TL;DR: Learning from mistakes requires more than problem-solving tools — it requires psychological safety.
In this Shingo Institute webinar, Mark Graban explains why fear and futility prevent people from speaking up, how Toyota and healthcare organizations respond constructively to mistakes, and what leaders must do to create a culture where continuous improvement actually works.
I recently had the opportunity to present a webinar hosted by my friends at the Shingo Institute on using mistakes as a catalyst for continuous improvement. I'd like to share some of the key points and insights from that session.
The Recording:
Key Themes from the Shingo Webinar
Why Psychological Safety Is Essential for Learning from Mistakes
I began the webinar by addressing a common misconception that mistakes should always be avoided at all costs. Instead, I emphasized that mistakes are inevitable and can be powerful learning opportunities. This is closely tied to the concept of psychological safety, a crucial element in fostering an environment where team members feel safe speaking up, admitting errors, and suggesting improvements.
Andon Cords and Cultural Expectations
Drawing on Toyota's practices, I highlighted the use of Andon cords as both symbolic and practical tools for quality assurance. These cords are pulled thousands of times a day in Toyota plants to signal a problem, reflecting a culture that encourages and expects team members to speak up. This behavior is underpinned by the Shingo principles of ensuring quality at the source and respecting every individual.
Two Preconditions for Effective Problem Solving: Safety and Structure
Effective problem-solving in any organization hinges on two key preconditions:
- psychological safety and
- a robust problem-solving framework.
Many organizations invest heavily in problem-solving training but fail to see results because they neglect the importance of psychological safety. Without it, employees are less likely to report problems for fear of punishment or futility — they'll say, “It's not dangerous, it's just not worth the effort.”
How Toyota Responds to Mistakes Without Blame
I shared examples from Toyota, where leaders respond to mistakes not with punishment but with support and a focus on improving systems. This approach helps build a culture where employees feel safe to admit mistakes, leading to more reported incidents and, ultimately, fewer serious safety events.
What Psychological Safety Really Means (Amy Edmondson's Definition)
Referencing Amy Edmondson‘s work, I shared her definition of psychological safety as:
“the belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.”
This is essential for creating an environment where continuous improvement can thrive.
Overcoming Fear and Futility to Encourage Speaking Up
One significant barrier to speaking up is the fear of retaliation. However, research by Ethan Burris shows that the futility factor–believing that speaking up won't make a difference–is even more prevalent. Overcoming these barriers requires a cultural shift where leaders not only tolerate but encourage and reward candor.
Real-World Applications and Data
I provided data from hospitals in the Pacific Northwest that adopted a “safety stop” process modeled after the Andon cord. These institutions saw an increase in reported concerns and a decrease in serious safety events, demonstrating the effectiveness of combining psychological safety with problem-solving processes.
Leadership Responses to Mistakes: Real-World Case Studies
I shared stories from Toyota leaders such as Isao Yoshino and David Meier, who experienced supportive, constructive responses to mistakes early in their careers. These examples illustrate the long-term benefits of a non-punitive, learning-oriented approach to mistakes.
Practical Leadership Behaviors That Build Psychological Safety
To cultivate psychological safety, leaders must model candor by admitting their own mistakes and uncertainties. This behavior encourages employees to do the same and reward them for speaking up, fostering a culture of openness and continuous improvement. I also discussed the importance of moving from a “nice” to a “kind” approach, in which leaders provide constructive feedback and support to help employees grow and avoid repeating mistakes.
Measuring Psychological Safety
We explored ways to gauge psychological safety within an organization, both indirectly through metrics like reported incidents and directly through employee surveys. These measures can help identify areas for improvement and track progress over time.
Why Psychological Safety Is a Prerequisite for Continuous Improvement
In summary, creating a culture of continuous improvement requires a foundation of psychological safety. Leaders play a crucial role in modeling and promoting this culture, ensuring employees feel safe and empowered to speak up and contribute to the organization's success.
Thank you to everyone who attended the webinar and contributed to the discussion. For those interested in learning more, I highly recommend Amy Edmondson's The Fearless Organization and Timothy Clark's The Four Stages of Psychological Safety.
And I hope you'll check out my book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation.
