The Science of Team Performance - Why Psychological Safety is Critical in Medicine - A Step Ahead. Leading Change. Best Practice Portal.

When we think of psychological safety, we might be uncertain about what it really means in practice. In many industries, teamwork is a factor in profitability or customer satisfaction, but in healthcare, the stakes are incomparably higher. This is why I’m so happy to talk to my guest today, who will be sharing plenty of examples of what it really means in the most intense practice in a medical sector – Alexandre Messager.

Together, we will look at why psychological safety in a medical setting isn’t just a “nice to have”, but a “must-have” that can literally mean the difference between life and death.

In this episode you will learn:

How psychological safety acts as the primary barrier between life and death in healthcare
Why leaders consistently overestimate how safe their employees feel
Why conflict in the first three months is a necessary sign of progress in team transformation
How to use structured dissent to stress-test ideas and build bulletproof solutions
How to bridge the gap between different thinking styles (e.g., surgeons vs. nurses)
Why writing ideas down before speaking prevents “majority bias” and groupthink
Why culture change fails unless leadership is willing to be vulnerable first
Why “engaged” teams outperform “comfortable” teams every time
How to build a 6–18 month roadmap for team performance instead of relying on one-off events

When you listen to this conversation, please think about any leader, HR, DEI expert that can benefit from it and share with this person later on. I really care to be reaching the right people with my content, so thank you very much for this in advance.

You can also watch the conversation on YouTube!

I wish you fun and discovery!

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If you need to educate leaders in how to create psychological safety in your remote teams, or if you would like to increase inclusive leadership practices, or resilience of your employees – please contact us at ETTA www.ettagoglobal.com.

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From Luxury Hotels to the Frontlines of Care

Alexandre’s path to becoming an expert in healthcare team dynamics was anything but linear. With an eclectic background starting in the high-luxury hotel industry, he worked across the globe – from Switzerland and Turkey to Canada and the United Arab Emirates.

Early on, he noticed a universal truth: you can have the best resources and the most flawless product, but at the end of the day, only one thing matters: the people.

Alexandre spent the last 14 years immersed in healthcare. It was here that the mission shifted from making sales to ensuring patient safety and quality of care.

The Missing Pillar: Is a Group of People Actually a Team?

While researching how to improve healthcare outcomes, Alexandre discovered psychological safety. He quickly identified it as the pillar that either makes or breaks a team. However, his diagnosis of the current state of healthcare may come as a shock to some: “There are no teams in healthcare.”

While turnover in the medical field is often low and people stay in their roles for years, Alexandre argues that proximity does not equal partnership. In many cases, healthcare settings consist of people simply working next to each other rather than with each other.

Defining a Real Team

To move from “people in a room” to a high-performing unit, we must look at what actually constitutes a team. According to Alexandre, a team is defined by three core elements:

Respect
Trust
Care for one another

Without a strategic investment in building, developing, and maintaining these bonds, a group of experts will never truly become a team. In the world of healthcare, failing to make this investment doesn’t just hurt morale – it puts patients at risk.

Why a Common Goal Isn’t Enough

In many organizations, leadership assumes that because everyone shares a mission – such as “patient care” – teamwork will happen naturally. Unfortunatelly…. having the same goal is not enough.

Strategic planning in most companies focuses almost exclusively on operations. When it comes to the people, the “strategic plan” often boils down to a once-a-year team-building lunch or free food. But trust, care, and respect aren’t built over a pizza party. To create a high-performing team, Alexandre focuses on three essential pillars:

Psychological Safety
Cognitive Diversity
Motivational Drive

In healthcare, the “Achilles’ heel” among these is almost always psychological safety.

The Hierarchy of Silence

Patients expect doctors to be perfect, but the reality behind the scenes is governed by a heavy, traditional hierarchy. This structure often prevents people from speaking up. In a field where mistakes are viewed as signs of weakness or failure rather than learning opportunities, the instinct is to hide them.

Mistakes are being seen as a sign of failure. But if we hide them to protect our reputations, the patient is the one who ultimately suffers

Psychological safety, a concept popularized by Dr. Amy Edmondson, is the belief that one can speak up without fear of being reprimanded or humiliated. Ironically, Edmondson’s research shows that the highest-performing teams actually report more errors – not because they make more mistakes, but because they feel safe enough to talk about them and prevent them from happening again.

