitals, people would be routinely encouraged to offer up ideas, questions, and concerns. But Edmondson's research in teaching hospitals found a large range among hospital units in the willingness of staff to report medication errors, for example.  While some units were constantly improving care for patients, other units were putting patients at serious risk by not creating a psychologically safe envrionment that supports organizational learning.