Let me know if you'd like me to share on this topic at your event or organization. Contact me about speaking.
Webinar Transcript (Lightly Edited for Clarity)
Introduction and Welcome
Mary Price: Welcome everyone today. My name is Mary Price. I'm the events and marketing director at the Shingo Institute at Utah State University, and I'm so excited to have Mark Graban with us today. I've known Mark now for over a decade and I truly value our relationship. Mark is an internationally recognized consultant, published author, professional speaker, blogger, podcaster, and entrepreneur.
Mary Price: He does it all. He's received the Shingo Publication Award for his books Healthcare Kaizen, Management's Role in Improving Work Climate and Culture, and How to Do a Gemba Walk. He recently wrote the article we published in our newsletter earlier this month. It's titled Psychological Safety, and you can read that article by visiting shingo.org/articles. With that, Mark, I'll turn the time over to you.
Mark Graban: Well, thank you, Mary. I appreciate the introduction. I'm going to make a slight correction. The topic is mistakes. We all make mistakes.
The Value of Mistakes and the Andon Cord
Mark Graban: You'll think I set Mary up to do this. The Gemba Walks book is not mine. My books are Lean Hospitals and Healthcare Kaizen that I was given the Shingo recognition for, but thank you for my mistake. We all make mistakes. I'm going to make mistakes so we can learn how to react graciously to mistakes.
Mark Graban: Sometimes you have to speak up and point it out, and we'll move on. But I want to share some thoughts here today about using mistakes as a driver for continuous improvement, if not innovation. For those of you that are practitioners of Lean, you'll probably recognize this is an Andon cord pictured at a Toyota plant. If you know Toyota, these cords are being pulled sometimes up to thousands of times a day in the typical plant. Team members doing so can be a cultural expectation.
Mark Graban: However, companies can't force this behavior if the cultural norms don't promote, accept, and encourage the behavior of pulling the cord or speaking up. We can connect this to Shingo principles of assuring quality at the source. We can connect it to the principle of respect for every individual, of realizing people want to do quality work. When they've made a mistake, see a problem, or have a concern, the expectation in certain cultures can be to pull the cord. If in doubt, pull the cord.
Psychological Safety and Problem Solving
Mark Graban: Doing so has to get a positive, constructive, reinforcing response. Otherwise, it's not going to happen. We can think and work backwards from this and other organizations that have people speaking up in different ways and ask what's required. I think there are at least two key preconditions we can work on addressing. One of them, which I'll share some more thoughts on here today, is this idea of psychological safety.
Mark Graban: Do I feel safe to pull the cord? Do I feel safe to speak up? Plus, effective problem solving. We need these two together. A lot of organizations have invested a lot of time, money, and effort in problem-solving training.
Mark Graban: That's a good thing, or it can be a good thing when it's combined with an environment where people feel a high sense of psychological safety. Otherwise, it's difficult to do problem solving if people are being punished for pointing out problems. This is something a lot of organizations in different industries and countries are working on. Pictured here, Dr. Yasuda is a chief medical officer at a hospital near Toyota City in Japan.
Mark Graban: I had a chance to visit there. I think this picture is from 2018. They're actually getting coaching directly from the local Toyota Global headquarters people, and they are focusing on creating an environment where people feel safer to speak up. Dr. Yasuda is smiling because she is showing and talking about this chart that shows a vast increase in what's labeled as incident reports. Why?
Mark Graban: The reason she's happy is that they are working on closing the gap between actual incidents and reported incidents. In this transition toward a climate of higher psychological safety, we're going to see more reports when people feel safe doing so. That's an important starting point. We can see the same thing in U.S. hospitals. This is data from a hospital in the Pacific Northwest modeling a process after the Andon cord–not literally a cord, but something they call a safety stop process.
Mark Graban: This chart shows that as they were rolling out that safety stop process and management system across different clinics and hospitals, the number of “safety stops,” RCAs, and serious safety events–meaning the number of reported concerns and events–is increasing. That's evidence of psychological safety and people feeling safe when it's combined with effective problem solving. Here's the key result.
Mark Graban: The number of serious safety events is going down over a very similar timeframe. It may seem counterintuitive, but we can have an increasing number of reports while the number of actual events is going down. I've used this phrase, psychological safety. There are a number of definitions that are similar. I like Amy Edmondson's definition.
