The Psychologically Safe Healthcare Team

Have you ever led a collaborative team meeting, only to be met with a deafening silence? Or have you noticed that the employees in your healthcare organization tend to keep their opinions to themselves, even when asked to share what they are thinking? Unfortunately, many healthcare administrators, leaders, and managers will struggle to get the best from teams if their work culture lacks a firm foundation for the safe exchange of ideas. Far too many workplaces, including healthcare organizations, have developed cultures where it is safer and smarter to keep one’s mouth shut.

The American Psychological Association(1) says that psychological safety has become a “catchphrase” to describe a shared expectation among team members that they can express ideas, take interpersonal risks, and solicit feedback without fear of embarrassment, humiliation, rejection, or punishment. Those unfamiliar with the term may think that psychological safety simply is protecting workers’ mental health or protecting workers from psychological harm to ensure a psychologically healthy workplace, just as physical safety means protecting workers’ bodily health. However, there’s more to it than that. The American Psychological Association says, “Psychological safety is one component of a psychologically healthy workplace.” It relies on far more than preventing psychological abuse or trauma.

Psychological safety describes a work environment where people believe that candor is not only possible but expected — the shared belief that team work spaces are safe for interpersonal risk taking. It is a kind of safety that can’t be handed down from on high or established in a moment. Rather, it must be developed over time and grow organically because it relies upon trust. Psychological safety exists when members of a team feel free to be themselves. It is their shared belief that they can take appropriate risks in their work relationships. Specifically, psychological safety occurs when team members can admit and discuss their mistakes, openly address problems and tough issues, seek help and feedback, trust that no one on the team is out to get them, and feel that they are a valued member of the team who matters.

Amy C. Edmondson and Derrick P. Bransby(2) report that there has been a dramatic growth in psychological safety research in recent years. In fact, they say, “Since its renaissance in the 1990s, psychological safety research has flourished — a boom motivated by recognition of the challenge of navigating uncertainty and change.” Today, awareness of psychological safety, and conceptual and empirical research on the topic, are “timely, relevant, and extensive,” the researchers say.

Psychological Safety at Work: A Brief History

The concept of psychological safety in the workplace was developed in the 20th century and traces back to early studies of organizational change. In 1965, Edgar Schein and Warren Bennis(3) noted that psychological safety was essential for making people feel secure and capable of changing. Nearly 30 years later, in 1993, Schein(4) discussed psychological safety as a means to help people overcome defensiveness at work by focusing on achieving shared goals and solving problems without excessive self-protection.

Notably, it was William Kahn(5) who brought psychological safety into the modern era in 1990 with a groundbreaking qualitative study of a summer camp and an architecture firm, in each venue connecting psychological safety to engagement. Kahn argued that psychological safety helped people “employ or express themselves physically, cognitively, and emotionally during role performances,” rather than disengage, or “withdraw and defend their personal selves” The participants in Kahn’s study expected to be given the benefit of the doubt (a defining characteristic of psychological safety in groups) and to enjoy the trust and respect of their coworkers and managers. Later research showed a positive correlation between team psychological safety, team learning, and team performance. In 2023, Edmondson and Bransby wrote, “Psychological safety is the subject of inquiry across many scholarly disciplines,” and it has received increasing attention from scholars, particularly over the last decade.

Today, both researchers and managers believe that psychological safety plays a significant role in enabling team performance. Psychological safety creates conditions favorable for speaking up, sharing ideas, and asking questions, and in so doing, helps individual employees and teams get things done. Edmondson and Bransby say, “Psychological safety has emerged as a factor that matters because of its role in facilitating communication and coordination.” Across studies, scholars have found time and again that there is significant empirical evidence linking psychological safety with better performance outcomes at individual, group, and organization levels. Edmondson and Bransby conclude, “At all levels, psychological safety emerged as a vital ingredient for overcoming obstacles to teamwork and unleashing potential in individuals and organizations.”

