Feeling safe to speak up

The idea in one sentence: people learn more when it feels safe to ask a question, say “I’m not sure” or own up to a mistake. That feeling comes mostly from how others react when someone does, and above all from how the person in charge reacts.

You’ve seen this already

Think about your first week in a new job, or your first time at a new gym class. You have a dozen small questions. Where’s the kettle? Is this the right weight? So you watch what happens to the first person who asks one. If they get a friendly answer, you ask yours. If they get an eye-roll, you keep quiet and guess.

One small moment told you the rules. That’s how most of us decide whether a group is safe to speak up in.

Why it matters for your teaching

Healthcare has steep hierarchies and high stakes. A healthcare assistant may not want to ask a nurse to explain something twice. A newly qualified physio may not admit she has never used that hoist. A student paramedic may nod along rather than say he’s lost. People who fear looking foolish stop asking. They copy, guess and hope. They may even pass the check, then struggle on shift.

Picture a huddle where you explain a change to the falls policy. You ask, “Any questions?” Silence. That may mean everyone understood. Or it may mean nobody felt safe to say they didn’t.

Psychological safety isn’t about lowering standards or dodging hard feedback. It means that asking, or getting it wrong, costs people nothing worse than a chance to learn. If you want people to do something differently, they need to practise it, get it wrong in front of you, and ask about it. How you react decides whether they will.

Teaching That Lands has set this topic aside for a possible future session on simulation. You’ll see small signs of it in Session 1, though. Saying whether you can read the colour-vision plates is voluntary. And feedback on each other’s slides follows a kind, two-part frame: one thing that works, one question.

Try this

• Say “I don’t know” out loud. When you’re not sure, say so and work it out together. It shows that not knowing is survivable.
• Treat a wrong answer as useful. Ask “What made you think that?” before you correct it. A sigh, or moving on fast, teaches the whole group to stay quiet.
• Ask a better question than “Any questions?” Try “What would you want to check before doing this on a real patient?” Or let people write questions down instead.
• Notice who outranks whom. If you’re the most senior person there, people will defer to you. Ask the most junior people first, and thank whoever says they’re unsure.

How sure are we?

Fairly sure it matters; less sure how best to build it. Many studies, in businesses and in healthcare, find that people who feel safer in their team speak up more. In business teams, safer teams also learn more together. But most of this research asks people to rate their own team at one point in time. That shows the two go together. It can’t fully show that safety causes learning, rather than the other way round.

The best-known healthcare result comes from one small study of eight hospital units. It’s striking, but it was exploratory. None of this has been tested in short teaching sessions like yours.

A common misreading is that psychological safety means being comfortable, or never being challenged. It doesn’t. The point is that people can be held to high standards and still feel safe to speak.

Where it comes from

The term goes back to Edgar Schein and Warren Bennis in 1965, and William Kahn used it about people at work in 1990. Amy Edmondson, a researcher at Harvard Business School, made it an idea about teams. In a 1996 study of hospital nursing units, she found that the better-led units recorded more medication errors, not fewer. The likely reason was that staff there felt safe enough to report them. In 1999 she studied 51 teams in a manufacturing company. Teams that felt safer did more learning together, and that learning went with better performance. Her 2018 book, The Fearless Organization, brings the work together for a general reader.