The Paradox of Psychological Safety: How Far Should We Take It? Volume 60- Issue 4

Fatimah Lateef*

• Senior Consultant, Department of Emergency Medicine, Singapore General Hospital, Core Faculty, Emergency Medicine Residency, SingHealth, Professor, Duke NUS Graduate Medical School, Yong Loo Lin School of Medicine, National University of Singapore and Lee Kong Chian Medical School, Nanyang Technological University, Director, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Faculty, Duke NUS Global Health Institute, Singapore

Received: January 21, 2025; Published: February 20, 2025

*Corresponding author: Fatimah Lateef, Senior Consultant, Department of Emergency Medicine, Singapore General Hospital, Core Faculty, Emergency Medicine Residency, SingHealth, Professor, Duke NUS Graduate Medical School, Yong Loo Lin School of Medicine, National University of Singapore and Lee Kong Chian Medical School, Nanyang Technological University, Director, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Faculty, Duke NUS Global Health Institute, Singapore

DOI: 10.26717/BJSTR.2025.60.009480

Abstract PDF

Psychological Safety (PS) is a dynamic phenomenon where individuals and teams believe in the safety of taking some calculated inter-personal risks. Organizations where PS flourish have highly engaged staff, with high levels of personal and professional satisfaction, who work collaboratively in creative and productive ways and are not afraid to speak up and share their thoughts and views. This kind of constructive culture will give employees and work teams a sense of shared purpose and meaning. They will be called upon in the co-creation of frameworks and guidelines for the organization. They have a high-level f trust and togetherness and there are frequent engagements at all levels of the organization. High levels of PS has been shown to be linked to positive organization culture and climate, better leadership, good people and conflict management and strong, positive personal growth. Despite all the positivity surrounding the concept and practice of PS for individuals, teams and organizations, there still exists gaps between the verbal endorsement and the execution of the principles in practice. This refers to the paradox, which remains a challenge in many organizations, institutions and groups. This paper discusses some of the current views on the subject matter.

Keywords: Psychological Safety; Inter-Professional Teams; Leadership; Learning Behaviour

In the early years, with the more traditional approach, medical teachers, faculty and seniors tend to be more authoritative, hierarchical and has been described as “the sage on the stage” [1]. The power distance between them and their learners, apprentice, juniors and medical students was so much greater compared to the current [2]. This is similar to other industries such as business, management and politics [2-6]. Decades have passed, and mindsets have evolved to the current state of practice, where Psychological Safety (PS) is adopted and recognized in almost every aspect of work and education. PS is now an important theoretical and practical entity that must meet the needs of today’s organizations, especially pertaining to learning, innovation, growth and development [4,6-8]. In fact, PS has even been recognized as the top driver of successful and high-performance teams [9]. PS means having an environment where vulnerabilities are acceptable, and people have the confidence to express themselves. PS is also about how people perceive the consequences if they were to engage in inter-personal risks [4]. This would refer to the potential impact it could have on their image, reputation, status and career. This is linked to intellectual bravery, which is a conscious willingness to negotiate challenging concepts, situations and ask the relevant questions beyond the routine. PS is especially important when change is being planned and implemented [2,5,10].People want to feel their ideas as well as suggestions being valued and appreciated , or at the least, being considered.

Having a psychologically safe work climate can prevent the deterioration of psychological health, which may result from anger, jealousy and aggression issues, neglect or even intentional negative behaviour and treatment of each other [11-13].

Clark TR has categorized PS into 4 stages, which includes the following: [5,14]

1. Inclusivity, where everyone feels they are part of the group

2. Learning safety, which is the experience of the safe climate of learning, with reduced anxiety

3. Contributory safety, which is the comfort and “at ease’ feeling people have in contributing their views in a variety of forms

4. Challenger safety, which refers to the possession of a safe mindset to be creative/ innovative, ready to challenge the status quo in order to move forwards in a constructive and positive way Edmondson conceptualized PS as the liberty to express ideas and concerns without fear of reprisal [4]. PS is pivotal in fostering innovation, agility and positive work culture. A psychologically safe environment can help leadership and management promote staff’s authenticity and continual engagement [4,15,16].

