Psychological Safety as a Pre-Condition for Lean and Continuous Improvement


“Simply put, we cannot get to zero harm without psychological safety.”

I wrote that as part of this page on the Value Capture website:

I've come to understand that psychological safety is a precondition for “implementing #Lean” or however you might say. Toyota seems to strive for (if not have) a relatively high level of psychological safety.

You can't copy Toyota tools and expect them to work the same in your workplace if you don't have a high enough level of psychological safety.

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You can't have continuous improvement without a high enough level of psychological safety.

You won't have world-class performance without a high enough level of psychological safety.

Why do I say “high enough”? Because psychological safety (or the lack thereof) is not a binary yes/ no situation. There's a spectrum.

Not “is it psychologically safe?” but more a matter of “how safe is it”?

And safety is a matter of individual perception. How safe do YOU feel that it is?

The same environment might feel relatively safe for you, but not for me based on our different experiences — both in our current organization as well as past experiences (or baggage) that we bring with us.

As we weigh the decision of “do I speak up to challenge the status quote?” or not, your risk/reward balance might be different than mine.

I'm excited to have been trained and certified by LeaderFactor on “The 4 Stages of Psychological Safety” methodology to measure, learn, and improve.

My learning continues.

I'd love to work with you on this within your team or your organization. Contact me if you'd like to talk.

What do you think? Please leave a comment or join the discussion on Linkedin.

See another post that I wrote recently on this topic…

My full post, as originally published at

Perfect safety for everyone in healthcare – patients, staff, visitors, and contractors – is a fundamental right.

Leaders we have worked with know that safety is the unarguable, aligning principle that all healthcare leaders should rely on to drive and sustain continuous improvement. Research and experience make clear that perfect safety requires a high level of psychological safety.

Simply put, we cannot get to zero harm without psychological safety.

Two Types of Safety

Value Capture identifies and defines two broad categories of safety:

  • physical
  • psychological

Physical safety is the absence of physical harm (injury), danger or risk that can be experienced by any person.

Zero physical harm would mean not only that no one is injured, but that the dangers and risks of physical harm are also zero.

As important as physical safety is, for employees and patients, it's not the only type of safety that matters.

What is Psychological Safety?

Psychological safety can be defined as “the belief that the environment is safe for interpersonal risk-taking by any person. Each person feels that candor is encouraged and expected. This is the condition in which you feel, among other things:

  • included,
  • safe to learn,
  • safe to contribute,
  • safe to call out problems,
  • safe to make mistakes and
  • safe to challenge the status quo

– all without fear of being embarrassed, shamed, blamed, marginalized or punished in some way.”

Achieving a state of continuous improvement is impossible without psychological safety

It is also not possible to achieve physical safety without psychological safety. Said another way, psychological safety leads to physical safety. Psychological safety leads to conditions where habitual excellence is possible.

Remember, psychological safety is not a “yes/no” binary condition. There are degrees of psychological safety that might exist in your part of your organization.

Higher levels of psychological safety are better than lower levels, of course, and leaders need to consciously work to move the organization in the direction of having more psychological safety.

Read more insights and see more resources about psychological safety via our blog.

Why is This True?

Why is it true that psychological safety is a necessary precondition?

When employees (at any level of the organization) do not feel a level of psychologically safe that is high enough, they do not:

  • speak up,
  • raise questions,
  • point out issues,
  • share ideas, or
  • seek the help they need to do their work properly and safely.

And without such conversations, progress (if any) slows to a crawl and continuous improvement – yet alone innovation – withers.

Have You Worked Here?

Think back in your career, to a job you had where any of the following occurred:

  • Your manager ignored or even belittled you for suggesting an idea or pointing out a problem; 
  • You didn't feel safe asking questions about your work
  • A co-worker warned you against calling out safety problems, process issues, or other concerns; 
  • No one in a meeting spoke up when asked if there were any questions; 
  • You and/or co-workers were blamed or disciplined for mistakes. 

Sadly, we've all probably worked somewhere like this. The result is a toxic and suffocating culture. It's not going to be a culture of excellence. Worse than that, it's likely to be a workplace that suffers from high turnover and the negative effects that come from that.

This type of all-too-common dysfunctional culture demonstrates why continuous improvement, performance excellence, and perfect safety /zero harm are impossible to achieve and sustain without psychological safety. The consequences of a lack of psychological safety are real and visible. 

But, we can thankfully change and improve our culture.

Insights from Prof. Amy Edmondson

We often look to Professor Amy Edmondson, of Harvard Business School, for a lot of great information and inspiration on psychological safety.

She defines it as:

“Psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.”

You can watch her fantastic TedX talk on the subject:

And here is an interview with Edmondson as part of my Lean podcast series:

Edmondson's research looked at companies (like Google) as well as healthcare organizations.

Her research question was: Do better hospital teams make fewer mistakes, such as medication errors?

She was surprised to learn that it appeared that better-performing teams appeared to be making MORE mistakes, not fewer.


The better teams aren't making more mistakes, they were more willing to discuss them in a climate of openness that allows them to report and better understand these incidents.

Her research showed that, at Google, the primary distinguishing characteristic was that the highest performing teams had the highest degree of psychological safety. And, we would expect that to be true in healthcare.

How Do Leaders Build Psychological Safety?

Professor Edmondson offers three concrete actions that we agree with, coach to and recommend:

  • Frame all of our work as a learning problem. There's always uncertainty ahead, therefore, we need everybody's brains involved.
  • Acknowledge your own fallibility as a leader, and model that for others.
  • Model curiosity — ask a lot of questions (which creates a necessity for people to speak up)

A question for you: Can you remember the last time you did each of those things as a leader or as a team member?

Another Definition (Timothy R. Clark)

Timothy R. Clark is another leading expert on psychological safety.

He defines it as:

“Psychological safety is a condition in which human beings feel (1) included, (2) safe to learn, (3) safe to contribute, and (4) safe to challenge the status quo – all without fear of being embarrassed, marginalized, or punished in some way.”

His more succinct definition is that psychological safety is:

“A culture of rewarded vulnerability”

Clark defines the four stages of our team's progression toward psychological safety as:

  1. Inclusion Safety (everyone is accepted as a human right)
  2. Learner Safety (being safe to ask questions, for example)
  3. Contributor Safety (“empower them with autonomy, guidance, and encouragement”)
  4. Challenger Safety (being safe to challenge the status quo)

Here is a short video of Clark speaking about these concepts and his book:

What are the Benefits of Psychological Safety?

  1. Increased learning for individuals, teams, leaders, and organizations
  2. Better risk management and better outcomes for patients and safety for workers and visitors
  3. More improvement, more rapid improvement, and innovation
  4. Higher job satisfaction and meaning

To create and nurture a psychologically safe workplace, leaders need to say and (more importantly) do a number of things, consistently over time.

Value Capture serves as advisors and coaches to leaders who are working to build psychological safety in their organizations as the key to unlocking habitual excellence.

One concrete way we help is by coaching leaders, at all levels, as they are facilitating problem-solving in their workplace. 

When a problem is found, leaders need to respond immediately — by thanking the person who identified the problem, ensuring that all understand the goal is never to blame people, but to find where the system failed and fix it for everyone.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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