Exceptional clinical care and public health work demands exceptional performance from leaders and their teams. Exceptional performance has been consistently shown to be underpinned by cultures of psychological safety. Leaders can proactively create psychologically safe cultures (cultures of valuing and respecting each and every team member, regardless of their individual status or speciality, because of the knowledge, expertise and opinion which each team member brings), however such cultures don’t just happen by chance.
This blog explains more about psychologically safe cultures and the leadership behaviours which increase the probability that such cultures will be created in a team.
Why does a psychologically safe culture matter?
The volume and complexity of medical and public health knowledge has exponentially increased in recent decades: public health and clinicians’ roles have become increasingly specialised as a consequence. The need for trans- and inter-disciplinary partnership working to prevent and treat ill health has become imperative, one individual can no longer hold all the answers to most of the care needs of an individual, let alone that of a whole population. Given this volume, complexity, and need for team and partnership working, psychologically safe cultures are needed now more than ever: for both clinicians and public health and clinical leaders.
Most medical and public health roles operate within at least a degree of a hierarchy, yet such hierarchies have been consistently shown to be barriers to effective communication. This dates back hundreds of thousands of years and relates to our need to know where we are in the social hierarchy in order to feel safe, rather than ‘out on the savannah’ on our own, our cave-people ancestors needed to be safe within their tribe, knowing their place and what was expected of them.
As leaders, it is easy to overlook human being’s basic neurobiology and hardwiring, how this impacts on both our own safety seeking behaviour, and how it shows up around us in our direct reports, colleagues, peers and top leaders.
Being a public health or medical leader who pro-actively creates a psychologically safe culture at work is one of the main ways which we can:
- Impact internal team dynamics
- Create a learning culture
- Reduce errors including medical errors
- Create inclusiveness and meaningful diversity
- Encourage the use of initiative within a team
- Identify and manage risks effectively
- Improve creativity, innovation and problem solving
- Engage others in quality improvement or partnership work
- Help others to adapt to change rapidly
- Improve team members’ job satisfaction and emotional wellbeing
What public health and medical leadership behaviours are needed?
Two aspects of leadership behaviour and role modelling have recently been identified by McKinsey (2021) as having a direct and/ or indirect effect on psychological safety, based on a recent global survey. These are:
- Supportive leadership behaviours: demonstrate concern for the welfare of team members; create a sense of teamwork and mutual support within the team.
- Consultative leadership behaviours: ask the opinions of others before making important decisions; give team members the autonomy to make their own decisions, try to achieve team consensus on decisions.
Both these styles of leadership were found to directly and significantly influence ‘a positive team climate’, which is the most important determinant of psychological safety in a team. A positive team climate occurs when: team members value each other’s contributions; care about each other’s wellbeing; and input into how the team conducts its work. Once a positive team climate is consistently established, the leader can then increase the level of challenge to the team to go further, question assumptions, and can coach the team and its members.
Authoritative (command and control) style leadership negatively impacted psychological safety in the survey.
It all starts with you, the medical or public health leader
If you wish to realise the benefits of psychologically safe teams, organisations and systems, you and your senior managers and senior leaders will need to be early adopters and to proactively role model these behaviours – consistently and in all contexts. Many senior medical leaders and senior public health leaders have had to resort to a ‘command and control’ model during Covid, for some contexts, this is still appropriate, while for others it may now be a leadership style which is more unhelpful than helpful.
How can I learn to role model these behaviours?
Public health and medical leadership coaching and leadership training and development can teach you the skills you need to role model these behaviours and to create psychologically safe cultures at work. Learning experiences which address the level of human thoughts, feelings, and body sensations based on evidence based psychological theory are needed to effect sustained change at the behaviour level and is generally most effective at a 1:1 level rather than a group context; developing these behaviours over time is less likely to be effective in a group context due to the level of vulnerability needed to really work effectively at one’s emotional or sensory level.
The learner (leader) needs to feel sufficiently psychologically safe themselves to be vulnerable and to increase their self awareness, to seek growth and development, and to begin to experiment with role modelling their learning at work and eventually creating the culture around them. This can happen very effectively through the process of guidance, reflection and feedback with an expert medical leadership coach / public health leadership coach. The leader who publicly role models their own learning and development journey helps to make it psychologically safe for other leaders and other colleagues to practice, try, fail – to be ‘learning on the job’.
Jonathan Emmett, Gunnar Schrah, Matt Schrimper, and Alexandra Wood, “COVID-19 and the employee experience: How leaders can seize the moment,” June 2020, McKinsey.com; Tera Allas, David Chinn, Pal Erik Sjatil, and Whitney Zimmerman, “Well-being in Europe: Addressing the high cost of COVID-19 on life satisfaction,” June 2020, McKinsey.com.
Nembhard, Ingrid & Edmondson, Amy. (2006). Making It Safe: The Effects of Leader Inclusiveness and Professional Status on Psychological Safety and Improvement Efforts in Health Care Teams. Journal of Organizational Behavior. 27. 941 – 966. 10.1002/job.413.
Dr Fiona Day is a former Consultant in Public Health Medicine, now working as an Executive Coach offering world-class coaching for senior doctors, medical and public health leaders in the UK and internationally.