Psychological Safety and Retention

Most of us, at some point in our careers, have worked for a manager who pushed us toward quitting, or, at least, entertaining the idea. Rakshitha Arni Ravishankar(6) says that today, “People are 10 times more likely to quit their jobs because of toxic work cultures — rather than compensation or work-life balance — and three in four people say that their boss is the most stressful part of their jobs.” Keep in mind, however, that organizational cultures don’t typically start out toxic. John Baird and Edward Sullivan(7) write that toxicity breeds when managers stop having quality conversations with their team members. Research bears this out. A number of studies show that managers play a critical role in employee motivation, satisfaction, and retention. For example, Ravishankar says, “A recent study on ‘quiet quitting’ revealed that managers become more effective leaders when they balance driving results with the needs of different team members.” Today, we believe that it is not enough for our leaders to drive strong employee performance. They need to take care of their team’s well-being, too. Ravishankar says, “When leaders make their teams feel seen, heard, appreciated, and supported, team members feel psychologically safe and are likely to deliver better results.” They also are less likely to quit and take a job with another employer.

Psychological Safety and Team Performance

There is a great deal that goes into the creation, care, and feeding of an excellent team. However, psychological safety is arguably one of the most important factors. In fact, some say it is the most important one. Among these is Amy C. Edmondson,(8) who says, “Google did a massive four-year study to find out what differentiated what separated great teams from not-so-great teams. And — bottom line — they found that the biggest differentiator, by far, of excellent teams at Google and not-so-good teams, was psychological safety.”

At work, employees can often fall into instinctual patterns of thinking and behaving that are counterintuitive to productivity, creativity, and innovation. These include behaviors such as avoiding risk, fearing failure, hiding problems, agreeing with the status quo, not asking for help, diverting blame, and becoming complacent. Conversely, when employees feel psychologically safe to take risks, they are more likely to contribute helpful ideas and take positive action. Edmondson(8) says, “The ability for people to come to work and speak up about what they know, what they don’t know, what they see, what they’re worried about is absolutely mission critical to success….”

M. Lance Frazier, Stav Fainshmidt, Ryan L. Klinger, Amir Pezeshkan, and Veselina Vracheva(9) link psychological safety to increases in a number of highly desirable employee behaviors. These include:

• Better communication;

• More knowledge sharing;

• More initiative to develop new ideas, products, and services;

• Improved organizational processes;

• Better employee engagement, job satisfaction, vitality, and confidence;

• Increased commitment to the organization;

• More promotive voice behaviors (such as championing the organization and generating ideas for improvement);

• More prohibitive voice behaviors (such as calling out harmful policies, processes, and practices);

• Higher levels of trust;

• More high-quality relationships and increased social capital;

• Improved organizational learning (including better critical thinking and problem solving); and

• Improved team and organizational performance (including quality internal auditing).

Edmondson and Bransby suggest that additional benefits of psychological safety at work include increased creativity and innovation, an improved work experience, feeling more like oneself at work, better skills for coping and managing stress, the ability to create an inclusive climate, and enhanced enterprise performance (such as a more entrepreneurial orientation and better financial performance).

The levels of psychological safety in your workplace represent your healthcare organization’s climate and culture. Healthcare administrators, leaders, and managers are especially important in shaping organizational culture both on their teams and in their larger organizations. Changing a culture is never fast or easy. However, transforming your healthcare organization to build psychological safety for everyone is definitely worthwhile. As you can see, psychological safety plays a significant role in enabling, motivating, and enhancing employee performance. It helps both individuals and teams to get things done by creating conditions favorable to speaking up, sharing ideas, and asking questions. Edmondson and Bransby say, “At all levels, psychological safety emerged as a vital ingredient for overcoming obstacles to teamwork and unleashing potential in individuals and organizations.”

The Four Stages of Psychological Safety

How can a leader develop a psychologically safe team? The best way to begin is to embrace the notion that psychological safety is a journey. According to LeaderFactor,(10) psychological safety is “a progression through four distinct stages that enable individuals to feel safe, valued, and empowered.” Understanding these stages and their unique characteristics is essential for creating psychological safety and unlocking the full potential of your teams. Keep in mind as you consider this that the stakes are very high, even though teams lacking psychological safety are very common. Edmondson(8) warns, “The data are overwhelming that many people feel they can’t speak up at work…That means that we’re losing enormous value.”

Timothy R. Clark(11) describes a conceptual model of four stages of psychological safety that teams can move through, progressing from Stage 1 to Stage 4:

• Stage 1: Create inclusion safety. Inclusion safety is the foundation of psychological safety within a team or organization. Stage 1 involves offering respect and unconditional positive regard for all individuals. Creating an inclusive environment begins with acknowledging and embracing the uniqueness of each person. It involves recognizing and appreciating the diverse backgrounds, experiences, and perspectives that team members bring to the table. In an inclusive setting, everyone feels valued and included, regardless of their gender, race, ethnicity, age, sexual orientation, or any other characteristic. Building an inclusive culture requires ongoing effort and commitment. Leaders who are more concerned with safe and innovative environments, rather than being right all the time, are well-positioned to build a sense of inclusion for all employees.