Despite all the positivity surrounding the concept and practice of PS for individuals, teams and organizations, there still exists gaps between the verbal endorsement and the execution of the principles in practice. Is PS always a good thing? This refers to the paradox, which remains a challenge in many organizations, institutions and groups [17-19]. Thus, questions such as:

• Are there limits and boundaries when dealing with PS?

• Are we taking PS too far, in terms of importance and practice?

• Is there too much focus on PS in workplaces and in training today, that we may be lacking in the push and the challenge to employees and learners to think outside the box? Whilst PS has been shown to be an essential element for learning and enhancing creativity, it should not suggest that there are no consequences for poor or non-performance, for not following rules and regulations or disregarding standard procedures and processes. People must not get away with the idea that with PS, “anything goes” or that they can get by with minimal effort [20]. In some work environments, high level of structure is needed. This may tend to make some employees feel stifled or restricted from the lack of variation or creativity [21]. This does not necessarily mean that organization has no PS, but such is the context of the job. This can be applicable to jobs that are more routine and repetitive, where creativity is not central. In fact, in the cognitive psychology literature there are suggestions that a high level of PS may harm performance of routine tasks. Yet this negative impact can be moderated by having collective accountability amongst employees and team members. Thus, PS may have to be viewed differently eg. by looking for more evidence-based and innovative ways to do a mundane or routine job. Otherwise, it may become too risky to adopt new ideas and methodologies [6,18,21]. People who feel stifled in such work environment may need to review their match and fitness for such jobs or consider branching into a different area.

In the practice of Medicine, having PS does not mean: [22-25]

1. Doing as one like, as this may endanger patients

2. Changing evidence-based practices into non-evidence based or anecdotal ones, and

3. Making mistakes and not being accountable for them as these may lead to death and/or morbidity

Thus, instilling PS requires leadership and management to contextualize and give weighted consideration on how to roll it out appropriately, communicate the message and continue to monitor closely. If leadership were to state, “all ideas are accepted” or “there are no bad ideas”, the messaging may be misconstrued and may lead to some taking risks they should not be taking [16,22]. If having PS in the organization means, “mistakes will not be held against me”, then certainly it cannot be applicable to jobs where employees have to go by the rules and conform to standards that have been set [26,27]. Realistically, it will be challenging to find an organization that has the time, finances and resources to allow for absolute freedom and safety to explore with no boundaries. It is also not practical and risk a backlash.

A large proportion of the publications on PS has emphasized that teams with higher levels of PS perform better, are more engaged, contribute more ideas or innovative solutions and provide constructive feedback to one another [4,9,10]. High performance team members share a common mental model despite coming from different backgrounds, with unique contributions. These high-performance teams often have been working and training with each other for some time and they are familiar with each other, have open and robust communications amongst themselves and are often very passionate about the causes they are pursuing. They often have regular training with deliberate practice, using simulation or they meet up often enough for them to understand and be familiar with each other’s ways of working. Members will be confident to voice their thoughts without feeling pushed towards embarrassment, rejections or damage to their self-image [6,8,12,15]. PS also contributes towards their social interactions, self-reflection, self-organization, learning behaviour and sharing of information (Table 1). In inter-professional teams, PS can be a sensitive and fragile entity. It can be easily lost via a single or multiple interactions which have gone negative [20,24-27]. It has been argued that with other teams (especially the more ad hoc teams or newly formed teams), as members are from different backgrounds and have different experiences, their perceptions, mindsets and contributions as well as participation in the team can be very varied, across a spectrum.

Table 1: Comparison of Teams with High and Low Average Psychological Safety Levels.

