Cultivating psychological safety in healthcare

How leaders can role model psychological safety in teams

At Insync, we survey over 100,000 patients annually across Australia. One of the questions we ask in the Australian Hospital Patient Experience Questions Set (AHPEQS) is whether they experienced unexpected harm or distress due to treatment or care at the hospital. So far, 94% of patients in 2025 have responded ‘No’ to this question. Of the remaining 6%, one statistic prompted deep reflection: more than 40% of those who did experience unexpected harm in a hospital had not discussed it with any staff member. That silence is not just a communication issue — it is a patient safety risk.

What might prevent staff from discussing harm or distress caused in a hospital, where patient safety is the main goal? Increased workloads might mean less time for staff to spend with patients. But there is another reason we can’t ignore: a lack of psychological safety, and the fear of backlash that can come with speaking up about difficult experiences.

What psychological safety means

Psychological safety is defined as “the belief that it is safe to take interpersonal risks, such as speaking up, asking questions, or sharing ideas without fear of negative consequences”. In hospitals, those interpersonal risks often look like questioning a senior clinician, flagging a near-miss, or naming when care has fallen short. While psychological safety has been studied across industries for more than 20 years, it remains one of the key ingredients in creating an organisation and culture where individuals and teams thrive.

Why psychological safety protects patients

In healthcare, psychological safety is not an abstract cultural “nice-to-have”; it is a patient safety mechanism. When staff feel safe to speak up, they are more likely to flag early warning signs, ask for clarification, or challenge a decision that doesn’t feel right. Those micro-moments — double-checking a medication order, voicing uncertainty about a diagnosis, or raising a concern about handover quality — are often where harm is prevented. The same dynamic applies after something has gone wrong. If a near-miss or adverse event is met with defensiveness, the next one may stay hidden.

How to spot psychological safety (and the absence of it)

How do we identify a psychologically safe team? Leaders can look for behavioural signals that indicate whether psychological safety is present — or missing — in everyday work. In psychologically safe teams, you’ll hear people say, “I’m not sure,” “I made a mistake,” or “Can we try another way?” without hedging or apologising for speaking. Meetings include clarification questions from junior staff, and those questions are treated as valuable rather than inconvenient.

Conversely, teams with low psychological safety often show tell-tale patterns: the same few people dominate discussion, problems are raised in corridors instead of in the room, and mistakes are quietly worked around rather than shared. A simple diagnostic for leaders is to ask: “When was the last time someone on this team challenged a decision or admitted an error, and how did we respond?”

Four characteristics of psychologically safe teams

There are four key characteristics that help psychologically safe teams stand apart from other teams.

1. They look at risks and failures as information for learning

While none of us likes making mistakes, especially in front of others, these teams will view failures as data points that inform future actions. An error in a project highlights a process gap and helps the team update it. A patient receiving the wrong meal highlights the need for clearer dietary communication with the kitchen, and prompts a simple process fix.

2. They have open and honest conversations

Difficult topics are not avoided or deferred. Conversations are had across levels and hierarchy within the team.

3. Everyone gets a say

Regardless of their background, seniority, gender, race, or any other factor, people are invited in. Inclusion is celebrated within the team, and diverse voices and opinions are welcome.

4. There is a willingness to help each other

Team members are proactive in offering their help to a team member. They appreciate each other’s contributions and are willing to step in to help their colleague succeed.

What leaders can do to build it day by day

Creating psychological safety is a daily discipline, and team leaders set the tone more than any policy ever could. The strongest leaders model fallibility (“Here’s what I missed”), actively invite input (“What am I not seeing?”), and respond productively when concerns are raised. They separate accountability from blame by focusing on systems and learning first, and on individual coaching second.

Just as importantly, they follow through, closing the loop when someone speaks up so staff see that raising issues leads to improvement, not discomfort. Over time, these small, consistent signals teach teams that honesty is rewarded, curiosity is expected, and support is the norm.

Why this matters now

As Victoria’s new Psychosocial Health Regulations came into effect on December 1, 2025, they also brought to our attention employers’ responsibility to create a workplace culture that supports staff mental health and well-being.  Employers will now need to not only identify potential psychological and social hazards within the organisation, but also take action to mitigate these risks. And supporting team leaders to create psychologically safe team environments will be an important step in this endeavour.