Diagnosing Psychological Safety

The Organization That Needed Both Approaches

Take a teaching case: a community health centre in trouble. Over three years, psychological safety scores had declined by 26%. Annual turnover had reached 31%. Attrition was disproportionately concentrated among racialized employees. The organization employed 18 supervisors and approximately 160 employees, with annual funding of about $14M CAD.

Exit interviews told a consistent story: inadequate support, feeling dismissed by leadership, unresolved interpersonal conflict. The data was clear about what was happening. It was not clear about what to do.

The organization faced a diagnostic dilemma that many HR leaders will recognize. A problem-based assessment would identify what was broken — but risked deepening the demoralization already present. A strengths-based assessment would build engagement — but risked overlooking the structural conditions driving people out the door.

The Case for Problem-Based Discovery

Block (2011) describes the traditional diagnostic model, borrowed from medicine: diagnose the problem, give a prognosis, offer a prescription. Its strength is that it takes the presenting symptoms seriously. When employees say they feel dismissed, a problem-based assessment asks: by whom, in what contexts, and through what specific behaviours?

Problem-based discovery is particularly important when the damage is structural. The community health centre was not dealing with a morale problem that a positive messaging campaign could address. It was dealing with measurable patterns of supervisory behaviour, policy gaps, and institutional responses that were producing predictable attrition among specific employee populations.

Edmondson (1999) explains why people hold back: asking for help, admitting errors and seeking feedback all carry an interpersonal risk, so “people in organizations are often reluctant to disclose their errors.” Call the result protective withdrawal — staff limiting their contributions when interpersonal risks feel too costly. In healthcare it reaches patients. Edmondson recalls an earlier study of hospital teams in which, in some teams, members “kept their knowledge of a drug error to themselves”; a review of the healthcare evidence finds that psychological safety “supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors” (O’Donovan & McAuliffe, 2020). A strengths-based approach that asks “what are we doing well?” without first addressing the conditions driving protective withdrawal risks being experienced as dismissive by the employees who are already withdrawing.

Key Research Finding: Edmondson (1999): because asking for help, admitting errors and seeking feedback carry an interpersonal risk, “people in organizations are often reluctant to disclose their errors.” In an earlier study of hospital teams she describes, members of some teams “kept their knowledge of a drug error to themselves.” Assessment must name these patterns before it can address them.

The Case for Strengths-Based Inquiry

Problem-based assessment identifies what is broken. It may not, by itself, generate commitment to change. Appreciative Inquiry takes the opposite approach: begin with what works, amplify it, and build forward (Miglianico et al., 2025).

The evidence supports this approach — with caveats. Virga and colleagues (2023) pooled 21 controlled trials of interventions that help employees use their strengths at work. They found small but significant gains in workplace well-being, which includes work engagement (d = 0.31 straight after the intervention, 0.27 at follow-up), and in self-reported performance (d = 0.28 straight after, no longer significant at follow-up). These programmes work with individual employees, not a whole organization.

The limitation is equally clear. Strengths-based inquiry, applied to an organization where specific groups of employees are experiencing systemic harm, can feel invalidating. Asking “what’s working well here?” of an employee who has just watched three colleagues of colour leave in six months is not appreciative. It is tone-deaf.

The Grey Zone: Integrating Both Approaches

Gilpin-Jackson and Crump (2018) describe a “grey zone” between diagnostic and dialogic organizational development — a space where practitioners combine problem identification with appreciative engagement. This integrated approach recognizes that real organizations are not purely broken or purely functional. They contain both — often in the same department, the same team, the same meeting.

The evidence leans the same way, though no study has tested integrated discovery against either approach alone. A review of fourteen interventions to improve psychological safety and speaking up in healthcare found mixed results: improvements in some, but not consistently across them, and education alone struggled to change “deeply rooted speaking up behaviours”. To learn what works, the authors concluded, “longitudinal and multifaceted interventions are needed” (O’Donovan & McAuliffe, 2020).

Key Research Finding: O’Donovan and McAuliffe (2020) reviewed fourteen interventions to improve psychological safety and speaking up in healthcare. Results were mixed; to learn what works, they concluded, “longitudinal and multifaceted interventions are needed.” Gilpin-Jackson and Crump (2018) describe a “grey zone” between diagnostic and dialogic OD, where the practitioner moves along the continuum “as appropriate to the circumstance.”

