This article was produced by Harvard Business School Working Knowledge and features the insights of faculty member Amy C. Edmondson, doctoral student Hassina Bahadurzada, and Harvard T.H. Chan School of Public Health’s Michaela Kerrissey. When times get tough and resources become constrained, programs that advocate for psychological safety—the ability of workers to speak their minds without fear of retribution—are often among the first to go. However, research by Harvard Business School’s Amy Edmondson and Michaela Kerrissey of the Harvard T.H. Chan School of Public Health, conducted with HBS doctoral student Hassina Bahadurzada, suggests that’s the worst time to halt such efforts. In fact, psychological safety is key to avoiding burnout and staff turnover in times of turmoil. Efforts to foster psychological safety are even more effective if they start long before a crisis hits. “Burnout is a kind of mental and physical exhaustion, when you are holding everything in and unable to get the help you need,” says Edmondson, who first coined the term “team psychological safety” in 1999. “But if you’ve had the experience of speaking up in the past during challenging situations, and nothing bad has happened to you, then you are more likely to have the ability to do it again.” The May 2024 study by Edmondson and Kerrissey, “Psychological Safety as an Enduring Resource Amid Constraints,” focuses on healthcare, but offers insights for any industry wrestling with upheaval and economic uncertainty. Many employees—coming out of the post-pandemic years of quiet quitting—are doing more with less as companies hire more cautiously and, in some cases, shed jobs. Psychological safety provides a powerful organizational salve for stressful times. Subscribe to the Working Knowledge newsletter to get their research coverage in your inbox every week. When Edmondson speaks at conferences, she often hears attendees frame psychological safety as a luxury, especially in the fast-paced, high-pressure healthcare environment. “They’d say, ‘Sounds nice, but in times of struggle, isn’t that something we have to set aside in lieu of more pressing needs?’” The paper, published in the International Journal of Public Health, contradicts such attitudes, showing that psychological safety is as essential as more material resources in the welfare and retention of staff. Kerrissey is an associate professor of management at the Chan School, and Edmondson is also the Novartis Professor of Leadership and Management at HBS. Probing the Ties Between Psychological Safety and Burnout “For many years, the theory has been that people get burned out as their resources get depleted,” Kerrissey says. “By thinking of psychological safety as a ‘social resource’ we unlock a whole new aspect of reducing burnout that can be helpful to physicians—and likely people in other high-pressure industries.” Healthcare is by nature a profession in which both stakes and uncertainty are high. Workers prescribe treatments based on sometimes incomplete or confusing sets of symptoms, and decisions can literally mean the difference between life and death. Because of that, it’s essential that healthcare workers can speak their minds and even express their doubts without fear of consequences. To test the importance of psychological safety, the researchers examined a dataset from a large hospital system with sites nationwide. The system surveys workers twice a year on a range of questions, including some on psychological safety, such as “I can report patient safety mistakes without fear of punishment” and “I feel free to raise workplace safety concerns,” rating their responses from 1 to 5. The researchers used two surveys, representing more than 27,000 workers. One was conducted in May 2019 before the onset of the Covid-19 pandemic; the other was offered in May 2021 during the height of stress from the virus. For the 2021 survey, the researchers also added questions addressing burnout, asking workers whether they would stay with the organization if offered a similar position elsewhere. The Protective Effects of Psychological Safety They found a strong correlation between psychological safety and protection against stress. For example, increasing psychological safety by one standard deviation in 2021 decreased burnout by 0.72 points and increased an employee’s willingness to stay by 0.63 points. “Over time during the pandemic, the staffing constraints were really intense and people were not always able to pull it together,” says Bahadurzada, who’s also a physician. “People with higher reported psychological safety were better able to cope with it—something was keeping them there despite the difficult material circumstances.” Not only did they find that psychological safety in the moment provided protection, but the researchers also found a positive correlation between psychological safety from the 2019 survey and willingness to stick it out in 2021. That suggests that the ability to speak their mind over time helped protect employees when times got tough. The results were stronger for physicians, women, and people of color, all of whom experienced higher levels of burnout. “Psychological safety becomes even more important when you are in a group that has historically been reluctant to speak up, or is less listened-to,” Edmondson says. Building Resiliency in Tough Times The study shows that increasing psychological safety through training not only improve workers’ morale, but also cuts down on turnover, which can cost an organization in staffing efficiency and hiring costs. “Burnout and turnover rate have a very direct connection,” Edmondson says. “It’s important to train physician leaders to be as direct and open as possible, reframing the work as something with a high level of uncertainty, that requires people to have humility and vulnerability.” That includes encouraging people at all levels to ask questions and seek feedback from colleagues, rather than assuming they know the right answer or faking it until they make it. While the study specifically addressed healthcare, the researchers say it likely applies to all industries in times of stress or crisis. “At its core, the paper is about adaptiveness during tough times,” Kerrissey says. “Many organizations have crisis management plans, but say less about establishing social resources, like psychological safety, during difficult times.” Whether dealing with supply chain issues, reputational harm, or climate disruptions, establishing a baseline of psychological safety can help provide employees the resilience they need to see their way through a crisis, helping guide the organization to safety on the other side. “Practices such as being open about not knowing, and rewarding people for taking interpersonal risks, can provide a foundation for doing the hard things necessary when crisis hits,” Edmondson says.
