Understanding psychological safety and developing leadership capability across mental health services
By Simon Giffin, Chief Executive Officer, Greybeard Healthcare Consulting in conjunction with Data Drives Insights
July 2026
Context and Objectives
Dubai Health is an integrated academic health system whose purpose is to elevate the standard of care; it comprises six hospitals, 26 ambulatory health centres and 21 medical fitness centres. For some time, it had been considering how to examine Psychological Safety in the workplace at its various facilities. This followed recent sentinel events in which investigations had shown that one potential root cause was the perceived inability to speak up when something looked out of place. It raised the key question “how psychologically safe do our teams feel in practice and not just in policy?”
Greybeard Healthcare Consulting (Greybeard) and its partner Data Drives Insight (DDI) had been talking to Dubai Health about the possibility of introducing some of their Team and Leadership diagnostic tools which are aimed at helping understand and improve Team Performance, Psychological Safety and Leadership Development and are specifically designed for the healthcare sector. A pilot program was subsequently agreed with the Paediatric Mental Health team; this team was selected as they had demonstrated a particularly elevated level of engagement, openness to learning and willingness to participate in a new approach.
Rather than relying on anecdotes or informal impressions, the decision was taken to adopt a structured, evidence-based approach. The intention was not to label the culture as “good” or” bad,” but to understand where psychological safety was strong, where it was more fragile, and how it varied depending on context.
We agreed to pilot the Team Excel tool as a way of supporting this exploration. Specifically, the objectives were:
- To create a safe and anonymous channel for staff to share their lived experience
- To map psychological safety within teams and across organisational boundaries, distinguishing local safety from interface safety
- To support leadership reflection on how everyday behaviours shape safety, trust, and escalation
- To test a repeatable, pulse-based model that generates insight over time.
From the outset, this was positioned as a patient safety and cultural learning intervention. It was not intended as a compliance requirement, a performance audit, or a one-off engagement activity. The work was undertaken between September 2025 and January 2026.
Defining Psychological Safety
Organisations across many sectors are increasingly focusing on creating a psychologically safe work environment as a way of developing a learning culture and achieving high performance. At its core, psychological safety is the shared belief that it is safe to speak up, raise concerns, admit mistakes, and respectfully challenge ideas, without fear of humiliation, blame, or exclusion.
For Dubai Health, this is not an abstract concept. It connects directly to patient safety: whether a junior clinician will escalate a concern across a team boundary, whether a nurse will challenge a senior decision in a review setting, and whether staff will raise a near-miss without fear of blame. These are governance and safety behaviours, and they are all shaped by psychological safety.
Methodology and Approach
We deliberately kept the approach light-touch but rigorous. At the centre of the pilot was the Team Excel Psychological Safety and Inclusivity Pulse, a short survey designed to explore experiences across three complementary lenses:
- Psychological safety within teams
- Psychological safety outside teams, across the wider organisational system
- Psychosocial risk factors that influence wellbeing and performance
Two pulse surveys were conducted at different points in time. This allowed us to move beyond a single moment and look for patterns, consistency, and stability in the data.
Each pulse was followed by a facilitated debrief session with the team. These sessions were critical. The data was not presented as a set of scores to be judged, but as information to be interpreted collectively. The focus of these conversations centred on questions such as:
- What stands out to you?
- What feels accurate or familiar?
- What helps explain your day-to-day experience?
Alongside the surveys and debriefs, short micro-learning resources were made available to support reflection and learning between pulses. These were designed to be brief and practical, reinforcing key concepts without adding burden.
In addition, seven leaders were selected to trial the Health Leads leadership capability assessment tool. The leaders assessed themselves across 50 criteria and were given feedback by their manager, peers, and subordinates; this allowed them to understand both core strengths and areas for development in their leadership style.
This approach and why this is different is captured in the graphic below: –
What the Results Showed
The main finding from the program reinforced the view that Psychological Safety is strong within teams but more fragile at organisational interfaces – and this is where patient safety risk sits.
One of the most striking aspects of the pilot was how consistent the findings were across both pulse surveys. Rather than fluctuating, the data told a coherent and stable story. Across all three lenses within-team safety, cross-team safety, and psychosocial risk scores varied by no more than 2% during the five months of the study. This level of consistency is significant: it suggests the findings reflect embedded cultural patterns rather than short-term fluctuations. The dial graphics below show the January 2026 scores with the change from September 2025 in parentheses: the line graphs beneath each dial plot both data points over time. A team performing above average will score above 50% for “Inside my Team” and “Outside my Team”, and below 50% for the psychosocial risk measure (where a lower score indicates fewer risk factors present). The DH Paediatric Mental Health team performed above average across all three measures.
The scores on the dial represent the survey scores from January 2026, with the change against the same survey in September 2025 in parentheses. The line graphs below plot the two sets of results over time. Response rates were also reasonably consistent with 13 people in the fist survey and 17 people in the second survey.
Psychological Safety Within Teams
Within immediate teams, psychological safety was generally strong. People described feeling respected, supported, and able to speak openly with colleagues they worked closely with. This aligned closely with what we observed during facilitated sessions, where discussion was open, reflective, and constructive, and was strong validation of the cultural investment the team had made over the preceding months.
Psychological Safety Across Teams and the Wider System
The picture became more complex when we looked beyond immediate teams.
Across both pulses, staff reported being more cautious when working across team boundaries, interacting with unfamiliar colleagues, or engaging within hierarchical or formal organisational settings. As Dr Hesham Abdalla, Director of Quality and Patient Safety for Dubai Health reflected following the second pulse:
“The results suggest strong local psychological safety within teams, but more mixed and fragile perceptions when working across teams and with the wider system.”
