Psychological safety is a term that has been gaining ground in leadership circles ever since it was coined in 1954 by clinical psychologist Carl Rogers. It is now recognized as a crucial condition for building effective teams. But what exactly is psychological safety, why is it important, and how can we create more of it as leaders?
Psychological safety is best described as a feeling within a group that it’s okay to speak up, suggest new ideas, ask for help, offer constructive criticism, make mistakes, express opinions, and voice concerns.
As Amy Edmonson pointed out in her book, The Fearless Organization, it is “the felt permission for candor.” In a psychologically safe workplace, there is an open exchange of ideas and information—even when “bad news” is being delivered—without fear of censorship, “punishment,” or retribution.
Why is psychological safety important, especially in a medical environment? Numerous reasons.
First, it enables an open exchange of ideas, thereby bringing the team’s breadth and depth of experience into play. Everyone on a medical team has valuable experience. Even someone who’s only been on the job for a week has one week of experience. They may have had prior jobs as well, and they certainly have experience from their educational years. Sometimes, their newness to the environment may give them a fresh perspective.
As team members watch each day progress, whether in a clinic or in a hospital, they can see when things might not be going optimally. In an environment of psychological safety, they’re willing to bring this up and say, “I think I know a better way to handle this,” or, “Hey, this is a problem, and someone’s going to get hurt.”
When everyone’s perspective is welcomed, more information comes to light, processes can be improved, and better decisions can be made. Conversely, when people are afraid to speak up, valuable perspectives are lost, and decisions are made from a narrower range of options.
Equally important, team members feel more engaged in an atmosphere where everyone’s perspective is valued. Engaged team members, in turn, are more motivated and committed. They develop an emotional connection to the job and the organization.
Turnover and absenteeism are reduced. On the other hand, when opinions are stifled or ignored, people feel they have nothing to offer, and they begin disengaging and looking for other opportunities.
In a psychologically safe team, mistakes can be admitted without fear of condemnation or penalty. Every misstep can be a source of learning, and management and training weaknesses can be exposed and addressed. By contrast, mistakes tend to be repeated when they are covered up or downplayed for fear of negative consequences.
How do we go about creating psychological safety?
It takes some effort in a healthcare environment where there is a strong tradition of hierarchy. Medical culture has historically been one of “Be quiet. Observe. We’ll teach you everything you need to know.”
Newer employees—especially younger, more junior ones—may be reticent to speak up to senior professionals. When you’re fresh out of medical school, it may not feel comfortable to make a suggestion to a chief of surgery, even if you have an exceptional idea.
As leaders, we can change this through explicitness and repetition. We can tell team members repeatedly, “Your point of view is welcomed and valued.” We say it through our words but also through our attitudes and actions, and it becomes part of the culture.
When team members do speak up, it’s crucial that we receive their comments in a positive way. Even if our ultimate decision doesn’t incorporate their suggestions, we should openly praise the act of bringing the matter to our attention.
In the hurried environment of medical care, it is easy to appear dismissive of teammates’ ideas and concerns, even if this is not our intention. Our body language often betrays a focus on more urgent things. That’s why it is important to practice good listening techniques. Turn your body toward the person, make eye contact, and listen for thirty or forty-five seconds. Then, let the person know you heard them and intend to follow through.
The ultimate acknowledgment, of course, is to put a team member’s feedback into action. When the team sees concrete change taking place because of something mentioned in the group, they learn there is real value in speaking up. As leaders, we can accentuate this by saying something like, “This was Janet’s idea from last week, and I think it’s going to make things better.”
To create psychological safety, the leader must also carefully manage team members who may intimidate others or speak too much or off-topic. If these detractors are severely impacting the group dialogue, counseling them individually with the intent to improve is warranted. The goal is to create a team where everyone feels equally heard and valued so that you are truly “running on all cylinders.”