• Stage 2: Provide learner safety. Learner safety occurs in an environment where individuals feel safe to explore, ask questions, take risks, and embrace a growth mindset. Learner safety encourages continuous learning and development. It is a culture of curiosity and innovation. A key element of learner safety is the presence of constructive feedback. Individuals are encouraged to provide and receive feedback in a supportive and nonthreatening manner. Constructive feedback helps team members identify areas for improvement, gain new perspectives, and refine their skills. It is given with the intention of helping individuals grow and learn, rather than criticizing or discouraging them. In Stage 2, leaders must build a feedback culture where employees and team members feel free to be vulnerable, try alternative approaches, and make mistakes. To do this, leaders must encourage and reward failure rather than merely accept it.

• Stage 3: Provide contributor safety. When contributor safety is present, team members are encouraged to take ownership of their work and make meaningful contributions. They have the freedom to exercise their expertise, apply their skills, and make decisions that affect the team’s outcomes. Autonomy is essential in allowing individuals to take ownership of their responsibilities and find innovative solutions to challenges. Alongside autonomy, accountability plays a crucial role in contributor safety. Individuals must be held accountable for their actions and the outcomes of their work. This accountability fosters a sense of responsibility and drives individuals to deliver their best work. Stage 3 is about providing opportunities for employees to put what they have learned into practice. It focuses on building relationships with team members. Leaders must get to know their team and their strengths before supporting them to think beyond the limits and restrictions of their role. Kristy Gardiner(12) says, “We are talking about autonomy and big picture thinking here.”

• Stage 4: Foster challenger safety. Challenger safety occurs when individuals feel safe to engage in constructive dissent, challenge the status quo, and drive innovation. In Stage 4, the final stage, team members are encouraged to express their opinions, provide candid feedback, and engage in healthy debates. Challenger safety recognizes the value of diverse perspectives and encourages individuals to question existing practices and assumptions. It creates an environment where innovative ideas can flourish, and teams can push the boundaries of what’s possible. By fostering a culture of trust and psychological safety, organizations empower their members to challenge conventional thinking and seek new solutions. Candor is a cornerstone of challenger safety. Team members are encouraged to communicate openly, honestly, and transparently. They can express their thoughts, concerns, and suggestions without reservation, knowing that their input is valued. This fosters a culture of trust and mutual respect, where everyone’s contributions are considered valuable and relevant. Leaders play a crucial role in fostering challenger safety. According to Edmondson,(8) “It’s always on the leader to go first, to do what he or she can to create psychological safety.” Leaders must set the tone by demonstrating open-mindedness, actively seeking diverse perspectives, and encouraging dissenting opinions. They create an environment where individuals feel safe to challenge assumptions and propose new ideas. They welcome devil’s advocates. Leaders also ensure that constructive feedback is welcomed and used as a catalyst for growth and improvement. They create an environment where it is safe to challenge the status quo.

Creating Psychological Safety: Five Guiding Principles for Leaders

Healthcare administrators, leaders, and managers play a crucial role in the overall psychological safety in their workplaces. They can set an example, protect the baseline for team culture, demonstrate respect in disagreements, use feedback as an improvement tool, and embrace vulnerability and authenticity to create a safe environment for team members. Of course, it will take time and effort for leaders to develop a psychologically safe culture within their teams. It will take even more time and effort to keep established psychological safety going. According to Gardiner, “Leaders have a responsibility to override the inherent interpersonal fear that employees carry with them, particularly fear of failure.”

The following list presents five principles that can guide leaders in their pursuit of creating psychologically safe teams:

• Protect the baseline: A team’s culture settles to the level of the worst behavior a leader is willing to overlook. Sonali D’silva(13) says, “When leaders don’t intervene in a timely way to address damaging and disrespectful behaviors, it’s a signal that bad behaviour is acceptable. This gives rise to more such incidents until a team turns into a contentious and unsafe place to be.” Leaders can interrupt this cycle by effectively and courageously managing poor behavior. They must highlight preferred behaviors and discourage those behaviors that diminish respect and safety at work. This includes not blaming and shaming people for what they did, but coaching and reinforcing workplace expectations. D’silva says that clamping down on unacceptable behaviors “helps teams to preserve interpersonal boundaries that promote mutual safety at work.”

