Psychological Safety Characterizes High-Performing Teams

Added on Jun 5, 2017

2imagesIn health care, we spend a great deal of time focused on issues of safety, and rightfully so. The delivery of safe, efficient, high-quality health care is foundational not only to success, but also to our ethical obligation to the patients that entrust us with their care.

Many efforts to improve safety are built on the principles of High Reliability and Lean methodology, with the aim of reducing variation and creating an environment in which errors and accidents are less likely to occur.

To be successful, these efforts must be supported by a solid foundation through which caregivers have clear expectations for how processes are to be carried out, sufficient training to develop the necessary skill set, an understanding of how they will be held accountable, and strategies to use when they notice an oversight or mistake that could lead to a larger problem. Such a foundation provides caregivers with a sense of confidence, personal empowerment and, importantly, psychological safety.

The term psychological safety was coined by Harvard Business School professor Amy Edmondson to describe the feeling or belief that the environment in which an individual works is safe for interpersonal risk taking, including speaking up with ideas, questions or concerns or pointing out mistakes, without fear of reprisal or humiliation. In a TEDx talk on the topic, Edmonson explained that creating an environment in which people feel comfortable to take risks is key to fostering innovative workplaces.

In an environment that supports psychological safety, teams view errors as learning opportunities, and team members are encouraged not only to embrace feedback, but also to seek it out in a genuine attempt to better the team’s outcomes. Conversely, in an environment devoid of psychological safety, individuals are hesitant or unwilling to admit gaps in knowledge or mistakes, and they are uncomfortable questioning the actions of others on the team. The fear or uncertainty about how others might respond to such behavior weighs heavier than the fear or uncertainty that staying silent might have negative consequences.

The climate of openness that results from a pervasive sense of psychological safety is essential for building highly reliable, high-performing teams. When team members feel comfortable admitting errors, discussing vulnerabilities and giving and receiving feedback from peers and colleagues, they are positioning themselves to learn from failures, prevent more serious mistakes and improve future performance.

Improving the psychological climate in work units cannot be dictated. Rather, it must be modeled and embraced. Some ways to begin include the following.

  • Embracing the concept of Just Culture—The Just Culture model, which has been widely used in the aviation industry, seeks to balance the need for an open and honest reporting environment with a quality learning environment and culture. The concept, introduced in a 2001 report by David Marx, emphasizes the importance of seeking root causes of error and correcting for them, rather than focusing on blaming individuals. Regardless of whether your organization is actively orienting toward Just Culture principles, you can utilize them when mistakes occur on your team. Setting the precedent that honest mistakes will be addressed fairly will assist you in building a psychologically safe environment.
  • Setting an example—One of the best ways to encourage team members to speak up and make themselves vulnerable is to show them you are willing to do the same. Admit your mistakes, be frank about your knowledge gaps and discuss how you’ve learned from them.
  • Building the team identity—When it comes to making decisions that affect the work being done in your unit, include the team and ask a lot of questions. Ensure that everyone gets an equal opportunity to share their thoughts and perspectives, and help the group “own” the end result. Look for opportunities for team members to make personal connections and build trust in one another through peer recognition, social events and collaboration. 
  • Being an advocate—Make sure your team members know you will support and back them up when it counts. The team should see that you put people first, and that they will get the benefit of the doubt if they are involved in an error or safety event.
  • Appreciating multiple perspectives—Encourage healthy debate in team meetings. This shows the team that it is OK to disagree, as long as they remain professional and respectful. Getting the group accustomed to offering alternative views and politely challenging one another fosters creativity and group learning and provides practice for speaking up in a real-life safety situation.
  • Creating a learning environment—Although the idea of embracing or even encouraging failure makes many managers uneasy, employees need to know that they won’t be unduly punished for a single honest mistake, and that collective learning for the team is the focus. The goal is to get the group comfortable with the inevitability of human error, convey confidence in their intentions and abilities and steer the focus toward correcting, learning from and preventing future errors.
  • Rewarding innovation—Encourage all ideas, even the bad ones. The process of innovation is messy and nonlinear, and encouraging the team to bring all their ideas to the table (not just the “sure to work” ones) is the key to learning and getting better more quickly as a team.

There are no shortcuts to establishing psychological safety, but strategies such as these lay the foundation for developing a psychologically safe work environment over time. With this foundation in place, the team will fail smarter and learn faster; interpersonal trust, respect, cohesion, emotional resilience and engagement of team members will grow; and outcomes—individual, team, patient and organizational—will improve.