Self-awareness as the missing link in psychological safety: how leadership awareness connects behaviour, emotions, and team voice in healthcare.

Research clearly shows that teams function better when people feel safe to speak up, ask questions, and admit mistakes (Edmondson, 1999; Edmondson & Lei, 2014). Yet, while psychological safety, leadership behaviour, and emotional intelligence are all well studied, they are often discussed separately. This raises the question: What connects leadership traits to psychological safety in everyday practice?

This blog post, that is based on the master thesis How psychological safety is created or damaged in healthcare teams: the role of leadership traits and self-awareness (Gudre, 2025) explores if leader self-awareness may be that missing link. Not as a new concept, but as a mediating process that determines how healthcare teams experience leadership behaviours.

Psychological safety is created in small moments

Psychological safety is not created by policies or value statements on the wall. It is created, or damaged, during daily exchanges: a calm response to a concern or a defensive reaction to a question; a leader who listens, or a leader who dismisses (Edmondson & Lei, 2014; Konečná et al., 2026). Research consistently shows that leadership behaviour is one of the strongest predictors of psychological safety in teams (West et al., 2017; Dixon-Woods et al., 2022). When leaders react with respect and openness, team members are more likely to speak up. When reactions are punitive or unpredictable, silence follows. Importantly, silence does not mean lack of care. It often means fear. In healthcare, this has serious consequences. Unspoken concerns can delay learning, increase errors, and undermine both staff wellbeing and patient safety (Dixon-Woods et al., 2022).

Self-awareness as a mediating factor

Self-awareness itself is nothing new. It is a well-established component of emotional intelligence (Goleman, 1995; Boyatzis et al., 2000), and connects leadership behaviour and psychological safety. Just like everyone else, leaders experience stress, frustration, uncertainty, and pressure. The difference is whether they notice how these feelings shape their behavior (Konečná et al., 2026). Self-aware leaders are more likely to pause before reacting, reflect on feelings, repair situations when things go wrong, and modify their behaviour in response to feedback (Goleman, 1995). Without self-awareness, even well-intentioned leaders can unintentionally create fear or withdrawal in their teams. This helps explain why similar leadership traits can have very different effects. For example, assertiveness can feel helpful in one moment and threatening in another. The difference is usually not the trait itself, but how the leader uses it. When leaders are aware of their own reactions, they can adjust how they speak and act. This is how self-awareness connects leadership behaviour with psychological safety in regular communications (Boyatzis et al., 2000).

When “dark” traits are not automatically destructive

The literature also points to so-called dark leadership traits, such as dominance, strong confidence, and emotional distance. These traits are often seen as harmful, particularly when leaders are not aware of how they affect others. (O’Boyle et al., 2012). However, several studies suggest a more nuanced picture. In stressful circumstances, some of these traits can support decisiveness and clarity, especially in crises (Vergauwe et al., 2018; Raineri & Cartes, 2024). Again, the key difference is self-awareness. Without reflection, these traits weaken trust. By raising awareness, they can be redirected in a more constructive direction. This does not mean excusing harmful behaviour. It means understanding why awareness matters so much in forming leadership impact (Vergauwe et al., 2018).

The pressure placed on healthcare leaders

The thesis also shows how idealised leadership often is in healthcare (Gudre, 2025). Many models describe leaders as emotionally balanced and endlessly resilient. Real life looks very different. Healthcare leaders work under intense pressure, juggling team responsibility, staff shortages, administrative tasks, and moral stress, often simultaneously (Ahokas et al., 2025). Expecting leaders to always remain calm, reflective, and emotionally available without adequate organisational support can feel almost superhuman (West et al., 2017). This highlights an important societal implication: psychological safety cannot be carried by individual leaders alone. Organisational culture, workload, and support structures have a key part in enabling or undermining psychologically safe leadership (Edmondson and Lei, 2014).

What can be done in practice?

Based on the findings of Gudres (2025) thesis, multiple applicable results emerge.

For leaders:

• Developing self-awareness is not a “soft extra”, but a core leadership skill.
• Reflection and feedback create space for repair, not perfection.
• Paying attention to emotional impact, not only outcomes, strengthens trust.