Mark Graban: I like her book, The Fearless Organization. She's considered one of the expert researchers and teachers of psychological safety, and she emphasizes that it's a belief. We could use words like perception or feeling that one will not be punished or humiliated. I would add that even just being ignored or marginalized would be a bad thing. It's a belief that we can do these things without punishment: speaking up about ideas, questions, concerns, mistakes.
Mark Graban: Speaking up about anything, even disagreeing with the boss, requires a high degree of psychological safety. Mistakes is the last thing on this list. What is a mistake? It's a word we know, but one definition is that mistakes are actions or judgments that turn out to be misguided or wrong. That's the key phrase here. We only determine something to be a mistake in hindsight. It could be pretty immediate–seconds–or it could be minutes, hours, or years that pass before we determine something is a mistake.
The Fear Factor vs. The Futility Factor
Mark Graban: I think there's a parallel to some Lean thinking and terminology about gaps in problems. We make a decision because we think it's the right thing to do, and then it turns out to be misguided or wrong, at least to some degree. When we make a decision, we have an expected outcome that something good is going to result from our action. If the actual outcome is lower, we can identify a gap and say, “Ah, what we did was a mistake.” We don't have to shame ourselves over that.
Mark Graban: Accept the idea that a mistake is a fact. It exists, much like a problem is a fact and it exists. We can choose our emotional reaction or learn to do so. How we react to a mistake makes a huge difference. Mistakes are by definition unintentional.
Mark Graban: There's some literature where people use the phrase “unintentional mistakes,” but they're all unintentional. By definition, an intentional mistake would be described as something like sabotage. So, we need to create an environment where people feel that it's safe and effective to participate. I visit a lot of hospitals.
Mark Graban: I visit other organizations. They often want to show off their huddle boards that they may have patterned off of or copied from an organization they visited that had a really robust continuous improvement process with boards all over the hospital. One potential mistake organizations make is assuming that people will use a huddle board that you've placed in front of them. One hospital I visited, it was quite literally a blank huddle board–blank other than some blank cards intended to be filled out to report problems or bring forward ideas. I'm not blaming the employees for this, but we need to ask why.
Mark Graban: Our favorite Lean question: we can ask many whys. How many whys are we going to ask? There isn't a single root cause. There could be many causes or a combination of why people aren't using the huddle board or why they're not speaking up. Professor Ethan Burris from the University of Texas has done a lot of research that shows there are really two primary factors and reasons why people choose to keep quiet.
Mark Graban: Ranking number two is the one that normally came to mind first for me: a fear factor. People are afraid to speak up, or they've learned that they get punished for doing so. Ethan's research shows that just slightly higher is not the fear factor, it's the futility factor. I've heard people quite literally say things like, “I'm not afraid to speak up. It's not dangerous to speak up. It's just not worth the effort because nothing happens as a result of speaking up.” So people give up. That's something we need to avoid if we're going to have a culture of continuous improvement.
Learning from Toyota: Punitive vs. Kind Responses
Mark Graban: If we're going to have a world-class culture, a Lean culture, or a Shingo Prize-winning culture, we can look to Toyota. I think there's a lot of evidence that psychological safety is present at Toyota. The only reference I found directly in the literature is in Jeff Liker and Mike Hoseus's excellent book, Toyota Culture: The Heart and Soul of the Toyota Way, a Shingo Award recipient. It says in the book, “Toyota believes people must feel psychologically and physically safe. They must believe that any concerns they have will be taken very seriously.” This, to me, points to eliminating the fear factor so that they feel psychologically safe to speak up. And it's eliminating the futility factor because taking a concern very seriously means there's going to be action and improvement.
Mark Graban: I've had a chance to talk to Mike Hoseus about this. He agrees with me that even though they didn't really use the phrase “psychological safety,” those principles and concepts exist. We can see the evidence of it. People are speaking up. People are participating in improvement.
Mark Graban: When we look in different organizations, our response to mistakes matters greatly. I've seen too many environments in different industries where the response was punitive. People get yelled at, people get in trouble, people get fired. I've heard stories even recently of an organization firing somebody for making a mistake that damaged some equipment. They replaced the equipment, they replaced the employee, and wouldn't you know, because they hadn't addressed the root cause, it was just a matter of time before the new employee made the same human error mistake of forgetting to do something and damaged the equipment.
