History, Theory and Application
The belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.
When people on a team possess psychological safety, they feel able to ask for help, admit mistakes, raise concerns, suggest ideas, and challenge ways of working and the ideas of others on the team, including the ideas of those in authority. Via this honesty and openness, risks are reduced, new ideas are generated, the team is able to execute on those ideas and everyone feels included. Building psychological safety not only improves organisational outcomes, but it’s the right thing to do.
A lack of Psychological Safety was a Component Cause Of The Chernobyl Disaster
In 1986, the Chernobyl power plant suffered a major disaster that directly killed 31 people and is estimated to have indirectly killed over 4000. Whilst the plant itself possessed an inherently unsafe design, the culture in Russia at the time did not encourage the raising of concerns or speaking up about mistakes. A fear of authority and the need to please political masters resulted in a fear-driven culture. During a simulated power shutdown, operators who were not fully equipped to deal with the situation made a series of protocol mistakes, including shutting off or ignoring safety systems, which resulted in a steam explosion, followed by a nuclear explosion. The cause of the disaster was in large part due to a lack of psychological safety resulting in operators not speaking up about their concerns. Of course, there is no root cause, but we know that the official findings state that the RBMK reactor could *only* have been operated in an environment where there was no safety culture.
How and Why Paul O’Neill Fostered Psychological Safety at Alcoa
When Paul O’Neill took over as CEO at Alcoa, an aluminium manufacturer, in 1987, he shocked board members and shareholders by pivoting the company strategy to safety and process over purely financial targets. Despite Alcoa already having a good safety record, he insisted that accidents were the enemy, and that unlike other manufacturing environments, he declared any level of risk to employees unacceptable. He encouraged everyone in the organisation to raise concerns, ideas, and mistakes with respect to process and safety.
Though it’s unlikely he used the word, what he was creating was an environment of psychological safety, and that psychological safety didn’t just result in fewer accidents, but in higher productivity, better quality, improved innovation and employee satisfaction. As well as fewer people suffering physical injury or death. By the time Paul left Alcoa, he’d improved the market value of Alcoa from $3 billion to over $27 billion.
The History of Psychological Safety
First known to be mentioned by Schein and Bennis in the 1960s, psychological safety was first defined as group phenomenon that reduces interpersonal risk. To quote Schein and Bennis’s paper “PERSONAL AND ORGANIZATIONAL CHANGE THROUGH GROUP METHODS : THE LABORATORY APPROACH” in 1965, psychological safety reduces “a person’s anxiety about being basically accepted and worthwhile”.
Deming, in his 14 Points for Management, also raises the point of reducing fear of interpersonal risk taking in point 8: “Drive out fear, so that everyone may work effectively for the company”. This highlights a growing change in sentiment at the time, away from reductionist and Taylorist views of workers towards more a progressive paradigm of empowerment and engagement to improve business outcomes.
Wherever there is fear, there will be wrong figures.
W E Deming, The New Economics.
William Kahn, in 1990, renewed interest in psychological safety with his paper “Psychological Conditions of Personal Engagement and Disengagement at Work” where he described psychological safety as the ability for someone to “employ or express themselves physically, cognitively, and emotionally”. At the same time, progressive management paradigms at the time such as safety culture and the Toyota Production System (TPS) were emerging that introduced concepts such as the the Andon Cord, which empowers employees to raise issues or concerns around safety and process (which is exactly what Paul O’Neill did).
Watch this 25-minute video on the history of psychological safety:
The Definition of Psychological Safety
Subsequently, in 1999, Dr Amy Edmondson was studying clinical teams and the number of mistakes that different teams made. During her research she was surprised to find that the teams with a higher number of good outcomes actually made more mistakes than teams with fewer good outcomes. It was a surprising result, but after further investigation, Dr Edmondson discovered that in fact those teams with better outcomes were admitting more mistakes, whilst the teams with fewer good outcomes were more likely to hide theirs. As a result, Dr Edmondson formulated the concept of psychological safety, namely: the belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.
“a shared belief held by members of a team that the team is safe for interpersonal risk taking.”
Dr Edmondson showed that psychological safety was a key factor in team performance, and continues to lead the field in expounding the importance of psychological safety in all fields of work and life, and literally wrote the book on psychological safety.