Team members have different life experiences, work exposures, cultural practices and interactions [28]. It is thus natural for such team members to have divergent and different levels of psychological safety. It is becoming more imperative today that it is important for leadership to consider the level of PS of each team member, rather than just a generic, average or overall consideration. Therefore, today’s team leads, and leadership must look at strategies to develop, uplift and sustain PS in their teams in a more customized fashion. They need to work on this in order to reap the beneficial results of strong PS culture. These strategies may focus on learning and behavioural approaches, information sharing methodologies and other tasks linked to job execution and performance. It must be recognized that variations exist. The uniqueness and contributions or strengths/ weakness of each individual staff or learner must be considered. Different team members may require slightly different approach to harnest their best performance. It is also important to observe the relational power interaction between team members and know how to manage and facilitate variations in situations [5,28-31]. “If you do the same things, you have been doing, you will always get the same results you have always gotten” This quotation should remind us to explore new ideas and find new ways of doing things. With PS, teams should feel they can be agile and take some degree of calculated risk in order to uplift themselves and grow.

They can challenge the status quo and explore or innovate [9]. The idea is similar to nurturing your ‘family’ members to excel. Strong and successful teams treat each other as their own family members. Indirectly, you can achieve talent retention or even attract good people to your team, who can go the extra mile, but not abuse the fact that they enjoy having that degree of PS [12]. Leaders must always be conscious on how to reinforce PS in their teams. This may involve understanding how to elicit feedback, conduct survey appropriately (whether open or confidential surveys), manage perceptions or hold focused group discussions [24,27,28,32-34]. O’Donovan et al collated, from various publications and suggested a list of observable measures of PS which include: [4,12,27,35-39]

a. A good environment

b. Responsibility

c. Knowledge sharing and work procedures

d. Learning behaviour

e. Voice behaviour

f. Priority for safety and

g. Orientation: support, familiarity with colleagues and status, hierarchy and inclusiveness

How organizations measure their PS performance is uniquely customized to their own individual setting. Various models of permutation or combination can be used as deemed fit. PS is applicable in a very wide spectrum of domains and this continues to increase. (Table 2) Eventually, the bottom line should be that PS is for the employees and staff to learn, develop and grow themselves with the organization. Its boils down to negating the “us versus them” mindset and creating safe spaces for all to flourish.

Table 2: Domains Where Psychological Safety is an Important Consideration.

Learners, students, junior staff as well as those lower in rank and hierarchy will view themselves as the more vulnerable parties compared to the faculty, teachers and senior staff. Their vulnerability is an experiential one, whereby exposure to questions, examinations, assessments, observations, feedback (both summative and formative) and other challenges may tug at their integrity and psychological safety. In these experiences, the learner groups may have to undergo a trade-off; between the opportunity to learn and ask questions versus that of putting their credibility and ‘reputation’ upfront (in case they feel they may make inappropriate comments or give the wrong answers). This can certainly impact their PS. The learned response then is to remain quiet, be less vocal or share less, with a view to not being judged [5,7,11,12,23]. This will definitely affect their PS from the perspective of Inclusivity PS, Learning PS and Contributory PS [14]. PS on the other hand should enable performance, create conditions conducive for speaking up, sharing ideas and asking questions. It should help unleash the potential of individuals. This way, students and learners can nurture their learning behaviour and knowledge transfer. PS facilitates having a ‘voice’ and being ‘yourself’. Learners can express themselves physically, cognitively and emotionally. The engagement will then be more satisfying and less stressful [31,39,40]. The older generation teachers and faculty may tend to feel that with the concerns on PS today, they have to be more lenient to the younger generation learners.