• Care more for people than results: Lack of psychological safety often shows up in workplaces where results are all that matters. D’silva says, “The easiest thing for leaders to do is to fix people and care for results.” Blaming the team breeds distrust, fear, and anxiety about being caught doing the wrong thing. A lack of psychological safety becomes the cultural norm when leaders fall for quick fixes that improve results in the short term. Instead, supporting the team, learning actively, and getting it right the next time encourages confidence. D’silva says, “Teams become emotionally resilient and accountable for mistakes when they know they are all on same side of the table.” Psychological safety ultimately accelerates improvements, reveals hidden risks, and promotes more creative problem solving — more so than quick fixes.

• Demonstrate respect: Work pressures and disagreements raise the possibility of impatience and disrespect. D’silva warns, “Teams keenly watch their leaders when things don’t go to plan.” One of the best ways for leaders to grow respect is to demonstrate it. Leaders can set an example of staying respectful in disagreements by listening actively and not jumping to conclusions. D’silva says, “Most employees don’t demand agreement. Instead, they value being heard, respected, and acknowledged, so they know they can trust their leader’s communication.” Leaders who are able to exercise self-control and who have a high level of emotional intelligence are the ones most likely to create psychological safety for their teams.

• Use feedback as an improvement tool: D’silva describes feedback as “one of the most misunderstood and misused communication tools at work.” Certainly, feedback must not be treated as a way to share one’s displeasure or punish a team. It should not be something to be feared, and it should never be psychologically damaging or toxic. Leaders can instill psychological safety in their teams first by seeking feedback on their leadership. That helps to normalize feedback. D’silva says, “When feedback is used as a tool for development, open communication, and ongoing improvement then teams welcome it, and even ask for it proactively.” Leaders who ask for quality feedback inspire everyone to take interpersonal risks because they will know that they will not be penalized or rejected for doing so. In fact, team members will learn that speaking fairly and candidly can be a strength for the team, and something to aspire to.

• Monitor psychological safety: Leaders need to assess the psychological safety of their teams and gather data about employee perceptions. Gardiner says, “it is important to collect data in order to gauge progress.” The most frequently used measure of psychological safety is Amy C. Edmondson’s(14) psychological safety scale. Edmondson’s scale assesses psychological safety on the group level through employee surveys. Questions are geared toward each individual’s perception about risk-taking within their team. Specifically, leaders ask their team members to complete a survey anonymously to score agreement with statements about their experience at work using a Likert scale of 1 to 5, with 1 being low and 5 being high. (See Edmondson(14 )and the sidebar that accompanies this article for specific questions leaders can ask their employees to assess the level of psychological safety the employees feel within their teams.)

Fifteen Ways to Build and Protect Your Teams’ Psychological Safety

There is much more that leaders can do to create and foster their teams’ psychological safety. Here are 15 specific strategies:

1. Let go of perfectionism. It’s normal for healthcare administrators, leaders, and managers to want to hold everyone to a high standard. That’s part and parcel of your job. However, Ravishankar says, “Focusing too much on being perfect can hurt more than help your team.” Perfectionist leaders tend to react to mistakes immediately. They are more likely to micromanage and to distrust employees who don’t display their perceived standard of excellence. Ravishankar suggests, “To build trust, let go of your perfectionism and let your team learn and grow on their own.”

2. Let your team make mistakes. Leaders may feel pressure to prove themselves, because when their teams make mistakes, it’s likely to reflect poorly on their own performance. However, your leadership and your own performance only can be as good as your team. Sonika Bakshi(15) says, “[As a manager], the best thing you [can] do is to offer an Eden to your team. This will allow your employees to grow and thrive.” The opposite, Bakshi says, is creating “a vicious environment where the fear of making a mistake overtakes the courage to fall and rise again.” Tip: an excellent way to allow and learn from mistakes is to build “lessons learned” debriefing sessions into every project.

3. Avoid blame culture. Effective leaders understand that blaming individuals for a problem is a futile exercise. Instead, your job as a leader is to figure out why the problem occurred and look for ways to minimize or eliminate similar issues in the future. To do that, Michael Timms(16) recommends using a systems approach. That means that instead of asking, “Who’s at fault?” leaders can shift the focus to, “Where did the process break down?” Timms says, “Discussing how to prevent a mistake — rather than shaming colleagues and peers — goes a long way in promoting trust on your team as opposed to fear or contempt.”

