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3 February 2022
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Developing psychologically safe cultures while also commanding and controlling

By Dr Fiona Day

FMLM associate member, executive coach with the FMLM Coaching Network, and former consultant in public health medicine

Providing exceptional clinical care at any time, let alone during a prolonged pandemic, demands exceptional performance from medical leaders and their teams. Exceptional leadership performance is related to the leader’s ability to cultivate a ‘culture of psychological safety’: a culture of valuing and respecting each and every team member - regardless of their individual status in the hierarchy or their individual speciality, because of the knowledge, expertise and opinion which each team member bring. Paradoxically, a ‘command and control culture’ – an appropriate style of leadership in clinical emergencies and incidents – has been shown to adversely impact on cultures of psychological safety. How can medical leaders create a culture of both psychological safety and also command and control?  

Safety seeking behaviours

Human beings have complex psychologies: we are shaped as individuals by evolution,  our genes, and our life experiences to specific patterns of stress responses. This impacts on both our own internal processes and behaviours as medical leaders, and also those of our direct reports, colleagues, and peers. Learning how to manage our internal neurophysiological and psychological processes is vital to ensure that we are effective leaders: our verbal and non-verbal communication is how others will be constantly reading us as they scan their environment for danger.

Psychologically safe leadership behaviours

Two aspects of leadership behaviour have recently been identified as having a direct and/ or indirect effect on psychological safety McKinsey (2021):

  • Supportive leadership behaviours: demonstrate concern for the welfare of team members; create a sense of teamwork and mutual support within the team.
  • Consultative leadership behaviours: ask the opinions of others before making important decisions; give team members the autonomy to make their own decisions, try to achieve team consensus on decisions.

Both these styles of leadership were found to directly and significantly influence ‘a positive team climate’, which is the most important determinant of psychological safety in a team. Authoritative (command and control) style leadership was reported to negatively impact psychological safety.

Both psychologically safe and authoritative

I have found with my senior medical leader coaching clients that it is wholly possible to both lead with authority in a crisis and also create psychologically safe cultures at the same time. To do this requires the highest calibre of leader who develops – and then continually refines - their own exceptional emotional regulation and emotional intelligence skills. 

The role of the coach is to create a psychologically safe space for you as a leader and to help you to develop the skills you need to lead effectively. This level of leadership development is most effective when taught at a 1:1 level rather than a group context or a course - due to the level of vulnerability and reflection needed to really work effectively at one’s emotional and sensory/somatic levels.

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’ even during a time of crisis.


Jonathan Emmett, Gunnar Schrah, Matt Schrimper, and Alexandra Wood, “COVID-19 and the employee experience: How leaders can seize the moment,” June 2020,; Tera Allas, David Chinn, Pal Erik Sjatil, and Whitney Zimmerman, “Well-being in Europe: Addressing the high cost of COVID-19 on life satisfaction,” June 2020,

Nembhard, Ingrid & Edmondson, Amy. (2006). Making It Safe: The Effects of Leader Inclusiveness and Professional Status on Psychological Safety and Improvement Efforts in Health Care Teams. Journal of Organizational Behavior. 27. 941 – 966. 10.1002/job.413.

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