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Achieving Psychological Safety in High Reliability Organizations.

Col Ret John S Murray¹, Jeannine Campbell², Stacey Larson³

¹Independent Consultant, Boston, Massachusetts.

Federal Practitioner : for the Health Care Professionals of the VA, Dod, and PHS

|August 20, 2025

Summary

Promoting psychological safety is crucial for high reliability organizations (HROs) in healthcare. Cultivating an environment where staff feel safe to speak up is essential for improving patient safety and outcomes.

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Area of Science:

Healthcare Management
Organizational Psychology
Patient Safety

Background:

The Veterans Health Administration aims to become an enterprise-wide high reliability organization (HRO).
High reliability organizations prioritize safe, high-quality patient care in complex, high-risk environments.
Psychological safety, where team members speak up without fear of reprisal, is integral to HRO success.

Purpose of the Study:

To describe strategies for promoting psychological safety within the Veterans Health Administration.
To enhance patient safety and outcomes by fostering a culture of psychological safety.
To support the Veterans Health Administration's transition to an enterprise-wide high reliability organization.

Main Methods:

Review of initiatives implemented by the Veterans Health Administration.
Description of strategies to cultivate psychological safety.
Focus on fostering a speak-up culture for safety concerns.

Main Results:

The Veterans Health Administration has implemented initiatives to develop psychological safety.
Strategies are available to promote psychological safety in healthcare settings.
Progress requires ongoing effort and purposeful attention.

Conclusions:

Psychological safety is critical for safe, quality healthcare in HROs.
Achieving psychological safety requires time, patience, and active promotion.
Thoughtful strategies are needed to create a culture where staff feel safe to voice safety concerns.