Mark Graban: I think the punitive response to mistakes is counterproductive because it teaches people to drive mistakes underground and to hide them. If we don't help people feel safe pointing out problems and even admitting “I made a mistake,” we can't move forward. The reaction to that might look at systems and processes instead of blame. Hopefully, we could be in agreement that we need to move beyond punitive responses to mistakes.
Mark Graban: But some organizations get stuck in the mode of being “nice.” They don't punish the person, they're not in trouble. Leaders say things like, “I know you didn't mean to do it. Please don't feel bad. It's okay.”
Mark Graban: If that's the end of the conversation, the person is still set up to maybe repeat the same mistake. If we haven't addressed the process and systems issues, if we haven't mistake-proofed the process based on what we learned from that mistake, it's not nice to set people up for repeated failure. As my friend and author Karen Ross has helped teach me, we need to shift from nice to kind.
Mark Graban: Kind means constructive and action-oriented. We can be candid or blunt about the impact of a mistake on the customer or our company, but we can also be kind, constructive, and helpful, working together to focus on what we are learning and what we are doing to improve. I've heard so many stories of this type of reaction at Toyota across the decades and across continents.
Mark Graban: Two stories shared on my podcast My Favorite Mistake and in my book The Mistakes That Make Us come from Asao Yoshino, who you might know from Katie Anderson's book Learning to Lead, Leading to Learn, also a Shingo Publication Award recipient. Mr. Yoshino told a story of working in a factory very early in his career in the 1960s. David Meier, co-author with Jeff Liker of The Toyota Way Fieldbook–which I think it's not a mistake to say is also a Shingo Award recipient–started his career at Toyota in Kentucky in the 1980s. He now makes bourbon, which is why he's pictured with the bottle there.
Mark Graban: Mr. Yoshino and David Meier were both working in a factory where they were involved in an incident where the wrong chemical was loaded into a machine. For Mr. Yoshino, it was in a paint shop. For David Meier, it was in a bumper part plastic molding operation. In both situations, when the problem was discovered, Toyota leadership basically apologized to them for putting them in the position where the mistake or the failure was even possible. They were not only not punished, the company took responsibility for the process and the system they were working in that was faulty.
Mark Graban: It was a materials management and supply chain problem in both cases where the incorrect chemical wasn't even supposed to be there. I've heard other stories from Toyota people where it seems like it's a very consistent culture, not coincidence, that Toyota leaders tend to react to mistakes in this way.
How Leaders Build Engagement
Mark Graban: What can we do to build this type of environment? I want to point first to Jamie Bonini from Toyota and TSSC, who defines the Toyota Production System as an organizational culture of highly engaged people solving problems or innovating to drive performance.
Mark Graban: How do we end up with what we would describe as highly engaged people? I would ask, how do we engage them? How do we get them participating? In the study of psychological safety and in the practice of it, we've learned one thing that does not work is just mandating or declaring, “You should speak up,” or “We want you to speak up.” It can be aspirational.
Mark Graban: It can sometimes be guilt-laden. Healthcare makes a mistake by often pressuring nurses to say, “It's your professional obligation to speak up if you think that surgeon is about to do something wrong,” when the nurses realize, sadly, the culture might be one of punishment and retribution for speaking up. So please, just don't mandate or say it's safe and now we want you to start speaking up.
Mark Graban: I think that's well-intended but ineffective. One thing I've learned is that an individual's choice to speak up isn't a matter of character or courage. I don't think it's fair to frame it that way. It's a function of culture. Do we feel safe speaking up, or do we protect ourselves by being quiet?
Mark Graban: I have a thought experiment that I'm certain has played out for real. Think about what would happen if you have a Toyota team member who's worked for years, if not decades, in an environment where pulling the Andon cord was an expectation and pulling the Andon cord was rewarded. That employee, that team member, would get very used to speaking up. Now, let's say they had to move across the country because of a family member. They had to take a job someplace else. Let's say it's a factory that copied the mechanics of an Andon cord.
