All too often, well-intentioned people in healthcare institutions choose not to speak up when they’re concerned with behavior, decisions, or actions of a colleague.

NASA employs some of the smartest and most dedicated professionals in the world. Individually they are the cream of the crop in their various science, engineering, and administrative disciplines. Their collective achievements have dramatically expanded the boundaries of our knowledge of both our universe and our world. And yet in spite of their individual dedication and collective brilliance, on February 1, 2003, seven astronauts died—perhaps unnecessarily—when the Columbia Shuttle Mission STS-107 incinerated on reentry into the earth’s atmosphere. The reason? A key contributor to the tragedy was a culture that “prevented effective communication of critical safety information and stifled professional differences of opinion.”1 People’s inability to confront risky topics allowed risks to go unaddressed—contributing to the loss of seven lives.