4. Recognize and celebrate people. As humans, we feel an innate need to belong and be valued. That’s the key to leading more engaged and productive teams, Ravishankar says, “Learning to acknowledge every individual employee’s needs is a critical skill for managers to master.”

5. Increase clarity. One tough challenge teams face is how to manage interpersonal threats that naturally arise within the workplace, often as a result of uncertainty. Gardiner says, “These threats tend to be subtle, yet they can pack a punch.” Leaders can make sure there is shared understanding of the task at hand by providing clarity around the novelty, risk of failure, and complexity of the task. Gardiner says, “In doing so, leaders can actively reduce uncertainty, which is the enemy of psychological safety.”

6. Advocate for diversity, equity, and inclusion. A diverse, equitable, and inclusive team is one where there is a shared sense of belonging. That is extremely powerful, because employees who feel that they belong will feel seen and valued for their differences, rather than feeling that they must assimilate into one dominant way of thinking, communicating, or behaving. Friederike Fabritius(17) suggests that managers can lead diverse individuals more effectively by creating a workplace that recognizes and honors different ways of thinking, learning, and communication. Specifically, Fabritius suggests that leaders play matchmaker (pairing employees who can complement one another), go video-optional (in online work environments), and embrace different communication styles.

7. Check your biases. Each of us is conditioned into certain beliefs and assumptions that may be harmful, and, sometimes, discriminatory. But we can and must recognize and overcome these biases. Carmen Action(18) suggests that you ask yourself questions such as: What core beliefs do I hold? How do I react to people of different backgrounds? Do I acknowledge and leverage differences on my team? Do my words and actions reflect my intentions? How would my team describe my leadership style to others?

8. Increase your cultural competence. Cultural competence is the ability to understand, appreciate, and interact with people from cultures or belief systems different from one’s own. Jeff Meade(19) says, “When a leader demonstrates cultural competence, they show respect for cultural differences and recognize how those differences drive engagement, productivity, and innovation on their team and throughout their organization.” Ultimately, a leader with a high level of cultural competence will be in the best position to create a psychological safe team.

9. Encourage vulnerability. Leaders who are open about their struggles or speak up about what they believe in will encourage others to follow suit. For example, you may be able to demonstrate your vulnerability if you openly advocate for equal pay for your team members, interrupt groupthink by encouraging new and different views, address traumatic news, or share your own experiences. Janice Omadeke(20) says, “When you extend them that grace, you’re letting your team know that it’s okay to take risks and speak up, as long as they grant one another that same respect.”

10. Respond appreciatively. It can take courage for employees to tell their bosses when there is a problem. It’s up to you to make them feel as comfortable as possible when they do. Be grateful when employees give you feedback about your leadership, or about ways that you can make your team more psychologically safe. Thank them for coming forward when it is appropriate for you to do so.

11. Demonstrate empathy. Psychological safety is at stake when a team member chooses to confide in you. It is fostered when you hold the confidence and understand that the employee’s decision to confide in you is not an invitation to interrogate or intrude. Rather, it is a moment for you to empathize and demonstrate solidarity and allyship. Ravishankar says, “One effective way to do this is to use inclusive language. Be kind, help them open up, and offer the support you can.”

12. Assess the superstars on your teams. The attitudes and habits of your highest performers can be an excellent barometer of overall team psychological safety. Robert Sutton and Huggy Rao(21) ask, “Are they the people who stifle, frighten, and blame their colleagues? Or do they promote learning and drive out fear by talking openly about their own mistakes and gently but candidly pointing out others’ failures and mistakes, and talking about what we can all learn together from such troubles?” A psychologically safe team is one where its superstars talk about their own mistakes and shortcomings, not only what everyone else did wrong. Tip: If you suspect a problem with your superstars, fixing that is an excellent place to start improving the psychological safety of your team. The key is to demonstrate to your superstars that what they achieve is important, but that, so too, is how they achieve it.

13. Invite engagement. Leaders can build a culture of innovation by asking exploratory, open-ended questions to deepen discussion and engagement. Gardiner says, “When leaders ask good questions on what matters, it can invite considered response.” However, leaders must be open to hearing new perspectives. Therefore, Gardiner says, “Leaders must be adept in communication and active listening.”