Psychological Safety Underpins Team Performance
Think about the best team you’ve been a member of. It could be a sports team, a business team, or some other group of people with a shared goal. Being a member of that team probably felt good, it may have even been energising and inspiring. Whilst the members of that team may well have been experts in their field, it’s likely that being a member of that team felt good because that team felt safe to be themselves. They, and you, likely felt free to admit mistakes, ask for help, and even challenge ideas from other team members without fear of humiliation or embarrassment.
Now think about one of the worst teams you’ve been a member of. Perhaps you felt that you had to put on a metaphorical “mask”, and be a different version of yourself in order to fit in. You may not have been able to admit mistakes, or ask for help, in case members of the team saw it as a weakness and used it against you. Chances are, you didn’t feel very “safe” in this team.
Think of these two teams when thinking about levels of psychological safety. Psychological safety isn’t a binary “on or off” factor, it’s a sliding scale. Teams (and members of those teams) possess it to varying degrees. The best team you’ve been on probably possessed a lot, whilst the worst probably did not possess much at all.
The Difference Between Leadership and Management
It’s important to recognise the difference between these two practices. The indubitable Grace Hopper once stated that “You manage things, you lead people.” What she meant is that management consists of all the processes, tools, and controls that need to exist in order for people to work effectively, whilst leadership is far larger in scope and consists of, for example, setting direction, making strategic decisions, supporting and motivating people, and elevating people in order to reach their highest potential.
In practice, this means that neither management nor leadership can be neglected.
In order for people to perform well and possess psychological safety, they need to operate in environments where safety, costs, tools and processes are managed effectively. A team cannot deliver if they do not know how, or indeed what to deliver. Management is therefore part of leadership, and contributes to the “structure and clarity” that Google’s Project Aristotle led by Julia Rozovsky in 2013 defined as the third most important factor in high performing teams. The Project Aristotle team uncovered four key factors (Dependability, Structure and Clarity, Meaning, and Impact) that are essential to team performance, but it was clear during the research that there remained one or more missing elements. The team discovered Edmondson’s 1999 research and applied the paper’s methodology to measure psychological safety. The results showed that “even the extremely smart, high-powered employees at Google needed a psychologically safe work environment to contribute the talents they had to offer”.
Google’s Project Aristotle was a turning point for psychological safety. It was enough proof for what we all intrinsically know – that feeling safe to be yourself as part of a team, where you’re able to contribute your ideas, admit mistakes, challenge others respectably, and try without fear of failure, is one of the most powerful aspects of human performance.
Psychological safety is the most important factor in high performing teams: high performing teams are happy.
Happiness precedes success.
Similarly, the 2019 and 2021 “State of DevOps” reports consistently show that psychological safety is an essential and foundational factor in software delivery team performance, and also to organisational performance more widely.
Westrum’s Cultural Typologies
Dr. Ron Westrum wrote in 2003 about “The Typologies of Organisational Cultures” that reflect how information flows through an organisation. He wrote: “organisational culture bears a predictive relationship with safety and that particular kinds of organisational culture improve safety…” That is: because the flow of information is influential and indicative of other aspects of culture, it can also be used to predict how organisations or parts of them will behave when problems arise.
Westrum was focussed on real-world physical safety measures in the realm of healthcare and aviation, but in our organisations we should also strive to adopt the same diligent approach to psychological safety for the sake not just of the products we build but for the humans on our teams as well.
See the table below for Westrum’s organisational typology model. Each column describes a broad cultural typology: Pathological, Bureaucratic, or Generative, and six aspects of those cultures. It is clear from the table that the Generative culture that Westrum describes is a broadly psychologically safe culture where team members cooperate, share their fears, admit failure and continually improve.
|Power oriented||Rule oriented||Performance oriented|
|Low cooperation||Modest cooperation||High cooperation|
|Messengers “shot”||Messengers neglected||Messengers trained|
|Responsibilities shirked||Narrow responsibilities||Risks are shared|
|Bridging discouraged||Bridging tolerated||Bridging encouraged|
|Failure leads to scapegoating||Failure leads to justice||Failure leads to inquiry|
|Novelty crushed||Novelty leads to problems||Novelty implemented|
The Westrum organisational typology model: How organizations process information ( Ron Westrum, “A typology of organisation culture),” BMJ Quality & Safety 13, no. 2 (2004), doi:10.1136/qshc.2003.009522.)
