Improving Retention By Prioritizing Psychological Safety

Physical safety is a known concern in the home-based care industry, but another concept is gaining attention for its potential to boost retention and job satisfaction: psychological safety.

A feeling of being psychologically unsafe can be caused by tension between coworkers or feeling threatened in some manner. Psychological safety involves feeling comfortable speaking up, asking questions, admitting mistakes and raising concerns without fear of negative consequences like humiliation, punishment or retaliation. Fostering a psychologically safe workplace can improve home-based care workers’ feelings of security and encourage employee loyalty, according to experts.

“The idea of psychological safety is relatively new and evolving in our workplaces and explicitly in home-based care,” Dr. Danielle Pierotti, director of undergraduate studies at the School of Nursing at Idaho State University in Pocatello, told Home Health Care News. “There are a lot of risks to home-based care workers. They work in isolation and in settings that are not regulated.”

Pierotti said the fundamental approach to psychological safety in a home-based care organization is about creating an environment where the team can ask for guidance and assistance due to the risks they face when entering the home.

When caregivers feel psychologically safe, they experience less stress and burnout, according to Dr. Michael Markopoulos, medical director of Coastal Detox of Southern California, who has previously treated caregivers for various conditions related to psychological safety.

They are more likely to feel a sense of belonging and value within their team and organization, which increases job satisfaction and morale. This sense of security enables them to be more resilient and proactive in their roles, leading to improved mental and emotional well-being.

“A psychologically safe environment directly improves care quality,” Markopoulos told HHCN. “Caregivers who feel safe are more willing to report near misses or errors, which allows the agency to address systemic issues and prevent future harm. They also feel more comfortable about asking for help or clarification on complex care plans, ensuring they provide the correct care. This transparency and open dialogue lead to more effective problem-solving and innovation in care delivery.”

Coastal Detox is an addiction treatment center located in San Diego, California, providing medical detox, dual diagnosis and residential care for drug and alcohol addiction.

Improving retention and job satisfaction

Fostering psychological safety greatly benefits caregiver retention and overall job satisfaction. When caregivers feel psychologically safe, they’re more likely to stay with their agency and view their work positively, according to Markopoulos.

“Psychological safety directly addresses key drivers of turnover in the home care industry — burnout and stress,” Markopoulos said. “When caregivers feel they can openly discuss challenges, ask for help or report mistakes without fear of punishment, they experience a significant stress reduction. They feel supported by their team and leadership, which acts as a buffer against the high demands of the job.”

A supportive environment fosters a stronger sense of job embeddedness, making employees less likely to leave their jobs. They develop a sense of belonging and loyalty to an organization that values their well-being, according to Markopoulos, which serves as a powerful tool for retention. Conversely, a lack of psychological safety contributes to a culture of silence, blame and fear, all of which are significant factors in burnout and lead to high turnover.

“People recognize when they’re being well cared for, when they have a leader who is a true advocate and cares about their psychological safety,” Wendie Colvin, American Nurses Credentialing Center Program Director and nurse educator at Activated Insights, said. “Just like a client who receives excellent care and feels happy and thankful, employees who know they have support are more likely to stay and be dedicated team members.” 

Rexburg, Idaho-based Activated Insights is a software company serving the post-acute and long-term care industries. 

Colvin said that when she worked as a manager in home care settings, she would tell her employees to come to her if they had a problem or needed to talk. She also told them to leave a client’s home if they felt unsafe and promised they would never get in trouble for doing so – emphasizing that they should never put themselves in danger.

“Say those words out loud and talk to your staff,” she reiterated. “Have routine conversations about what it means to feel psychologically safe and unsafe. … They will respect you and, more often than not, have a stronger sense of pride in their work, more confidence to work independently, and feel more comfortable coming to you when a situation does feel unsafe.”

According to Colvin, psychological safety is a vital part of a positive work environment and is essential for job satisfaction. When caregivers feel secure, they become more engaged and committed. They take pride in their work because they know their voice is heard. Instead of worrying about their own protection, they can focus their energy on providing the best care for their clients, which boosts their sense of purpose and fulfillment. A psychologically safe workplace promotes professional growth, learning from experience and thriving in their roles— all of which are crucial for high job satisfaction.

Identifying problems

According to Markopoulos, several key indicators can reveal whether an agency’s caregivers feel psychologically safe. 

Caregivers who feel psychologically safe openly share ideas, concerns and feedback during meetings or one-on-one conversations with their supervisors, Markopoulos said. They also feel comfortable admitting errors without fear of severe reprimand, instead focusing on learning from their mistakes.