14. Celebrate wins. Do you notice and acknowledge what’s going well? Or do you focus most or all of your gaze on problems? Positive interactions and conversations between individuals are built on trust and mutual respect. They provide a firm foundation for building team psychological safety. The Center for Creative Leadership(22) says, “Share credit and embrace expertise among many, and the success of the collective, versus a single ‘hero’ mentality.” Celebrate what’s going well within your team, however small, and appreciate people’s efforts. Encouraging and expressing gratitude reinforces your team members’ sense of self. The Center for Creative Leadership says, “Give your team members the benefit of the doubt when they take a risk, ask for help, or admit a mistake. In turn, trust that they will do the same for you.”

15. Encourage more employee participation. Jacqueline Brassey, Aaron DeSmet, and Michiel Kruyt(23) suggest that a few changes in the way leaders communicate with their employees can “encourage all voices.” For example, they suggest that leaders reframe mistakes as “steps in a longer journey, as valuable feedback and data we can work with, and as an opportunity to learn.” They urge leaders not to use discrediting language such as “Yes, but” and “There is a lot of context that you don’t know.” They suggest encouraging participation in a nonthreatening way with questions such as, “What could be a viewpoint we are missing?” and “Are there any blind spots we missed?” Brassey et al., also suggest that leaders fill long silences with questions instead of comments and that they acknowledge the points that others make during a meeting (e.g., “To build on Victoria’s point…”). These and other encouraging ways of communicating ultimately will help employees feel more psychologically safe to speak up and take risks at work.

Myths and Misconceptions about Psychological Safety

Some leaders believe, mistakenly, that psychologically safe teams must have no challenges. However, psychologically safe teams have their fair share of challenges, just as every team does. They may face fewer challenges than others because they head off problems effectively and don’t create a climate of high drama. But, they do face challenges nonetheless, and when they do, they typically handle them better than other teams. They also tend to be more productive and perform at a higher level overall.

Daniela D. Franco(24) urges leaders to differentiate psychological safety myths from reality. Otherwise, they will not be able to foster a supportive team culture that is psychologically safe. Ultimately, this can hinder progress. Franco describes four common myths about psychological safety:

• Myth #1: Psychological safety = no conflict. A psychologically safe team isn’t devoid of conflict. In fact, it may welcome conflicting opinions. Psychological safety ensures that disagreements are handled constructively. Franco says, “Healthy conflict resolution allows diverse perspectives to surface and fosters innovation.” The key lies in promoting respectful dialogue in a culture where team members feel safe to challenge ideas without fear of retaliation.

• Myth #2: Everyone needs to agree on everything. Psychological safety does not mean uniform agreement. Instead, Franco says, “It’s about creating a supportive culture where differing opinions are welcomed and valued.” Encouraging open discussion and diverse viewpoints strengthens decision-making and enhances team dynamics within the psychologically safe team.

• Myth #3: Psychological safety is just about being nice. Although kindness or niceness is important, psychological safety involves more than being nice. Franco says, “It’s about implementing leadership strategies that empower employees to voice concerns, share ideas, and take risks without fear, even when the conversation is challenging.”

• Myth #4:Psychological safety and accountability can’t coexist. Psychological safety is not about avoiding accountability. In fact, safety flourishes in environments where clear expectations are established and team members feel responsible for their roles. Franco says, “Balancing accountability with mental health support is a hallmark of effective leadership” for psychological safe teams.

Another popular misconception about psychological safety is that it is the same as psychological comfort. However, there is an important difference. Shane Snow(25) says, “The job of a leader is not to protect their team from discomfort. It’s to protect them from harm — and to help motivate them to push through the discomfort and harness it for growth.” Snow likens the work of leaders to that of personal trainers. If you stay completely comfortable at the gym, Snow says, your muscles will never grow. A great leader’s job is to help people combine their different knowledge, skills, and abilities and push further than they could go on their own. That is inherently uncomfortable. Snow explains, “A good fitness trainer will help you to safely exercise and grow your muscles. And you will be uncomfortable. But you will be safe.” Effective leaders, likewise, will work through their teams’ discomfort with them while protecting them from harm and reassuring them that they are and will continue to be safe.

Nine Exercises to Promote Psychological Safety within Your Team

Effective communication is at the core of creating and building psychological safety in the workplace. And, at the core of effective communication is courageous conversations — those conversations that stir emotions that are about topics that are difficult to broach. Courageous conversations can be difficult for some or all of the people involved. Leaders who seek to handle courageous conversations effectively with their teams will need to tread carefully and mindfully. Also, they will need to observe objectively how the conversation develops and change their communication tactics when needed.