The Four Stages of Psychological Safety
Timothy R Clarke in his book “The Four Stages Of Psychological Safety” described a model of four “stages” of psychological safety that teams can move through, progressing from stage 1 to stage 4. These are:
(1) Inclusion Safety – members feel safe to belong to the team
(2) Learner Safety – members are able to learn through asking questions
(3) Contributor Safety – members feel safe to contribute their own ideas
(4) Challenger Safety – members can question others’ ideas or suggest significant changes
Whilst “all models are wrong, and some are useful” applies in this case (people do not move linearly through stages 1-4, nor do the stages exist in discrete reality, The “four stages”can be a useful model to reinforce the point that psychological safety is not a binary “on/off” phenomenon: we all move through different degrees of psychological safety in different teams, contexts, times of day, etc.
Another useful model for team development is Tuckman’s Model of Team Development, where teams “Form”, “Storm”, “Norm”, and finally, “Perform”. It is only in psychologically safe teams that true performance will be reached, since this stage requires the ability for team members to admit and learn from mistakes, and to contribute and challenge ideas. Reaching this stage, as a leader of a team, is one of your goals.
Measuring Psychological Safety
It’s really important, and fortunately, really easy to measure psychological safety. You can do this in your team or across an entire organisation: one way to do it is via a survey, which asks for agreement with multiple statements that reflect the degree of psychological safety on a team. This provides quantitative metrics that are really powerful in building psychological safety and ensuring momentum is maintained. Another way, particularly useful for short lived teams, is to use a more discursive method such as the psychological safety matrix, which encourages people to describe where they are.
The Psychological Safety Action Pack is a toolkit that contains thorough and detailed resources on measurement, specific actions to take according to the scores you record, and exercises, tools, and workshops to run with your teams to continuously build psychological safety and performance in your workplace.
Is it possible to be “too” psychologically safe?
In short, no. However, it’s important to distinguish psychological safety from existential or other kinds of safety. A mountaineering team climbing K2 require very high degrees of psychological safety in order to know that their teammates will support each other, and make it safe to raise concerns, however small. Their existential safety is very low, and they’re in real danger of dying on the mountain: but their high psychological safety aids in maximising their chance of success, and not dying on the mountain.
The lesson: maximise the psychological safety of your teams, but do not shelter them from the real world. Building psychological safety doesn’t mean hiding the challenges ahead; quite the opposite.
The Three Fundamentals of Psychological Safety
There are three core leadership behaviours which support psychological safety in teams. These may seem simple, but in practice they extend to every single leadership behaviour and every single aspect of communication. Those three core behaviours (thanks to Amy Edmondson for codifying these) are:
- Frame work as a learning problem, not an execution problem. Everything is an experiment. The outcome of work should not exclusively be the output; it must also be learning how to do it better next time.
- Acknowledge your own fallibility. By admitting when you make a mistake or don’t know the answer, you allow (indeed, encourage) others to do the same.
- Model curiosity and asking questions. Stay curious, ask other people what they think, and ask them to contribute. By asking questions and asking for help, you’re creating a space and a need for people to speak up, which is essential for psychological safety and for high performing teams.
Dr Amy Edmondson elucidates these core principles in The Fearless Organization.
Whether you work for a private company, non-profit organisation, a government agency or a sports team, building psychological safety and working through the psychological safety action pack will return real results:
The Benefits of Psychological Safety:
- Increased likelihood of successful innovation, resulting in quicker time-to-market.
- An increased ability to learn from mistakes, resulting in fewer problems or outages, higher quality, and improved governance and controls.
- Increased reporting of concerns and security issues, resulting in decreased risk of security, health and safety or non-compliance incidents.
- Increased employee engagement, resulting in lower churn rates and decreased costs related to recruitment and absenteeism.
- Improved reputation resulting in an increased ability to recruit the best people.
- Increased profitability as a result of all of the above.
Fundamentally, building psychological safety is not only the right thing to do for members of your teams, but it’s the right thing to do for your business or your organisation.
Download your Psychological Safety Toolkit to measure, build and maintain psychological safety in your teams.
For more information about high performing teams and psychological safety or for training, consulting or workshops, please get in touch.