They frequently ask clarifying questions about care plans, equipment or patient needs without hesitation and actively participate in team discussions and agency initiatives. They also respectfully disagree and debate different approaches to care.

Signs that caregivers do not feel psychologically safe include silence in group settings, a tendency not to admit mistakes or blame others, hesitations to ask for help or admit they don’t know something and sharing information through unofficial channels or displaying distrust in leadership or peers.

Agencies can effectively evaluate the psychological safety of their caregivers through a comprehensive approach, Markopoulos said.

Anonymous surveys that ask specific questions about team dynamics, communication and fear of speaking up can often uncover core issues. Questions about how comfortable team members are asking for help or admitting mistakes without fear of punishment are especially important.

Small, moderated focus groups with a mix of caregivers from around the agency may help individuals feel more comfortable sharing ideas and giving feedback. A skilled facilitator can create a safe space for employees to share their experiences honestly.

Supervisors should regularly schedule private, non-evaluative check-ins with caregivers. During these conversations, they should ask open-ended questions to explore challenges or ideas for improving the agency. Supervisors should also sincerely listen to the answers and not just go through the motions, according to Colvin. 

“Ask your employees if they feel safe,” Colvin said. “It seems too simple, but ask. Send a confidential survey, sit with people one-on-one, take an open poll at a staff meeting and start a conversation. You must be open and willing to ask hard questions, even if it means you get hard answers in return. Your employees need to know that you are worried about their psychological safety.” 

Learning from leadership

Markopoulos stated that the most effective ways to promote psychological safety are those that are consistently implemented and demonstrated from leadership down.

Leaders should aim to foster a “no-blame” culture. When an error happens, the priority should be understanding why it occurred rather than assigning blame. A helpful approach is to hold a blameless debriefing to identify systemic issues and avoid future mistakes, Markopoulos said. Leaders should also acknowledge their own errors and share what they’ve learned from them.

“Leadership is the most important factor in creating a psychologically safe environment,” Markopoulos said. “Leaders set the cultural tone. If a leader is defensive or punitive, caregivers will be afraid to speak up. If a leader is approachable and transparent, caregivers will follow that lead.”

Activated Insights recently surveyed caregivers, asking them to rate whether they felt safe while caring for someone, according to Colvin. About 29% said they felt unsafe at least once.

“If a quarter of your staff had an unsafe experience, wouldn’t you want to know?” Colvin asked. “Leaders must listen to the feedback from their employees and find out why they feel unsafe, because it might be something that can be fixed. If you don’t realize that your employees are experiencing psychological distress, then you can’t address the problem and may unintentionally create a toxic environment.”

Leaders are responsible for “weaving and maintaining the fabric of safety” in the workplace, according to Colvin. Every decision they make – whether arranging for specific individuals to be absent during care, ensuring a pet is secured or negotiating safer home conditions – must involve adding another strong thread.

“[Their] role is to reinforce that fabric so employees know they are supported and can trust it will hold them if they face challenges,” she said.

Leaders are also responsible for building relationships with new employees to ensure that those coming on board feel safe and comfortable speaking up if an unsafe situation presents itself.

“It’s harder to get your arms around psychological safety in home-based care because of the way caregivers work; they’re so isolated,” she said. “It’s also a challenge because there are often organizations that never get physically together, they may not have staff meetings in person, and it’s harder to develop the kind of trust required for true psychological safety within that team, so the manager must lead the charge.”

Implementation challenges and overcoming them

Agencies may encounter several challenges when trying to improve psychological safety, but they can be addressed with a strategic and patient approach. The main obstacles often involve changing established cultural norms, managing limited resources and rebuilding trust that may have been lost over time, according to Markopoulos.

To address resistance, agencies should start with small, manageable steps. Instead of a complete overhaul, providers can begin by implementing a safety moment at the start of a team meeting where everyone shares a small challenge or success. Two effective tactics include celebrating early wins to build momentum and demonstrate that the new approach is effective and involving caregivers in designing these initiatives to gain their buy-in and make them feel part of the process.

Agencies should incorporate psychological safety practices into their current workflows, according to Colvin. For example, a supervisor can spend a few extra minutes at the end of a check-in to ask about any safety concerns. The aim is to integrate these practices smoothly so they don’t feel like separate, time-consuming tasks.

Rebuilding trust requires time and steady action, Markopoulos said.

“Leaders must demonstrate the desired behavior by being vulnerable and owning their mistakes,” he said. “It’s essential for leaders to follow through on their commitments consistently. If a caregiver raises a concern, the leader must address it and communicate the outcome to the caregiver. This consistency over time will show that the agency is genuinely committed to change and that caregivers can feel safe speaking up.”