Mark Graban: We've all seen or heard situations where companies have the Andon cord equipment without having the culture. I'm guessing that Toyota team member would learn pretty quickly, if they got yelled at for pulling the cord, to stop doing that in a different environment–same person. This is why I say it's not a matter of their character or their courage. Instead of telling people to be brave, let's do what Dr. Deming said and let's eliminate fear. So what can we do to cultivate and improve psychological safety?
Modeling Vulnerability and Candor
Mark Graban: It starts with leaders modeling and speaking candidly. When leaders say things like, “I made a mistake,” “I was wrong,” “I have an idea, but I could be wrong, so let's test that idea,” or “I don't know,” and model those key behaviors, then they've earned the right to encourage others to do the same. Without modeling the candor, encouraging the candor might fall on deaf ears. We need to model the behavior, then encourage people to speak up, and then to close the loop when they do so.
Mark Graban: We need to reward that candor. We can see this type of culture in all sorts of industries and companies of different sizes. Greg Jacobson, pictured here, is an ER doc. He's the CEO of KaiNexus, a software company. Greg says, and I know he believes this, “You can't have a culture of continuous improvement without learning from mistakes.”
Mark Graban: Greg is great at modeling these behaviors of saying, “I don't know,” “I was wrong,” or “I made a mistake.” Pictured here is a middle manager–it's a pretty flat organization–Chris Burnham, who sadly passed away last year. I like to honor Chris by continuing to use the example he set.
Mark Graban: This was at an all-hands company meeting. Chris is following Greg's lead. You can see the report out here. In plain language, we talk about not only what went well, but what went wrong. As Chris said in plain language, not sugarcoating it, “I made mistakes.”
Mark Graban: He explained those mistakes. He explained what he learned from those mistakes. He explained what he was going to do differently in the future. He's following the behavior modeled by Greg. He's in turn modeling that behavior for members of his team, including Stephanie Hillen, who posted on LinkedIn–and I'm using this with permission–she shared in response to somebody's post: “I thought I had a pretty significant failure. I told everyone I might want to know. Instead of pointing fingers at me, everyone rallied around me to help right the ship. At no time did they imply I was wrong. All they said was, ‘We learned.' It encouraged me to continue trusting them with my mistakes.”
Mark Graban: The thing I've heard repeatedly from Toyota people is that executives and leaders would ask, “What did we learn?” in the aftermath of a mistake. It's far more helpful than the punitive or even just nice approach. So we need both psychological safety and problem solving. If all we have is psychological safety where people feel safe to speak up but nothing happens, we end up replacing the fear factor with the futility factor, and we need to do better than that.
Mark Graban: If we only have problem-solving training or knowledge or ability without psychological safety, then people won't feel safe speaking up. We can't solve problems we don't know about. There's a different factor when we think about PDSA cycles: can we be candid and effective experimentalists? Can we actually be candid about the study after what we've planned and done?
The Four Stages of Psychological Safety
Mark Graban: When we have psychological safety, it's safe to say things like, “We could be wrong. Let's test it and see,” or “That didn't work as expected.” This all comes again as a result of leader behaviors: modeling candor, encouraging candor, and rewarding candor. As we do so, I want to share one last thing. This is a model that comes from Timothy Clark's book, The 4 Stages of Psychological Safety.
Mark Graban: I recommend this book just as much as Amy Edmondson's book. What Tim Clark's research showed us is that we can break down psychological safety into four components that tend to be a progression. Stage one is what Clark calls Inclusion Safety. Do I feel included, accepted, and respected? This makes me think of all kinds of Lean thinking and Shingo principles.
Mark Graban: Can I be my authentic self? If we don't have that feeling, it's going to be very hard to participate in improvement and innovation. Stage two is what Clark calls Learner Safety. Do I feel safe to learn and grow? Do I feel safe asking questions, admitting a mistake? That leads to Contributor Safety.
Mark Graban: Do I feel safe to contribute, create value, and do my job without being micromanaged? That leads to the pinnacle and the most difficult stage to reach, but the most meaningful, called Challenger Safety. Do I feel safe challenging the status quo? That's where Kaizen and innovation ultimately come from. Can I be candid about change?