Five Discovery Questions That Bridge Both Approaches

Effective organizational diagnosis requires questions that surface problems without creating defensiveness, and identify strengths without dismissing harm. Five questions can structure this dual inquiry:

1. What conditions would need to be present for every employee to feel safe raising concerns about their direct supervisor? This surfaces psychological safety barriers without asking employees to name specific perpetrators.

2. When you have seen a conflict resolved well in this organization, what made that possible? This identifies existing capacity while implicitly acknowledging that conflict exists and is often resolved poorly.

3. What prevents the best practices in your strongest team from spreading to other teams? This validates strength and diagnoses systemic barriers simultaneously.

4. If you could change one thing about how leadership responds to employee concerns, what would it be? This is direct enough to surface real problems and specific enough to generate actionable data.

5. What would need to change for employees who have left to have stayed? This uses attrition data — which the organization already has — as the foundation for forward-looking intervention design.

The Role of Inclusive Leadership

Shore and Chung (2022), reviewing the research on inclusive leadership, suggest that psychological safety “is particularly important for minority employees,” and that inclusive leadership “can play a major role in encouraging psychological safety for people of color.” This finding is critical for the community health centre scenario, where attrition was disproportionately concentrated among racialized employees.

Inclusive leadership is not a general management competency. It is a specific set of behaviours. Shore and Chung, drawing on Randel and colleagues, name five: supporting group members, ensuring justice and equity, sharing decisions, encouraging diverse contributions, and helping every member contribute fully. Because they are behaviours, they can be measured: the studies Shore and Chung review used a scale that asks employees whether, for example, “The manager is open to hearing new ideas.”

The working alliance matters too. In coaching, Graßmann, Schölmerich and Schermuly (2020) pooled 27 samples and found a moderate, consistent relationship between the quality of the coach–client working alliance and the client’s outcomes (r = .41). Organizational diagnosis is not coaching, but the parallel is worth taking seriously: how the assessment is conducted — the trust built with leadership, the transparency of the process, the perceived fairness of the methodology — is likely to shape whether the findings are acted upon.

From Diagnosis to Intervention Design

Assessment that combines problem-based and strengths-based approaches is likely to produce a more complete picture than either alone. It identifies the structural conditions driving harm while also mapping the existing organizational resources that can be mobilized for change.

In the case, the centre needed to know whether supervisory behaviour was driving attrition among racialized employees. It also needed to know which supervisors were doing it well — because those supervisors hold the operational knowledge that an intervention can build from.

Assessment without intervention design is academic. Intervention design without rigorous assessment is guesswork. You need both — that is the argument of this piece — and the quality of the diagnostic process is likely to shape the quality of the outcomes it produces.

References

Block P. Flawless Consulting: A Guide to Getting Your Expertise Used. 3rd ed. Pfeiffer; 2011.

Edmondson A. Psychological safety and learning behavior in work teams. Administrative Science Quarterly. 1999;44(2):350-383. doi:10.2307/2666999

Gilpin-Jackson Y, Crump M. Practicing in the grey area between dialogic and diagnostic organization development: lessons from another healthcare case study. OD Practitioner. 2018;50(4):41-47.

Graßmann C, Schölmerich F, Schermuly CC. The relationship between working alliance and client outcomes in coaching: a meta-analysis. Human Relations. 2020;73(1):35-58. doi:10.1177/0018726718819725

Miglianico M, Dubreuil P, Miquelon P, et al. Appreciative inquiry and strengths development in the workplace: a dual comparative study. Journal of Positive Psychology. 2025;20(2):291-304. doi:10.1080/17439760.2024.2362433

O’Donovan R, McAuliffe E. A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour. BMC Health Services Research. 2020;20(1):101. doi:10.1186/s12913-020-4931-2

Shore LM, Chung BG. Inclusive leadership: how leaders sustain or discourage work group inclusion. Group & Organization Management. 2022;47(4):723-754. doi:10.1177/1059601121999580

Virga D, Rusu A, Pap Z, et al. Effectiveness of strengths use interventions in organizations: a pre-registered meta-analysis of controlled trials. Applied Psychology: An International Review. 2023;72(4):1653-1693. doi:10.1111/apps.12451