Breaking the Taboo: Data vs. Feelings

Healthcare is a data-driven industry. To convince medical leaders to invest in “soft” concepts like psychological safety, you have to speak their language: measurement.

In the past, leaders could deflect by saying, “My department feels safe.” Today, using tools like the ICQ Global assessment, Alexandre can move the conversation from “feelings” to “facts.” Yet, making these “invisible forces” visible often reveals a deep-seated fear of discovery. When faced with hard data, many leaders hesitate, fearing that the results will expose their weaknesses or “rock the boat” shortly before their retirement.

The “Leap of Faith”: Who is Leading the Change?

Interestingly, Alexandre has observed a distinct trend among those willing to confront this data. Approximately 95% of the leaders open to these 6-to-18-month transformation projects are women or leaders from visible minority groups.

While more research is needed to back this up, the instinctual reason is powerful: those who have personally experienced a lack of psychological safety in their daily lives are often more attuned to its crucial importance in the workplace. These “early adopters” are more willing to take a leap of faith, using data not as a threat to their reputation, but as a vital tool to protect both their staff and their patients.

The Ultra-Marathon of Culture Change

Changing a culture that has pitted clinicians against each other since medical school is not a “100-meter dash” – it’s an ultra-marathon. Doctors are trained to be the “best of the best” through intense competition. Once they graduate, they are often thrown into a “sink or swim” environment without ever being taught how to actually function as a team.

Alexandre’s process involves:

Month Zero: Measuring the three “invisible forces” (Psychological Safety, Cognitive Diversity, Motivational Drive) alongside existing patient metrics
Continuous Improvement: Re-measuring every three months while providing targeted workshops and operational exercises
The Long Game: Creating research papers to provide the “ammunition” needed to convince more wary leaders

Ultimately, the goal is to shift the culture from one of perfection and silence to one of learning and cohesion.

It doesn’t matter what your initial numbers are… what’s important is how we are improving them over time

The Reality of the “Multidisciplinary Team”

In the world of organizational change, there is a significant difference between working with a uniform group and navigating the complex reality of a modern clinic. When an intervention involves only clinicians – for example, a group of doctors – the process is relatively straightforward. These individuals share a similar educational background, a common “mental language,” and a unified perspective on risk and responsibility.

However, the heartbeat of healthcare is rarely found in such silos. The true reality of the sector is multidisciplinary. It is a delicate ecosystem where doctors, nurses, administrative staff and so on, must move in sync. In these diverse groups, “moving the needle” is undeniably more challenging and time-consuming, as it requires bridging different professional cultures and communication styles. Yet, it is precisely in this complex intersection of roles where the most significant impact on patient care is made. It is here that the transformation shifts from a theoretical exercise into a life-saving practice.

The “Can of Worms”: Why the First Three Months are Chaos

One of Alexandre’s most surprising insights is his warning to teams: The first three months will be chaotic.

Opening the Can: To build a real team, you must first “undo” years of bad habits and unspoken frustrations. This requires putting everything on the table.
The Conflict Phase: Productivity often dips initially as conflicts surface. This isn’t a sign of failure; it’s a necessary step to clear the air and start fresh.
The Turning Point: Around month four, the “magic” happens. The team develops a common language – specifically regarding cognitive diversity (understanding how each person processes information) – and begins to move forward in sync.

The 20-Point Gap: A Pattern of Perception

When measuring the health of an organization, a consistent and dangerous pattern emerges – the Hierarchy Gap.

Leadership Blindness: There is typically a 20-point difference between how leaders perceive psychological safety and how their subordinates experience it. Leaders almost always believe the environment is safer than it actually is.
Cognitive Blind Spots: While teams are often naturally diverse, people unconsciously gravitate toward those who think like them because it feels “certain” and “easy.” This creates a collective blind spot of about 70%, leaving the team vulnerable to errors.