For organisations:

• Psychological safety requires shared responsibility.
• Leadership development should integrate emotional and relational dimensions.
• Leaders need support systems, not just expectations.

Small changes matter. How meetings are run. How mistakes are discussed. How leaders respond under pressure. These moments shape whether people speak or stay silent. Psychological safety is not an unrealistic concept. It is created moment by moment.

To conclude, the findings presented here does not introduce new concepts but instead points out a new connection: self-awareness as a mediating process linking leadership behaviour to team psychological safety. In healthcare, where the stakes are high and emotions run deep, this connection is crucial. Perhaps the most important question is not whether leaders are skilled enough, but whether they are supported enough to remain aware, human, and present. If we want safer healthcare systems, we must care not only about what leaders do, but also about the conditions that allow them to lead with awareness. Moreover, that responsibility belongs to all of us.

Linda Gudre, Master in Healthcare, Arcada UAS
Christoffer Ericsson, Ph.D., senior lecturer, DPD, Arcada UAS
Jonas Danielson, Ph.D., principal lecturer, DPD, Arcada UAS

References

Ahokas, F., Silén, M., Höglund, A. T., & Hemberg, J. (2025). Care leaders' moral distress in older adult care: A scoping review. Nursing ethics, 32(5), 1545–1563. https://doi.org/10.1177/09697330251315939  

Boyatzis, R. E., Goleman, D., & Rhee, K. S. (2000). Clustering competence in emotional intelligence: Insights from the Emotional Competence Inventory. In R. Bar-On & J. D. A. Parker (Eds.), The handbook of emotional intelligence: Theory, development, assessment, and application at home, school, and in the workplace (pp. 343-362). Jossey-Bass/Wiley. 

Dixon-Woods M, Aveling EL, Campbell A, Ansari A, Tarrant C, Willars J, Pronovost P, Mitchell I, Bates DW, Dankers C, McGowan J, Martin G. (2022) What counts as a voiceable concern in decisions about speaking out in hospitals: A qualitative study. J Health Serv Res Policy. Apr;27(2):88-95. doi:10.1177/13558196211043800. Epub 2022 Jan 3. PMID: 34978470; PMCID: PMC8950712

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

Edmondson, A & Lei, Z. (2014). Psychological Safety: The History, Renaissance, and Future of an Interpersonal Construct. Annual Review of Organizational Psychology and Organizational Behavior. 1. 23-43. doi: 10.1146/annurev-orgpsych-031413-091305

Gudre, L. (2025). How Psychological Safety Is Created or Damaged in Healthcare Teams: the Role of Leadership Traits and Self-Awareness. Arcada UAS. https://urn.fi/URN:NBN:fi:amk-2025121938511

Goleman, D. (1995). Emotional intelligence: Why it can matter more than IQ. Bantam Books.

Kadović, M., Mikšić, Š., & Lovrić, R. (2022). Ability of emotional regulation and control as a stress predictor in healthcare professionals. International journal of environmental research and public health, 20(1), 541.

Konečná, L., Lisá, E., & Čiriková, V. (2026). The role of leadership in shaping psychological safety: a qualitative study from Slovakia. Scientific Reports, 16, 7249. https://doi.org/10.1038/s41598-026-38706-1  

O’Boyle, E. H., Forsyth, D. R., Banks, G. C., & McDaniel, M. A. (2012). A meta-analysis of the Dark Triad and work behavior: A social exchange perspective. Journal of Applied Psychology, 97(3), 557-579. https://doi.org/10.1037/a0025679  

Raineri A and Cartes M (2024) Psychological Safety and Work Design as Mediators of Supervisors’ Dark Triad Traits Impact on Nurses’ Task Performance. Int J Public Health 69:1607340. doi: 10.3389/ijph.2024.1607340 

Vergauwe, J., Wille, B., Hofmans, J., Kaiser, R. B., & De Fruyt, F. (2018). The double-edged sword of leader charisma: Understanding the curvilinear relationship between charismatic personality and leader effectiveness. Journal of Personality and Social Psychology, 114(1), 110-130. https://doi.org/10.1037/pspp0000147  

West, M., Eckert, R., Collins, B., & Chowla, R. (2017). Caring to change: How compassionate leadership can stimulate innovation in healthcare. The King’s Fund.