Psychological Safety and its Essential Link to Continuous Improvement

Perfect safety for everyone in healthcare – patients, staff, visitors, and contractors – is a fundamental right.

Leaders we have worked with know that safety is the unarguable, aligning principle that all healthcare leaders should rely on to drive and sustain continuous improvement. Research and experience make clear that perfect safety requires a high level of psychological safety.

Simply put, we cannot get to zero harm without psychological safety.


Two Types of Safety

Value Capture identifies and defines two broad categories of safety – physical and psychological.

Physical safety is the absence of physical harm (injury), danger or risk that can be experienced by any person.

Zero physical harm would mean not only that no one is injured, but that dangers and risks of physical harm are also at zero.

What is Psychological Safety?

Psychological safety is “the belief that the environment is safe for interpersonal risk-taking by any person.  Each person feels that candor is encouraged and expected. This is the condition in which you feel included, safe to learn, safe to contribute, safe to call out problems, safe to make mistakes and safe to challenge the status quo – all without fear of being embarrassed, shamed, blamed, marginalized or punished in some way.”

Psychological safety is the condition in which you feel included, safe to learn, safe to contribute, safe to call out problems, safe to make mistakes and safe to challenge the status quo – all without fear of being embarrassed, shamed, blamed, marginalized or punished in some way.

Achieving a state of continuous improvement is impossible without psychological safety. It is also not possible to achieve physical safety without psychological safety.

Why Is This True?

When employees (at any level of the organization) are not psychologically safe, they do not speak up, raise questions, point out issues, share ideas, or seek the help they need to do their work properly and safely. And without such conversations, progress (if any) slows to a crawl and continuous improvement – yet alone innovation – withers.

Have You Worked Here?

Think back in your career, to a job you had where any of the following occurred:

  • Your manager ignored or even belittled you for suggesting an idea or pointing out a problem; 
  • A co-worker warned you against calling out safety, process or other problems; 
  • No one in a meeting spoke up when asked if there were any questions; 
  • You and/or co-workers were blamed or disciplined for mistakes. 

Sadly, we’ve all probably worked somewhere like this. The result is a toxic and suffocating culture. Improvements, if any, are top-down, often siloed, and marginal, if not counter-productive.

This type of all-too-common culture is why continuous improvement, performance excellence, and perfect safety /zero harm are impossible to achieve and sustain without psychological safety

Insights from Prof. Amy Edmondson

We look to Professor Amy Edmondson, of Harvard Business School, for a lot of great information and inspiration on psychological safety. She defines it as:

“Psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.”

You can watch her fantastic TedX talk on the subject:


And here is an interview our own Mark Graban conducted with Edmondson:


Edmondson’s research looked at companies (like Google) as well as healthcare organizations. Her research question was: Do better hospital teams make fewer mistakes, such as medication errors?

She was surprised to learn that it appeared that better-performing teams were making MORE mistakes, not fewer. Why? The better teams aren’t making more mistakes, they were more willing to discuss them in a climate of openness that allows them to report and better understand these incidents.

Her research showed that, at Google, the primary distinguishing characteristic was that the highest performing teams had the highest degree of psychological safety. And, we would expect that to be true in healthcare.

How Do Leaders Build Psychological Safety?

Professor Edmondson offers three concrete actions that we agree with, coach to and recommend:

  • Frame all of our work as a learning problem. There’s always uncertainty ahead, therefore, we need everybody’s brains involved.
  • Acknowledge your own fallibility as a leader, and model that for others.
  • Model curiosity — ask a lot of questions (which creates a necessity for people to speak up)

Another Definition (Timothy R. Clark)

Timothy R. Clark is another expert on psychological safety. He defines it as:

“Psychological safety is a condition in which human beings feel (1) included, (2) safe to learn, (3) safe to contribute, and (4) safe to challenge the status quo – all without fear of being embarrassed, marginalized, or punished in some way.”

Clark defines the four stages as:

  1. Inclusion Safety (everyone is accepted)
  2. Learner Safety (being safe to ask questions, for example)
  3. Contributor Safety (“empower them with autonomy, guidance, and encouragement”)
  4. Challenger Safety (safe to challenge the status quo)

Here is a short video of Clark speaking about these concepts and his book:

What are the Benefits of Psychological Safety?

  1. Increased learning for individuals, teams, leaders, and organizations
  2. Better risk management and better outcomes for patients and safety for workers and visitors
  3. More improvement, more rapid improvement, and innovation
  4. Higher job satisfaction and meaning

How Value Capture Helps Leaders Build Psychological Safety

To create and nurture a psychologically safe workplace, leaders need to say and do a number of things, consistently over time. Value Capture serves as advisors and coaches to leaders who are working to build psychological safety in their organizations as the key to unlocking habitual excellence.

One concrete way we help is coaching leaders, at all levels, as they are facilitating problem solving in their workplace. 

When a problem is found, leaders respond immediately — by thanking the person who identified the problem, ensuring that all understand the goal is never to blame people, but to find where the system failed and fix it for everyone.

When a problem is found, leaders respond immediately — by thanking the person who identified the problem, ensuring that all understand the goal is never to blame people, but to find where the system failed and fix it for everyone.

Trust is Built Over Time

Establishing safety is more than a one-time task. Building trust happens over time. Value Capture partners with you over a long-term basis, helping leaders build habits so that these practices become the norm and are embedded in the culture.

Value Capture Coaches Leaders

Value Capture helps leaders create an environment where it’s safe to identify any problems that colleagues see, even if others don’t see them as problems, and even if they aren’t sure how to articulate the problem or a countermeasure. Value Capture coaches leaders as they work through all of the steps of effective root-cause, real-time problem solving — with psychological safety being a precondition for this work.

Talk with Us

If you’d like to learn more about creating psychological safety in your organization and how Value Capture can help, please contact Helen Zak, hzak@valuecapturellc.com or call her at 617-935-1636, or complete our Contact Form.

Additional Resources

Free eBook: Habitual Excellence Starts with Safety — Before, During, and After a CrisisRead Now!
+