The Leader as the “Gatekeeper”

Alexandre is clear: if a leader isn’t ready to be vulnerable, the project is doomed. He now vets his clients as much as they vet him. To illustrate this, he shares a cautionary tale of a department that “imploded”:

I showed the results to the leader, and she said, ‘I’m not sharing this with the team… I don’t like these results.’ We had to shut down the program because transparency is the foundation. Six months later, the department collapsed, and half the staff left

The Strategy for Sustainability

Team building cannot be an “end of the fiscal year” checkbox activity. To be sustainable, it must be:

Long-term: 6 to 18 months to overcome “habitual PTSD” from past toxic environments.
Strategically Maintained: Moving past labels and titles to see the human being (e.g., understanding “who is Monika” rather than just “the manager”).
Top-Down & Bottom-Up: Leaders must “walk the talk” by displaying psychological safety first, creating a comfort zone where others feel safe to follow.

From Personal Attacks to Collective Strength

How do you practically move from a culture of silence to one of proactive safety? Alexandre introduces the Red Teaming approach. In this exercise, a team is split into two:

The Blue Team: Presents an idea or a solution.
The Red Team: Tasked with finding every possible flaw, regardless of their personal opinion.

The goal isn’t to bruise egos, but to build a “bulletproof” solution. In healthcare, this ritual normalizes challenge, transforming it from a personal attack into a necessary step for patient safety.

Avoiding the “Majority Bias”

Psychological safety is often sabotaged by the instinct to follow the crowd. Alexandre suggests a simple yet powerful shift: ask team members to write their ideas on paper before speaking.

The Problem: Once the first two people speak, others often self-censor to avoid standing out.
The Solution: Written ideas capture a wider range of diverse perspectives, ensuring the team doesn’t lose critical insights to groupthink.

Identifying the Early Adopters

While every team is unique, Alexandre has observed patterns in who is most willing to embrace these changes. Interestingly, cognitive diversity plays a role in how we adopt change:

Risk-Takers: Surgeons and emergency doctors often share a “short-term, high-risk” thinking pattern, making them more open to trying new, experimental team dynamics.
Analysis-Driven: Researchers and pediatricians may be more risk-averse, preferring to see significant data and research papers before fully committing to a new cultural shift.

The Myth of the “Average” Team

A dangerous trap for leaders is looking only at average scores. Alexandre warns that a team might have a “good” average score while being split into silos.

You can have two teams within one: one that feels perfectly safe and another that feels completely silenced. The average looks fine, but the reality is two different worlds.

A Strategic Plan for People: The Final Verdict

Alexandre concludes with a challenge to all leaders, whether in a hospital, a tech firm, or a hotel. Most organizations spend months on an operational strategic plan but zero time on a people strategic plan.

To build a High-Performing Team, you must define:

What does it mean for us to be a team?
How will we perform and behave?
How will we measure our progress?

A final, vital distinction must be made between Satisfaction and Motivation.

Satisfaction is sitting on a couch eating popcorn – comfortable, but nothing is happening. Motivation is the drive to achieve more. I don’t care if a team is satisfied; I care if they are engaged

Ultimately, your organization is only as strong as your team. Whether you have golden faucets in a hotel or the latest medical tech in a hospital, it is the how – the human connection – that defines success.

From Psychological Safety to High-Performance Teams – The Growth Zone™

If you want to learn how to measure team dynamics and work developmentally with organizations to create High-Performance Teams, I invite you to equip yourself with the tools that make this measurement possible. As a certified provider, I offer licensing courses for the ICQ Global toolkit, including Growth Zone™ – a framework specifically designed to define and track high-performance parameters. This allows you to build every development program on hard data, not hypotheses.

Growth Zone™ makes the “soft” and elusive aspects of teamwork visible, providing concrete, numerical, and practical insights.

Who is Growth Zone™ for?

Trainers and Coaches looking to enrich their portfolio with professional, credible diagnostics.
HR and L&D Professionals focused on building effective and healthy work environments.
Leaders who need measurable evidence that their development initiatives are delivering real results.

If you want to work with this tool independently – you can obtain a license from me.

If you want to see how Growth Zone™ can support your organization – I invite you to collaborate with ETTA. Go Global, where we implement full diagnostic and development projects.

Curious about how Growth Zone™ can change the way your team or your clients work? Get in touch – I would be delighted to share more!

Thank you!

Photo by Vladimir Fedotov on Unsplash

The Science of Team Performance – Why Psychological Safety is Critical in Medicine - ASA 23