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Communication influences virtually everything that happens within a practice – and the number of interactions that occur between dental office team members throughout a day are virtually impossible to quantify.

When you consider communication within your own practice, try to recall the last time you heard someone in your practice say, “That's a great idea!”

Given the sheer volume of communication that occurs in a dental practice, this phrase should be common among practice teams. But if you haven't heard this phrase recently (or ever) within your practice, it probably comes down to three things:

  1. You're not surrounded by the right people.
  2. You're not a good listener.
  3. You're not a good leader.

Don't panic. All of these are symptoms of a single underlying issue: A lack of psychological safety in your practice. In fact, you may be inadvertently disincentivizing psychological safety with your team – and consequently undermining practice growth and performance.

Back in 2010, I was in this same position within my own practice. At the time, I was traveling frequently for lectures around the world – I would spend the limited time I had in the practice doing my best to treat patients with a profoundly unmotivated team.

Not only did I rarely hear someone say “that's a great idea” during the day, the term psychological safety was not on my radar. I lived under the delusion that my team knew what was going on in my mind and vice versa. Of course, nothing could have been further from the truth.

While I spent countless hours educating and inspiring dentists abroad, lethargy and lack of enthusiasm permeated my office at home. Worse yet, I was solely responsible for the situation because I was not allotting any of my time to teach nor inspire anyone within my team.

This changed when I came across a copy of Patrick Lencioni's bestselling book, The Five Dysfunctions of a Team, which defines those five dysfunctions as:

  1. Lack of trust
  2. Fear of conflict
  3. Lack of commitment
  4. Avoidance of accountability
  5. Inattention to results

I realized my team had a perfect score – 5 out of 5!

On the bright side, I finally had a diagnosis for what was happening in my practice. I knew communication among the team was largely dysfunctional or completely non-existent – and that this was the issue behind the team's lack of motivation.

In the months that followed, I embarked on a practice renovation journey designed to improve communication and engagement in our practice. My efforts to foster team psychological safety were instrumental in transforming a group of unmotivated staff into a high-performing practice unit. So why (and how) did psychological safety impact my efforts to motivate my team?

Why psychological safety matters for high-performing teams

“People must be allowed to voice half-finished thoughts, ask questions out of left field, and brainstorm out loud in order to create a culture that truly innovates.”
–Dr. Amy Edmonson
People sitting around a table with coffee, laughing and smiling

In a recent article about creating a new vision for your dental practice, I discussed the concept of F.L.O.W. (Focus on Letting Others Win) which noted how practice owners must highlight individual contributions so everyone recognizes their impact on the bigger picture.

Of course, it's impossible for practice owners to highlight individual contributions if there aren't any contributions to highlight. This happens when team members fear being embarrassed or punished for speaking up.

The construct of 'team psychological safety' was first introduced by Harvard scientist Dr. Amy Edmonson in 1999, who defined this as “a shared belief held by members of a team that the team is safe for interpersonal risk taking.”1 When psychological safety is high, teammates feel confident that no one on the team will embarrass or punish anyone else for admitting a mistake, asking a question, or offering a new idea.2

In her book The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth, Dr. Edmonson explains why this matters for leaders: “People must be allowed to voice half-finished thoughts, ask questions out of left field, and brainstorm out loud in order to create a culture that truly innovates.”3

The link between psychological safety and team performance is best illustrated by a 2012 Google research initiative (code-named Project Aristotle) that uncovered the secrets of effective teams. After analyzing countless interviews, survey responses, and employee datasets, Google researchers concluded that the single most important factor that differentiated high-performing teams from the rest was the presence of psychological safety.2

Communication influences everything that happens in a dental practice, and this research strongly suggests that high-performing teams depend on open communication to succeed. It stands to reason that practice owners who actively nurture a sense of psychological safety will have more enjoyable, productive and effective days in the dental practice.

Let me give you an example from my own practice.

Two women in lab coats working with a sample in a dental office

One evening while my team was wrapping up from a busy working day and preparing for the following day's appointments, a team member asked me to review preps in our IOS Primescan prior to fabrication for a patient. During the conversation, he indicated areas he believed the prep could be improved. Incidentally, the team member who created the prep design was also sitting nearby and quietly listening in.

Shortly after the conversation, this other team member approached me and said, “Since you were both discussing my prep design, it would have been so much better had you invited me into that conversation.”

While I understood her perspective, I also recognized that a perceived lack of psychological safety was the core of the issue.

Thankfully the issue didn't escalate. One of my most profound realizations as a practice leader is that fostering psychological safety through team-building efforts must be among my primary goals. Because of the work we had done together, we were able to align shortly after to review preps and discuss potential improvements collectively.

The imperatives of psychological safety

“...When people don't feel comfortable talking about initiatives that aren't working, the organization isn't equipped to prevent failure.”

While there are certainly benefits associated with promoting psychological safety within a team, there are also risks in failing to foster this type of culture.

According to the Center of Creative Leadership, “A lack of psychological safety at work has major […] repercussions. First, when people don't feel comfortable talking about initiatives that aren't working, the organization isn't equipped to prevent failure. And when employees aren't fully committed, the organization has lost an opportunity to leverage the strengths of all its talent.”2

When I hear practice owners complain about staff turnover and hiring scarcity in the wake of the COVID-19 pandemic, only one question comes to mind: What are we doing to make our dental practices appealing places to work?

Research makes it clear how psychological safety plays a role in finding and keeping the right people. Google has created one of the world's most sought-after working environments by embracing team psychological safety. The same is possible for dental practice owners.

Consider the last time you heard someone in your practice say: “That's a great idea!” How frequently you hear those words is a litmus test for psychological safety within your team. What are you doing to promote it within your practice?

Ricardo Mitrani, D.D.S., M.S.D., is a member of Spear Resident Faculty.


  1. Edmondson, A. Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly 1999; 44(2), 350-383. doi:10.2307/2666999https://rework.withgoogle.com/print/guides/5721312655835136/
  2. What is psychological safety at work? CCL. https://www.ccl.org/articles/leading-effectively-articles/what-is-psychological-safety-at-work/. Published July 6, 2021. Accessed July 29, 2021.
  3. Edmondson AC. The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. Hoboken, NJ: Wiley; 2019.


Commenter's Profile Image Michael M.
August 6th, 2021
Love this Ricardo. 3 weeks ago we had an all day team meeting and our focus was overcoming the 5 dysfunctions of a team. Starts with Vulnerability based Trust. People can’t be vulnerable though if there’s a lack of psychological safety. Ultimately a lack of the vulnerability based trust and safety leads to a bunch of team members that are hiding their true feelings (cause they don’t feel safe enough to bring them up).
Commenter's Profile Image Ricardo M.
August 7th, 2021
Thanks for your comment Michael, I fully agree with you. We all need to be aware of that vulnerability based trust that you talk about.