TL;DR: In healthcare huddles, how leaders ask about patient safety can either invite honest discussion or make speaking up feel risky. Open-ended, system-focused questions–combined with consistent follow-through–are essential for building psychological safety and preventing harm.
I think that working to reduce patient harm (to improve patient safety) is one of the most important (and most noble) applications of Lean.
Daily huddles can be an effective way to engage staff and improve communication. Sometimes, they are sadly just that 10-minute block when people look at their shoes or watches.
But, when we have effective huddles, the leader asks questions to help draw out issues, problems, risks, opportunities for improvement, or the like.
If we're asking staff to speak, we have to make it “psychologically safe” for them to do so. Psychological safety has been my theme this week, and you might want to check out my podcast with an expert on the subject, Amy C. Edmondson, PhD.
How Leaders Ask About Patient Safety Matters
There are many different words and phrases that we could use to ask staff about risks or incidents related to patient safety.
A Closed-Ended Question That Can Feel Unsafe
“Any safety problems?”
I don't like this approach for a number of reasons. For one, it's a closed-ended question. Depending on the tone used and the history or culture in the department, this might seem like a question that demands “no” as an answer. It might seem like the leader doesn't really want to hear what's going on, even if they truly do. That question might seem unsafe.
A More Open Question That Invites Speaking Up
A better way to phrase it might be:
“What safety risks or problems exist today?”
It's an open-ended question. Granted, it's a leading question. But, the field of “Motivational Interviewing” says that's OK at times — in the context of counseling or helping people.
The question presumes that there are risks. That is probably an accurate assumption in healthcare. If the leading question is incorrect, somebody can say so.
But, I think a question like this recognizes the real reality (there very likely are risks) and that seems to make it safer for people to speak up.
As Toyota leaders famously say:
“No problems is a problem.”
Maybe we only have a slight risk of minor harm, but it's still there. We probably can't eliminate all risk in a healthcare environment.
Toyota leaders also like to ask:
“What are your top three problems?”
That's an open-ended leading question that presumes there are problems (and the leader is probably correct). The implication is that if somebody replies, “We don't have any” (risks or problems), then it's possible that they aren't doing a good job of being aware of risks that are present… or they aren't feeling safe about speaking up (which is a cultural problem, not a problem with the individuals).
An Aspirational Question That Builds Psychological Safety
In her outstanding book, The Fearless Organization, Edmondson suggests this question:
“Was everything as safe as you would like it to have been this week with your patients?”
This question presumes that we all want things to be safe. We might debate whether the question means “as safe as possible” — and what is “possible?” As safe as reasonably possible in this environment? Or safe meaning zero harm and near-zero risk?
Edmondson says leaders need to “invite participation” after “setting the stage.”
She says about that question, asked by a healthcare leader to their staff:
“The question – genuine, curious, direct – was respectful and concrete: “this week,” “your patients.” Its very wording conveys genuine interest. Curiosity. It makes you think. Interestingly, she did not ask, “did you see lots of mistakes or harm?” Rather, she invited people to think in aspirational terms: “Was everything as safe as you would like it to be?” Sure enough, psychological safety started to take hold. People began to bring up incidents that they had seen and even contributed to.
Edmondson, Amy C.. The Fearless Organization (Kindle Locations 3683-3687). Wiley. Kindle Edition.
She says the question was effective in that context, so that's what really matters. I can't tell you exactly what to say, but I'd hope you would experiment with questions to see what engages people most.
It's a closed-ended question — triggering a yes or no answer. But maybe it sparks more discussion than that if it's a psychologically safe setting.
Testing Questions That Focus on Systems, Not Blame
We could modify the question to be something like:
“What was preventing us from providing the safest care to our patients yesterday?”
It's an open-ended question. It presumes that care was not as safe as possible and that something was preventing us. I'd try to ask the question in a way that focuses on systemic factors and not blame.
Maybe “What were the barriers to providing the safest care yesterday?” would be another variation.
2025 Reflection: Why This Still Matters
Five years after this post was written–and after a global pandemic that pushed healthcare systems to their limits–the link between patient safety and psychological safety is even clearer.
Many organizations now say they want staff to speak up about risks and harm. But the way leaders ask questions in huddles and meetings still sends powerful signals about what is truly safe to say. Closed-ended questions, rushed tone, or a history of inaction can unintentionally teach people that silence is safer than honesty.
What's changed since 2020 is not the principle, but the stakes. Staffing shortages, cognitive overload, and constant operational pressure mean that small barriers to speaking up can have outsized consequences. Leaders don't need perfect wording–but they do need curiosity, consistency, and follow-through.
The real test of psychological safety isn't whether people are invited to speak. It's whether their experience teaches them that speaking up actually leads to learning, improvement, and safer care.
Common Questions About Patient Safety and Psychological Safety
Why can patient safety questions feel psychologically unsafe?
Patient safety questions can feel unsafe when they imply blame, demand a “no problems” answer, or are asked in cultures where speaking up has led to punishment or inaction. Tone, timing, and past leader responses matter as much as wording. If people expect negative consequences–or no follow-up at all–silence becomes the safest response.
How should leaders ask about patient safety in healthcare?
Leaders should ask open-ended, system-focused questions that assume risk exists and invite learning. Questions that emphasize curiosity, shared goals, and improvement–rather than fault–are more likely to encourage honest discussion. Consistent follow-through on what is raised is essential for credibility.
What are examples of psychologically safe patient safety questions?
Examples include:
- “What safety risks are we seeing today?”
- “What got in the way of providing the safest care possible?”
- “Was everything as safe as you would want it to be for your patients this week?”
These questions normalize risk and signal that speaking up is expected and valued.
What is the link between psychological safety and patient safety?
Psychological safety enables patient safety by making it safer for staff to report risks, errors, and near misses. When people fear blame or embarrassment, critical information stays hidden. Organizations that reward speaking up are better able to identify system weaknesses before harm occurs.
Do daily huddles improve psychological safety?
Daily huddles can improve psychological safety–but only if leaders use them to listen, learn, and act. When huddles become performative or dismissive, they can actually reinforce silence. The effectiveness of huddles depends on leader behavior, not the structure alone.
I don't know what the answer is. I'd probably go test questions like the last iteration. Again, what matters is what works. I don't know if there is a “best practice” question phrasing that everybody should use or copy.
Plan, Do, Study, Adjust. I think that's still good advice. What do you think? What have you seen in practice?
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If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.