Mark Graban: To reach world-class performance, or however we're framing it, we need in part a culture of improvement. To have a culture of improvement, we need in part a culture of learning from mistakes. To have a culture of learning from mistakes absolutely requires a culture of psychological safety. That's why I've come to believe very strongly that psychological safety is a foundation and precondition for continuous improvement, for Lean, for innovation, for operational excellence, and for business success.
Assessing Psychological Safety in the Workplace
Mark Graban: This is about the fear and futility factors. How much at work does the fear factor affect you? Please use the slider. One means “I always stay quiet because of fear.” Ten means “I feel safe speaking up.”
Mark Graban: One for the futility factor means “I always keep quiet because of futility.” A ten would mean, “Nah, that's not a concern. I can always speak up.” As we see the votes coming in, with any reasonable number of votes and people from different organizations, you can see not just the average but the distribution. We've got a range of responses, sadly.
Mark Graban: We've got some ones, some twos, and threes. We've got some eights, nines, and tens. I think a lot of this is an impact. It's one way of measuring or thinking about culture. Ideally, we would want these scores to be tens.
Mark Graban: I'm going to move along. Thank you to everybody who voted. Let me hit advance. Here's a question of choosing one of three responses. What's the most likely reaction to mistakes in your workplace?
Mark Graban: As I tried talking through it: Punitive, Nice, or Kind? We know what punitive means. Nice is about making people feel better. Kind is that constructive, helpful, even challenging approach.
Mark Graban: We've got some kind votes, but right now it's at six punitive, 13 nice, three kind. Thank you for those responses. That's hopefully an opportunity for some discussion. I'm going to move to the last question here.
Mark Graban: Four responses with the sliders. Again, this is related to Tim Clark's four stages of psychological safety. A one here means I feel very unsafe. A ten would mean I feel very safe on these four dimensions. The first is, I feel inclusion safety–safe to be myself.
Mark Graban: Second is, I feel learner safety–safe to learn. Third is, I feel contributor safety–safe to fully contribute. Fourth is, I feel challenger safety–safe to challenge the status quo. We've got responses coming in. Oh, I see someone put in the chat, “I'm sorry to hear.”
Mark Graban: Yes, the futility is real. That's an opportunity for all of us to try to help reduce that futility factor. The responses are coming in here on the four answers. Again, with groups of any reasonable size, this very much follows the pattern that I've seen in different industries, in different settings, and even with groups in different countries. The average on inclusion safety is 7.2. There's, of course, some distribution.
Mark Graban: Unfortunately, some people don't feel safe to be themselves. The learner safety is at an average of 8.1 with a little bit less of a spread. Contributor safety is at 7.8. Then challenger safety–again, that is the hardest stage for a team or organization to reach–the average score is, not surprisingly, lower. Sadly, that distribution again goes more evenly across the distribution of one to ten. Thank you, everyone, for answering those polls. I'm glad I had that queued up.
Audience Q&A: Overcoming Fear and Moving from Nice to Kind
Mary Price: Thank you so much, Mark. We do have a couple of questions that have come across.
Mark Graban: Yeah, and I'm happy to stay over if that's okay.
Mary Price: Okay, great. Let's go ahead and just ask one of the questions. Peter asks: “I love the futility factor thinking, since many people I work with on the front line don't want to be seen as complainers if there's a little pattern of actions coming with these concerns, especially for retaliation. I've seen that the fear factor weaponized by bad managers in the form of insubordination. Any advice to sidestep this concern?”
Mark Graban: What I hear from the question is bad managers are creating fear because they're labeling people as insubordinate for pointing out problems or concerns. Is that the way you read it, Mary?
Mary Price: That's exactly how I read it, yep.
Mark Graban: There's the futility factor. If people are being seen as complainers, that's probably because of a fear factor or punishment. There are some cases where people will speak up even though it's dangerous because it's meaningful and worthwhile. I'll give credit to Stephen Shedletzky, who's written a great book called Speak Up Culture. He talks a lot about psychological safety.
Mark Graban: I love his framework that people will speak up if it's some combination of safe and worthwhile. So you think in situations where safety is at stake, people might say, “Hey, I've got to speak up, even if there are consequences.” But then if nothing happens, they might stop speaking up because of futility. So the advice to sidestep the concern is, I think, one of these situations where you've got to try to change the leaders' behaviors. I think that's going to tend to flow in a top-down way. Frontline supervisors who are punishing people for speaking up might also be punished themselves for speaking up by their group leaders or directors.