Leaders can use the nine exercises that follow to have courageous conversations with their teams, and, ultimately, promote psychological safety. Gustavo Razzetti,(26) who suggests these exercises, says that most resources about psychological safety “are vague and fail to provide concrete methods and tools to put into practice right away.” That’s what motivated Razzetti to suggest these nine actionable exercises:

1. Check-in round: A facilitator invites each member to share, one at a time, what mindset they’re bringing to the table before the work conversation starts. Checking in is about addressing the status of the mind, not that of a project. Razzetti says, “This practice allows people to be fully present and feel listened to. It reinforces collective trust, gives everyone a voice, and reminds us that we’re human.” Examples of questions you can ask at a check-in are: What has got your attention? What mindset are you bringing to this meeting? What kind of day have you had so far?

2. Conversational turn-taking: In most organizations, 80% of the conversations are dominated by only 20% of the participants. Razzetti says, “Psychological safety is not just about helping people feel safe but encouraging participation — all voices must be heard.” To ensure turn-taking, ask participants to speak one at a time, taking turns, and do not allow interruptions and groupthink. Razzetti suggests, “Senior executives get to talk last, so they don’t influence or intimidate others.”

3. ”No interruptions” rule: Meetings can become painful experiences for a team member who is continually being interrupted. Razzetti says, “The lack of psychological safety makes people feel anxious and choose to stay silent.” The No Interruptions rule is self explanatory; when someone is talking, the rest must actively listen. Sharing an opinion, reacting to what the person is saying, or trying to impose one’s ideas over others is not allowed. Razzetti suggests “Interrupt people when they interrupt others and ask them to stop.” Also, talk to repeat offenders privately to ensure they can adjust their behavior in future meetings.

4. Uncover the stinky fish before it rots: The “stinky fish” is a metaphor for issues that we don’t want to talk about. Razzetti warns, “The longer we avoid a problem, the stinkier it gets.” The stinky fish exercise asks team members to expose what makes them feel anxious and afraid. It helps people address past issues they can’t get over, and, most importantly, talk about what everybody’s thinking but no one is saying. Facilitating this exercise is simple but challenging. Razzetti says, “People feel encouraged to fill the canvas with all the issues that keep them awake at night.” However, sharing those issues in the open requires building a psychologically safe space to address all stinky fishes, not just the easy ones. When facilitating this exercise, Razzetti likes to ask each participant to share one stinky fish. It doesn’t matter if they choose to share an easy topic or a harder issue. Razzetti says, “For me, the most crucial factor is to get people talking; to get the conversation started.”

5. Host an anxiety party: Like the stinky fish exercise above, the anxiety party is another exercise in vulnerability. Razzetti says, “Don’t get caught up with the name.” An anxiety party is a designated, structured time when everyone can be vulnerable and get their anxieties out in the open. First, everyone spends 10 minutes individually writing down their biggest work anxieties. Then, they spend an additional two minutes ranking their anxieties from most to least. Next, each person gets to share the anxiety that worries them the most. Colleagues score the issue based on how much it troubles them from a 0 (“It never even occurred to me that this was an issue”) to 5 (“I strongly believe you need to improve in this area”). Often, it turns out that most anxieties are baseless. Razzetti says, “We usually worry about pointless things.” Getting people’s feedback in the form of a score often makes the anxiety go away. However, many anxieties are well founded. Razzetti says, “Start by addressing the issues that get a 4 or a 5. Discuss with the team what needs to happen and whether it requires an individual or collective behavioral change.”

6. 1-2-4-all: People often feel more comfortable talking to strangers or to one person than to a larger group. Razzetti says, “Brainstorming sessions or large meetings can be intimidating for most; people don’t feel psychologically safe to speak up and share their ideas in the open.” The 1-2-4-all exercise is ideal for encouraging participation in problem-solving or feedback sessions. It helps with open and candid conversation by making participants feel safe to share gradually. How it works: Ask participants to start working on their own. Then, pair two together and give each duo two minutes to share individual ideas. Then, give them an additional 2 or 3 minutes to discuss and find surprises, contradictions, and commonalities. Encourage them to use this time to build on each other’s ideas. Next, pair up duos to create foursomes. Give each foursome four minutes to share and continue building on each other’s ideas. Afterwards, ask each team to share its critical thoughts with the entire group, which then are consolidated. Depending on their nature, participants can rank the most pressing issues or vote on the best ideas (if it’s a brainstorming session). Razzetti adds, “When working with large groups, I like to add an additional round. I practice 1-2-4-8-All.”

