Video Transcript: Three Ways to Create Psychological Safety in Health Care

​Amy Edmondson, Novartis Professor of Leadership and Management, Harvard Business School

Let me tell you three things that need to be done that make an enormous difference in creating psychological safety in the workplace.

The first one is framing the work. By that I mean two things. Adding meaning to the work; why is the work we do so profoundly important. People’s lives depend on it, for example. Now you might think that’s obvious and doesn’t need to be said. I would argue it does need to be said because when people in positions of leadership, as I said all the way up and down the organization, remind us of what’s at stake and why it’s important it brings us back to why we’re here, why we’re doing this. It brings us in a sense away from that need to manage other’s impressions of us and back to the actual work that we do. But that’s only the first part of framing the work.

The second part is reminding people that the work we do is uncertain and is interdependent and has a lot of potential for error, potential for things to go wrong. If I remind you of the nature of the work we do it makes it quite clear how important it is that we’re open, that we bring our full selves to work. In other words, if I remind you the nature of the work, the riskiness of the work that we do, it just creates a kind of invitation for you to take it seriously and bring your full self to work.

The second thing that leaders absolutely have to do is what I call “model fallibility,” and invite input. These are behaviors; these are really important leadership behaviors, that help other people experience a sense of psychological safety. By modeling fallibility, I mean very simple things. If you are the medical director, for example, of an intensive care unit modeling fallibility might involve behaviors like saying, “Hey, I may miss something. I need your help.” Now, think about what a simple statement that is. It’s a simple statement of fact.  I may miss something; after all I don’t have eyes on the back of my head. I need your help.

So I’m modeling fallibility. I’m letting you know that I know that I am a fallible human being, as we all are; ergo your input is crucial. So I’m modeling fallibility. The second thing I’m doing is I’m actively inviting input. What does that mean? Very simple; it means I’m asking questions.  I’m saying, and often it’s helpful to say directly your name, the other person’s name, and say, “What you think? I’d love your input on this. What did you see? You were on the overnight shift, what did you notice? How were the patients doing?” If I ask you a direct question I lower the very real psychological costs of you having to speak up, or having to speak up in a situation of hierarchy. So by modeling fallibility, very simple, very straightforward way, by inviting input through asking genuine questions, I do an enormous amount wherever I am in the organization in creating psychological safety for others.

The third thing that leaders must do to create psychological safety is what I call “embrace messengers.” When people speak up, when people offer ideas, or point to a process failure, thank them. When people are willing and able to come to you and to offer their ideas, their concerns, it is absolutely crucial to thank them, to acknowledge and make it a positive experience rather than a negative experience. You’ve got to close that loop, otherwise people will initially take the invitation seriously that you are serious, that you want people to bring their full selves to work, but if there’s never anything in it for them that behavior will die out over time.