Cultivating Psychological Safety

“The ability for staff members to speak up is critical to team learning, team effectiveness and organizational performance.”

Leaders play a crucial role in creating psychological safety by demonstrating openness and flexibility and developing emotional connections.

More fairness promotes increased psychological safety and trust, which increases feelings of empowerment.

Empowerment promotes excellence and innovation.

Psychological safety, as defined by Amy Edmondson, professor at Harvard Business School, is “a shared belief that the team is safe for interpersonal risk taking.” This definition focuses on the team, rather than the individual.  When the team shares the belief that no one will be punished or humiliated for speaking up with ideas, questions, concerns or mistakes, the work environment is perceived as psychologically safe.

Successful healthcare leaders intentionally create environments where staff feel engaged and empowered. Psychologically safe environments promote a series of beneficial outcomes as individuals and teams learn and adapt together to increase overall performance. Practicing psychologically safe behaviors activates humanness in healthcare.

Humanness can be lost when staff fear
  • being rejected or marginalized
  • being seen as incompetent or ignorant
  • being labeled as negative, disruptive or creating conflict.

When humanness is lost, people fear rejection or negative consequences as a result of speaking up. When humaneness is present, people are more likely to speak up, which prevents errors and improves patient safety.

Types of human exchange prevalent when psychological safety is present in healthcare
  • knowledge is readily shared
  • questions are easily asked
  • help is offered and sought as a regular practice
  • errors are readily admitted
  • feedback is constantly solicited and openly received
Key outcomes in psychological safe environments
  • knowledge sharing
  • engagement
  • creativity
  • innovation
  • performance
Leader behaviors that cultivate psychological safety
  • be accessible
  • invite participation
  • display fallibility and acknowledge limits
  • highlight failures as learning opportunities
  • set boundaries and hold people accountable

Large healthcare organizations, such as the Mayo Clinic, utilize psychological safety as a foundation to success. The Mayo Clinic defines their primary value as the “the needs of the patient come first.” Eight core values make up this primary value: respect, integrity, compassion, healing, teamwork, innovation, excellence and stewardship.

Mayo Clinic Leadership Model Foundations

  • Inspiring values
  • Engaging colleagues
  • Bold and forward thinking
  • Driving results
Examples of Activating Humanness in Healthcare

In the operating room, the scrub nurse during the “surgical pause” can raise a question, but it’s how the surgeon responds to that question that creates a safe environment.

In the laboratory, technicians can ensure their colleagues have a voice in creating a standard operating procedure; but if their supervisor relies only on her favorites and their opinions, other technicians will learn it doesn’t matter what they say.

In research, a biostatistician may have the support of her colleagues to inform the principal investigator he lacks sufficient data to take his results to the bedside. The investigator can reject the biostatistician’s viewpoint, and, in turn, limit team members from speaking up in the future

Work environments where physicians can freely express concerns, ideas, and opinions create the best outcomes. Read more at


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