This insight helped sharpen the leadership conversation. It highlighted that psychological safety is contextual, and that people assess whether they feel safe to speak up depending on who is present and how power and accountability are experienced.
From a patient safety and quality perspective, this distinction is critical. As Dr Hesham noted: “This is exactly where many of the real risks sit, at interfaces between teams.”
Behind each overall score, results were presented by question (not shown here for confidentiality reasons). Reviewing this information in a workshop setting allowed the teams to understand where cross-team and hierarchical fragility manifests and discuss ideas to address this; for example, did people feel listened to? were new ideas welcomed? were people willing to share concerns?
Psychosocial Risk Factors
Examples of the psychosocial risk factors included how well people felt they were rewarded and valued, how included they felt, and how manageable the workload was… For Dubai Health, the psychosocial risk indicators remained largely within acceptable ranges but at the same time, the data pointed to three consistent underlying pressures that warrant attention not as complaints, but as structural intelligence about the realities of working in mental health services.
The consistency of these indicators across pulses suggested that these pressures were systemic rather than episodic. This reinforced the value of monitoring experience over time rather than relying on one-off assessments.
Workshop Activity
Three working sessions were carried out in total as part of this process – an initial launch meeting and two working sessions to review the results from the survey and to generate and discuss ideas about: what are our strengths? what should we keep doing? where do we have gaps? and what can we do to close them?
Some of the results of these discussions are presented below:
Things to keep doing / focusing on
- Respect and a genuine no-blame culture.
- Adaptability and flexibility.
- Team collaboration and relational connection.
- The “coffee test”: a team that genuinely wants to spend time together.
Ideas for improvement
- Team-building activities every two months — strengthening cross-team relationships.
- Quarterly and monthly recognition — specifically including the nursing team.
- Building bridges between teams — intentional contact at departmental interfaces.
- Staff well-being clinic.
- Complaint triage — reducing individual burden and clarifying ownership.
- Sickness cover improvements (locums and incentives).
- Monthly updates at Mental Health governance rounds.
- Opportunities for specialisation.
These actions were generated by the team and not prescribed from outside. That is the difference between a genuine cultural intervention and an engagement exercise.
Behavioural shifts observed across the pilot:
Constructive dissent was voiced in working sessions and welcomed. Dialogue matured between the two pulses: the second session was noticeably more specific and probing than the first. Leadership conversations shifted from reporting on results to reflecting on their own influence and impact. Team members increasingly framed challenges as systemic rather than individual — a meaningful and observable cultural shift. Many people who participated commented on the openness of the sessions and the value they had got from discussing important cultural challenges in a safe space.
Health Leads leadership capability assessment tool
The Health Leads assessment was run in parallel to the Team Excel survey. Time was allowed for each of the participants to complete their self-assessments, and for their colleagues to complete their part as well. DDI then collated the results for each individual who then had a one-hour debrief with the Greybeard coach to go through the results and identify potential action areas.
Overall, the process was very positively received, especially some of the specific positive feedback from colleagues. Many commented that this was the first time they had been through such an exercise and how valuable it had been for them. In the words of Dr Nadia Taysir Dabbagh, Chief of the Paediatric Mental Health Team “The 360 exercise with 1:1 feedback was very useful for the leaders – for me personally, it helped identify a couple of blind spots”.
Each participant received a comprehensive 24-page report with different data cuts and information summaries. Below is a typical example of one of the outputs – a spider graph against the 50 categories of self-assessment, assessment of others and potential areas of focus for the future: –
The Health Leads assessment works because it creates a multi-source picture of leadership behaviour: how they are experienced by the people above, alongside, and below them. Each leader completed a self-assessment across 50 criteria covering how they invite challenge, handle disagreement, support their team, and model psychological safety in both formal and informal settings. The same 50 criteria were then assessed by their manager, peers, and direct reports independently. The result is a 360° view that makes visible the gaps between self-perception and lived experience and it is precisely in those gaps that the greatest impact on psychological safety is often found.
The individual results for the Health Leads assessment, of course remain confidential and between each leader and their coach. It is possible to present some overall strengths and areas for development which are captured below and reinforce the link to cross team fragility:
Across the cohort, the 360° data reinforced and deepened what the pulse surveys had already suggested: psychological safety is heavily shaped by individual leadership behaviours, particularly in how leaders handle challenge and escalation in hierarchical or formal settings.
Conclusions and Next Steps
This pilot demonstrated the value of using a repeatable, pulse-based approach to understand psychological safety within a complex mental health service, and the value of using leadership diagnostic tools.
The key insights were clear. Psychological safety can be strong within teams while remaining fragile at organisational interfaces. Many of the most significant risks sit between teams rather than within them, across professional boundaries, and within formal governance structures. This shifts the conversation from team culture alone to organisational design, leadership behaviour, escalation processes, and interface safety. Leadership behaviour remains the most powerful lever for sustaining safety over time.
The process was also immensely powerful for the participants. Reflecting on both the group and individual sessions, Simon Giffin, the Greybeard CEO and coach commented “This was an incredibly rewarding process to be part of. The debriefs of the 360 assessment gave great insights to the participants and many were visibly moved when they saw the positive comments from their colleagues – feedback that might otherwise have stayed unsaid. The group sessions were conducted in an incredibly positive spirit with high energy and generated some great ideas to move the team performance to the next level.”
Using Team Excel and the Health Leads assessment tools allowed these insights to surface in a way that was constructive, evidence-based, and respectful of the realities of clinical work. The workshop sessions allow specific ideas for further intervention to be discussed and agreed. The opportunity now lies in spreading this approach to various parts of the organisation, using it to support ongoing leadership reflection, quality conversations, and organisational learning rather than treating it as a one-off pilot.