Mark Graban: You've got to try to change behaviors. It starts with leaders at as high a level as possible modeling new behaviors. If people have got such deeply ingrained habits where they just cannot shift to a new way of behaving, sometimes you're going to have to maybe send people off into retirement. It's hard. I see another question here.
Mark Graban: “How do you go about gauging the psych safety in a company or department?” You can do it in both direct and indirect ways. The indirect way is to look at measures like the number of ideas being submitted or, more importantly, the number of ideas being implemented, how many problems are being reported, how many incidents are being reported–whether that's safety or quality. Look at those measures where I think you can reasonably say when psychological safety is stronger, we will have more of those things that are countable.
Mark Graban: You can also do surveys of employees. Tim Clark and his organization, Leader Factor, have a survey that I've facilitated with different teams that asks twelve questions related to those four stages of psychological safety. Some open-ended questions, of course, really tell you where the opportunities for improvement would be. So if anyone's interested in doing some of that direct measurement, feel free to reach out. Or again, sometimes indirect measurements serve as a really good proxy. So Jacob asked, “What key behaviors should leaders demonstrate to create the safety?”
Mark Graban: Again, it's acting candidly, speaking up candidly. Sometimes you could use the word being vulnerable, where vulnerable means you're putting yourself at some risk. Let's say a leader or an executive shares a mistake that they've made. It might not be vulnerable in that they're going to get fired for it, but they may feel like it's embarrassing or that it may somehow hurt their reputation. So they admit a mistake anyway.
Mark Graban: Here's the counterintuitive thing: people tend to respect you more when you're candid and honest and admit mistakes. Employees know their manager is not perfect, right? Nobody's perfect. When you can be candid about that as a leader and say things like, “I was wrong,” “I might be wrong,” “I don't know,” or “I made a mistake,” those are some of the key behaviors. You can also break down a long list of other behaviors that help people feel safe, like drawing out opposing views or opinions.
Mark Graban: Instead of a leader saying, “Well, people should speak up,” go out of your way to continually encourage people to speak up to disagree, then react well when they do. That can help build that sense of safety. I think it's a helpful habit when leaders, let's say if a leader presents a plan or an idea, don't ask the closed-ended question of “Do any of you disagree with this?” That might be scary. You could ask it more positively and more open-endedly and assume there are some problems with the plan. So the question might be, “Please tell me what flaws or gaps you see in the plan. How can we make this better?”
Mark Graban: I think questions like that are more likely to draw out input. We can get to better ideas and better performance. And then again, if you encourage people to speak up, you'd better reward it. Don't just tolerate it. Don't ignore it. Don't punish it. Reward it.
Mary Price: Great. We do have one other question.
Mark Graban: Sure.
Mary Price: “What are some ideas to get leaders to go from nice to kind when it comes to a response to mistakes?”
Mark Graban: I mentioned Karen Ross earlier. Her book The Kind Leader is a great resource for this, or anything that Karen has said or presented about this. In a nutshell, nice is about helping the other person feel okay. Or nice might be easier for you as the leader.
Mark Graban: There are times where an employee's made a mistake, and one example of nice would be to just ignore the mistake. You're like, “Yeah, it's a typo. It's not a big deal. I don't want them to feel bad. I'm not going to point it out.” I think a kind response would point out the opportunity for improvement because we're trying to help that person.
Mark Graban: We know they can do better. If they're making a grammatical error, they can learn. They're an adult. They're a professional. So I think kind is really more about the person you're trying to help instead of your feelings of, “Well, I don't want to feel bad. I don't want them to be uncomfortable.” That's one way I would try to summarize this.
Mary Price: Perfect response. All right, I don't think we have any other questions, so thank you again, Mark, and I hope everybody enjoys the rest of your day.
Mark Graban: Thanks, Mary. Thanks, everyone, for being here.
For a deeper exploration of how leaders can respond constructively to mistakes and build psychological safety, see my book The Mistakes That Make Us, which expands on these themes with real-world examples from healthcare and beyond.
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.
