Psychological Safety – why all the fuss?

I recently read a provocative tweet commenting on Google’s Aristotle Project   – an exhaustive study over 2 years documenting the themes among their highest performing teams. A number of attributes were identified, and number 1 – the most significant predictor of whether a team was successful – was Psychological Safety. The recent tweet cited this research and read as follows;

And after 2 years of research, Google have concluded that the secret to high performing teams is……being nice to each other!

Quite apart from the sarcastic tone (does sarcasm ever contribute to constructive debate?) does this tweet misunderstand what Psychological Safety is all about?

Is Psychological Safety about making sure everyone is always happy with every decision, with making sure people always get what they want? Is it about treading on eggshells and stifling any potential conflict through compliance?

Certainly not in the eyes of Professor Amy Edmondson, the Harvard Psychologist who is now among the most commonly cited researchers in this area and a globally recognised expert. Professor Edmondson describes Psychological Safety as:

So really, we could say that the essence of Psychological Safety is creating an underlying attitude of mutual respect for one another, regardless of position in the organisation.

So why does this matter in healthcare?

Put simply, levels of openness and Psychological Safety have been shown to be directly correlated to mortality and quality of patient care. According to a study conducted among 137 acute trusts in England by Veronica Toffolutti (Bocconi University and London School of Hygiene & Tropical Medicine) and David Stuckler (Bocconi University) found that:

This is on top of numerous previous studies showing links between other positive outputs, such as better patient safety or better understanding of patients’ care goals.

So what can we do to create and sustain Psychological Safety?

Clearly this multifaceted and complex, but there are a few basic principles that we believe are vital as a minimum:

What you tolerate is what you promote

Ask yourself the question – do you ever walk past a behaviour that you know is destructive without doing or saying anything?

Realistically we can’t remove decision-making hierarchy

But we can remove a hierarchical approach to how we communicate. Think about the language and tone we use when communicating with those who have less experience or perhaps are less familiar to us.

How do you react when someone asks a question or disagrees with you and they are wrong?

It’s easy to be gracious when someone is clearly correct and have prevented an issue, but how we react to divergent thinking is equally important if they are wrong. Ask yourself the question – does my reaction make it more or less likely for someone to do it again next time? Because you can guarantee that at some point they have vital information that someone else has missed.

As with most concepts that make a difference to performance – they are relatively simple in theory, but hard to apply consistently in practice. Developing a really clear understanding of how we process the world around us is always a useful starting point as it results in far greater situational humility.

In the long term, individuals, teams and leaders need sufficient self-awareness to be able to notice the impact of our behaviour on the underlying Psychological Safety in our working environment, and the social skills to be able to adapt accordingly as the demands on us change over time.