The latter has at times been described as the “strawberry” generation; easily bruised and too ‘soft”. Some may feel that it is their right to have PS in their educational or working years and it becomes an entitlement which may be wrongly perceived or be taken advantage of. Too safe an environment, may not inculcate accountability and can perpetuate recalcitrant negative habits or behaviour. At the end of the day, a balance should be struck, with mutual respect from both parties working on an open and trusting relationship. No organization or institution will be able to provide employees absolute freedom with no barriers or boundaries. Some degree of restraint and control will still be required. Afterall, PS does require trust, togetherness, positive relationships and open dialogue. PS is not about being nice all the time, avoiding challenging conversations, lowering our standards or allowing things to go unchecked. It is not about doing anything one wishes and not thinking of the consequences. Despite the above, the level of PS is also driven by culture [41]. Organizational culture is strongly linked to the climate shaped by the members. It refers to the shared understanding, norms and values which hold members together and strengthen their relationships. It is also about how they develop trust in each other, communicate and interact together. Their sense of togetherness is key to generate higher levels of inter-connectedness , which is linked to their PS levels.

Despite diversity, there will be open conversations and sharing. The bottom line is that the work of the organization must be framed and executed appropriately, as well as conducted to encourage engagement, growth and productivity [5,41].

Leaders of organization are instrumental and accountable for their behaviour as well as the climate they create for their employees and teams. They play a critical role in fostering PS and define the objectives for their teams. New leaders may require a run-in period to familiarise and study the dynamics of the organization, the culture and people. The perception of PS by the employees is impacted significantly by the leaders’ styles and approach, thus the latter should: [5,8,16,42-44]

• Project a positive aura with positive energy
• Be open to discussions and conversations with all levels of staff
• Be reflective, in decision making and judgment
• Be very adaptable to change, employees will observe how their leaders negotiate change and work with them
• Help to create opportunities, once they have understood the company culture and the dynamics of working
• Be humble enough to seek answers and ask questions for their own learning and understanding
• Be around; showing presence is important if leaders want to demonstrate PS
• Have a growth mindset for himself/ herself and the team
• Strive to establish a positive, collegial and cordial relationship with employees

This lost represent some of the fundamentals but is not exhaustive. Leaders should focus on performance targets and goals that help to prioritise mastery in individual development, cultural competencies and other relevant skills and capabilities. They must encourage employees to see opportunities in challenges, which may unleash their professional and personal growth. Each leader will have their unique approach, character and style of leading or managing. Leaders must realise that PS is not a given equal to everyone but a very nuanced and personal attribute. PS has a lot to do with communications, verbal, nonverbal and also the hidden curriculum [8]. The ‘hidden curriculum’ which refers to a spectrum of norms, behaviour, values and culture that is closely linked to the growth and development of the learner or employee. Many aspects of these hidden curriculum may be transmitted sub-consciously and are less obvious. However, its impact can be very significant, especially in some form of training such as in healthcare (eg. in Medicine and Nursing) where the hierarchical environment is very apparent [5,7,8]. The values, norms and behaviour referred to here are those demonstrated by the leadership, seniors and supervisors. They may be observed, acquired or be emulated through the day-to-day socialization process which happens in the ED. These are embedded in the departmental culture. Some of the workplace learning that happens mostly through the hidden curriculum include: [5,45]

1. Leadership
2. Friendship and Camaraderie
3. Communications: both verbal and non-verbal communications
4. Collaboration
5. Inter-professional relations and behavior
6. Teamwork and cooperation

This learning happens via the interaction the learners/the ‘hidden curriculum’ which refers to a spectrum of norms, behavior, values and culture that is closely linked to the growth and development of the learner. Many aspects of these hidden curriculum may be transmitted sub-consciously and may thus, be less obvious. However, its impact can be very significant, especially in some form of training such as in healthcare (eg. In Medicine and Nursing) where the hierarchical environment is very apparent [5,7,11]. The values, norms and behavior referred to here are those displayed and demonstrated by the leadership, faculty, seniors, supervisors and even colleagues. They may be observed, acquired or be emulated through the day-to-day socialization process which happens in the ED. These are embedded in the departmental culture [5]. Some of the workplace learning that happens mostly through the hidden curriculum include: [5]

1. Leadership
2. Friendship and Camaraderie
3. Communications: both verbal and non-verbal communications
4. Collaboration
5. Inter-professional relations and behavior
6. Teamwork and cooperation

