The Power of Psychological Safety in Health Care Teams

The Office of Academic & Professional Development’s (OAPD) Healthcare Leadership Program (HLP) launched in 2023 with a cohort of leaders from Yale School of Medicine (YSM) and Yale New Haven Health System (YNHHS. The program is designed to enhance the leadership skills of participants and support them as they guide their teams toward the shared alignment aspiration of becoming a leading academic health system. The HLP curriculum was developed by the OAPD professionalism and leadership team, Daryn David, PhD, Robert Rohrbaugh, MD, Andrea Terrillion, JD, and Karen Wu, JD, to include workshops from Yale and national experts on leadership development, conversations with alignment leadership, self-assessments in leadership styles, and individual coaching sessions. Highlights from this year’s cohort included discussions on the importance of emotional intelligence and creating psychological safety in health care settings.

If you are interested in participating in the next HLP cohort, scheduled to begin in fall 2025, please note nominations to the ten-month program are submitted by department chairs and we ask that you contact your chair to be considered.

This year’s HLP cohort explored the importance of psychological safety in health care teams. Taylor Mauriello, PhD, principal consultant with Aristotle Performance, and a national expert on enhancing psychological safety, team learning, and team performance, led the cohort through an all-day session, including:

• Understanding psychological safety and its crucial role in promoting effective teamwork, improved patient outcomes, and resilience in health care
• Identifying barriers that hinder psychological safety in health care settings
• Cultivating leadership practices that foster psychological safety among dynamic health care teams

Psychological safety can be described as the belief that one can speak up about ideas, issues, concerns, or mistakes without fear of punishment, rejection or humiliation (Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383).

In health care settings, psychological safety is especially crucial given the challenging, complex, and demanding high stakes work, where collaboration among teams is critical as the impact of any decision is immediate.

When team members feel safe, there is a greater opportunity to share vital information, collaborate effectively, and address issues before they escalate. Promoting psychological safety in the workplace, leads to better patient outcomes and a stronger workplace environment for the individual, team, and the organization:

• For individuals, feeling safe helps improve personal well-being, reduce work-related stress, and creates a greater sense of belonging.
• For teams, safety results in a greater willingness to discuss errors, share knowledge and information, and give and receive constructive feedback, resulting in enhanced trust among team members.
• For organizations, promoting psychological safety leads to increased patient safety and outcomes, an increase in job satisfaction and performance, and helps contribute to a more positive workplace culture.

Fostering psychological safety starts with creating an open and inclusive workplace culture, with leadership and team members playing a role in helping to overcome common barriers to feeling safe. Common barriers include a culture of blame, lack of trust among teams, fear of retaliation, power imbalances and team dynamics, or unclear communications, ultimately effecting the entire team’s performance and outcomes:

• For individuals, barriers may include negative prior experiences, low self-efficacy, or a high workload.
• For teams, barriers can include unclear or unrealistic expectations, unprofessional behavior, competition, or a lack of acknowledgement and appreciations.
• For organizations, barriers contribute to a workplace culture where hierarchical norms or a culture of blame are enforced, or there is no system in place to allow teams to raise concerns in private.

Building psychological safety in a health care setting requires inclusiveness among teams, strong relationships between colleagues, and supportive organizational practices and norms.

Improving psychological safety begins with team leaders creating an open and inclusive work culture, prioritizing clear communications, and actively encouraging team members to share their thoughts without fear of retaliation. Below are five tips for leaders and their teams to ensuring a culture of safety prevails:

1. Create shared meaning and expectations with a clearly defined purpose and roles for each team member. This can be achieved through regular check-in meetings, encouraging different perspectives, and providing constructive feedback.
2. Ask more than you tell where teammates know their voice is welcome and expected. This can also be achieved through a commitment to continuous improvement between leaders and their teams.
3. Admit fallibility and show your colleagues that you are receptive to hearing the truth, accepting their feedback with humility versus creating a culture of blame. It can be helpful for leaders to acknowledge the courage it takes to speak up and share how feedback can result in learning opportunities for everyone.
4. Thank the messenger and reinforce a culture that encourages team members to speak-up when an issue occurs. Expressing appreciation when information is shared strengthens trust among teams.
5. Repair when breakdowns occur and validate the experience of your team member in coming forward and rebuild the relationship, if needed. It is important to acknowledge the impact of their actions, agree on solutions, and find the best way to move forward.