In this article, we have Dr Fiona Day share her insights on how public health leaders can Improve team effectiveness through creating psychologically safe work environments.
Dr Fiona Day is a Coaching Psychologist and former Consultant in Public Health Medicine. She specialises in working with senior doctors, medical and public health leaders in the UK and internationally.
To connect with Fiona, you can follow her on LinkedIn.
Public health is all about relationships with people - with staff, colleagues, managers, and a wide range of internal and external partners – and almost all public health work takes place through groups of professionals in the format of teams. These range from formal Boards and Committees at international level, to working groups, to internal staff teams. When leading in the complexity of a public health context, there are both great opportunities to collaborate and transform outcomes at scale, and also plenty of additional challenges when agendas compete, resources are constrained, and demands are high, leading to relationship difficulties both within individuals and between organisations.
Psychology teaches us about the elements of team effectiveness, which include physical factors such as team size, task attributes, individual factors such as member competencies and personality, and organisational/social/environmental factors such as resources and remit.
Growing the psychological assets of a team leads to greater innovation and synergy: one way of achieving this is to create psychologically safe work cultures. Such cultures are a buffer to the challenges of implementing public health practice, and occur when each and every team member is (and feels) valued and respected, regardless of their individual status or speciality, because of the knowledge, expertise and opinion which each team member brings.
Public health leaders can actively create and shape cultures of psychological safety in all the different domains of their working life.
Most public health roles are highly focused on collaboration and partnership working, yet still operate within at least a degree of a hierarchy or ambiguity about the equality of individual relationships. Hierarchies, and the inherent power differences which they engender, have been consistently shown to be barriers to both effective communication and feeling ‘safe’. This dates back hundreds of thousands of years and relates to our need to know where we are in the social hierarchy in order to feel safe, rather than ‘out on the savannah’ on our own, our cave-people ancestors needed to be safe within their tribe, knowing their place and what was expected of them. When we feel at risk of blame or shame, we release cortisol, the ‘stress hormone’ into our blood and this has a range of physical and psychological consequences.
Actively creating a psychologically safe culture at work is one of the main ways in which we can:
Psychological safety impacts team effectiveness by creating a ‘safe-to-learn’ environment where team members feel they can speak without fear.
By understanding the basic neurobiology and hardwiring of every human being on the planet, we can gain insight into how the culture and quality of our relationships at work impact both our own safety seeking behaviour, and that of our direct reports, colleagues, managers, and partners. This insight can then help us to take specific skilful actions - including ensuring effective human resources policies and processes to protect psychological health - to increase the probability of developing psychologically safe cultures around us, whatever the context of our public health practice.
Two styles (consistent patterns) of leadership behaviour have recently been identified as having a direct and/ or indirect effect on psychological safety. These are:
Both these styles of leadership have been found to directly and significantly influence ‘a positive team climate’, which is the most important determinant of psychological safety in a team. A positive team climate occurs when: team members value each other’s contributions; care about each other’s wellbeing; and input into how the team conducts its work. Once a positive team climate is consistently established, the leader can then increase the level of challenge to the team to go further, question assumptions, and can coach the team and its members.
Unsurprisingly, authoritative (command and control) style leadership negatively impacts psychological safety.
If you wish to fully realise the benefits of psychologically safe teams, organisations and systems, you and your colleagues from the bottom to the top of the organisation and system have the opportunity to champion this issue, and to proactively role model these behaviours – consistently and in all contexts. There are of course times when a ‘command and control’ model is required during a crisis or period of crisis such as during Covid; however, even within this context, it is still possible to create psychological safety within the constraints of the emergency such as allowing dissent when appropriate and actively seeking to model learning even in the context of crisis.
The learner (leader) needs to feel sufficiently psychologically safe themselves to be vulnerable and to increase their self-awareness, to seek growth and development, and to begin to experiment with role modelling their learning at work and eventually creating the culture around them. The leader who publicly role models their own learning and development journey helps to make it psychologically safe for other leaders and other colleagues to practice, try, fail – to be ‘learning on the job’. Learning experiences which address the level of human thoughts, feelings, and body sensations based on evidence-based psychological theory are needed to effect sustained change at the behaviour level and can support you to become a more psychologically safe public health leader whatever the context of your practice.
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I've worked with hundreds of senior doctors and public health professionals across the UK and internationally over the last 6 years, supporting them with all aspects of their careers and professional lives. Many doctors and public health professionals tell me that they feel like they are floundering in their career, at a crossroads, are stuck in procrastination, are worried about burning out, or fear being able to sustain their role into the future. Others feel excited, and perhaps daunted by their leadership challenges.
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