How has ‘psychological safety’, which you identified as a concept in 1999, evolved over the years?
I initially conceived of psychological safety as a sense of what I labelled ‘low interpersonal threat’—which I had detected as a palpable difference in the climate across work groups in a hospital. I had stumbled into this difference, without looking for it, in my first study at graduate school. Here is how it happened. As a first-year doctoral student, I was asked to join an interdisciplinary research team studying medical error in hospitals. I had long been interested in the idea of learning from mistakes at work—as a crucial competency for building a learning organisation. My role in the study team was to examine the relationship between survey measures of teamwork and medical error rates. I hypothesised, of course, that better teams would make fewer errors.
When all the error and survey data was compiled, the results provided an unexpected, and at first unwelcome, surprise. The correlation was the opposite of what I had predicted. Better teams had higher, not lower, error rates. Then a provocative question occurred to me: What if better teams had a climate of openness that made it easier to report and discuss error? This would mean that good teams do not make more mistakes, they report more.
I had to hire a research assistant to go out and study these patient care teams carefully, without preconceptions. He did not know which units had higher error rates, nor which ones scored better on the team survey. In research terms, he was ‘blind’ to both the hypothesis and the previously collected data.
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