7. Address silent problems: We can solve only the problems that we know about and are willing to talk about. Razzetti says, “Denial is a cultural thing. When leaders avoid conflict, their team will adopt the same pattern. Silencing issues quickly becomes an unwritten company rule.” Hold a meeting and invite your team to address silent problems. First, name the problem. Naming the problem turns it from silent to real. Next, share accountability. Address the root cause of that problem. Don’t look for a single person who’s causing it or should fix it. Turn the issue into a collective matter. Razzetti suggests you ask: What are the things that we are doing to perpetuate this problem? What are the things that we are not doing to perpetuate this problem? What shall we start and stop doing to solve this issue? Destigmatize the problem and have someone play devil’s advocate. Razzetti says, “It’s vital to have a team member who always challenges our perspective … Positive friction creates energy that propels teams into the future.”

8. Celebrate the messenger: Razzetti says, “Organizations need to increase their bad news tolerance. Divergent, dissident voices are crucial to driving innovation and growth.” How do you celebrate the messenger? Reward people who bear bad news or who raise problems that need to be addressed right away. Razzetti says, “Celebrate the messenger instead of demonizing those who bring issues forward.”

9. Share personal stories: Stories are the perfect way to increase a sense of belonging and start building psychological safety among teams. Razzetti says, “The purpose of this exercise is to get to know your colleagues at a deeper level, understand their feelings and emotions, and share the stories that shaped their lives.” A great exercise is to ask participants to share personal stories with one another in pairs. Give each person five minutes to speak, then switch and give the second person five minutes more. Once all the pairs have finished, ask each person to tell the story they heard from the other person as if it was theirs. Razzetti says, “Not only does this reinforce belonging, but it deepens empathy, too.” It also helps participants practice their active listening skills. Another more straightforward way to do this exercise is to ask participants to “share a meaningful story; something that happened to you that you feel proud about, but very few people know,” Razzetti suggests. The key lies to this exercise in the words “feel proud” and “very few know,” which will help trigger profound and revealing stories.

Sidebar: How to Assess Your Team’s Psychological Safety: 20 Questions

A survey answered anonymously can help you assess the psychological safety of your team. Unfortunately, if your survey data show a drastically low level of safety within your team, it is unlikely that you will glean the qualitative insights you’re seeking from your employees, precisely because of the lack of psychological safety they feel. In those instances, and beyond numeric data gathered through a survey, Gardiner says, “It is important that leaders talk to their team members to understand how they feel about their working environment.” Employees who feel psychologically unsafe may be able to open up to you about the specifics more easily in a one-on-one confidential conversation, rather than through a survey instrument. Employees who feel psychologically unsafe will need extra care and attention from you before they will be willing to open up.

Here are 20 questions you can ask your employees through a survey or in conversation to gauge how psychologically safe they feel at work:

1. Do you have a job description? Is it clear to you?

2. Do you know and understand what is expected of you?

3. Do you have reasonable autonomy to achieve what’s expected of you?

4. Are disagreements within your team resolved? How are they resolved? How quickly are they resolved?

5. Do you feel included by your teammates while at work? What about outside of work? Can you think of anyone on your team who may not feel included?

6. Do you feel safe making suggestions at work? Do you feel that your suggestions are wanted? Are your ideas valued?

7. What happens when something goes wrong at work? Do you work with your teammates to find systemic causes when something goes wrong? What has your team learned by making mistakes?

8. Do you feel that you are able to bring up problems and concerns to your coworkers? To your manager? To me?

9. Do you feel that it is safe for you to take smart risks at work?

10. How comfortable is it for you to ask other members of your team for help?

11. How likely are your team members to help you when you ask them to?

12. Does anyone in our organization undermine your efforts, consciously or unconsciously?

13. Do you get to use your talents and skills at work? Are your talents and skills valued here?

14. Do you feel that our organization values you?

15. Have you ever felt punished for making a mistake?

16. What do we need to do differently to achieve that reputation and fulfill our purpose?

17. Do you feel informed about work-related issues within your team? Can you identify a time when you felt left out of the loop?

18. Does anyone at work hold a grudge against you?

19. Do you feel encouraged to think outside the box? To try new approaches?

20. How much feedback do you receive at work? How do you feel about that feedback? Does it help you improve your performance? What kind of feedback would help you even more?

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