This learning happens via the interaction the learners/ employees have with the faculty/ leadership, through their observations as well as their personal experiences. These are not formally or strictly planned but is happening all the time. Thus, learning from the hidden curriculum should never be under-estimated. It can certainly have significant influence. In fact, it is also closely intertwined with the level of PS in the department and the two are interdependent. I would even go one step further to add that the synergy between PS and the Hidden Curriculum (HC) contribute to the Psychological Capital (PC) of the department i.e. [5]

“PS + HC = PC”

Leaders must communicate the organizational efforts, goals and accomplishments pertaining to inclusion, diversity etc to their teams and staff. In many countries, documents on workplace safety policies, guidelines or framework do not include advisories on PS. Today, there are more organizations that have included clauses on mental wellness and handling mental health issues at the workplace, but when it comes to PS, there is often no mention or clarity pertaining to the topic. Thus, it would be very useful for leadership to share their stance and thoughts on this with their staff and teams. Writing organization guidelines is important, but more crucial is the execution of what is written [46]. PS in an organization is about having a safe environment work where employees can be their authentic selves, be open, be able to speak up and share their views/ opinion, ask questions, discuss their thoughts, provide feedback, request for help when needed, take appropriate risks as well as learn, from both their successes and failures.

To summarise the current literature on PS, the following represents what is known and observed:

• PS may be situational; it may not always be very obvious in every step of every interaction but may be more prominently demonstrated when change implementation is involved, when learning new skills and procedures are on board, when brain-storming new ideas and when adopting new innovations. Thus, it needs to be viewed practically.

• If an organization has low levels of PS, it will need to be enhanced to improve the situation. A constructive and critical review is needed to identify specific examples and fix them. How each organization handles this may vary.

• In situations involving routine and repetitive or very structured jobs and tasks, the level of PS may not be as high as this may affect job performance. However, this can often be customised and moderated accordingly within each organization with collective accountability.

• Every employee and staff in the organization can contribute towards PS and strengthen the culture of PS. This can be done with proper framing of work, positive and open communications and listening skills, respect and kindness for one another and not stereotyping in interactions. Every small action or word towards this will certainly count towards building a workplace with appropriate levels of PS.

Understanding the concept of PS, as applicable to the various settings (eg. Workplaces, types of industries, learning institutions) is fundamental. Creating and sustaining PS is also crucial as the latter can be a weak link in many organizations. PS, simply put, is about how we treat each other with compassion, kindness and a developmental viewpoint (Table 3).

Table 3: What it Means to Have Psychological Safety.

1. King A (1993) The sage on the stage to the guide on the side, College Teaching 41(1): 30-35.
2. Castanelli DJ, Weller JM, Molloy E, Margaret Bearman (2022) How trainees come to trust supervisors in workplace-based assessment in a grounded theory study. Acad med 97(5): 704-710.
3. Papaux E (2016) The role of vulnerability in supervision: from pain to courage, inspiration and transformation. Trans Anal Journal 46(4): 331-342.
4. Edmondson AC (1999) Psychological safety and learning behaviour in work teams. Adm Sci 44(2): 350-383.
5. Lateef Fatimah (2021) Culture of Psychological safety in the ED: Don’t forget the hidden curriculum. Archives of Emerg Med and Intensive Care 4(1): 18-26.
6. Bynum WE, Haque TM (2026) Risky Business: Psychological safety and the risk of learning medicine. Journal of Grad Med Edu 8(5): 780-782.
7. Torralba KD, Jose D, Byrne J (2020) Psychological safety, the hidden curriculum and ambiguity in Medicine. Clin Rheumatol 39(3): 667-671.
8. Lateef F (2020) Face to face with Covid 19: maintaining motivation, psychological safety and wellness. Journal of Emergencies, Trauma and Shock 13: 116-123.
9. Rozovsky J (2015) The five keys to a successful Google Team. Re: Work.
10. Frazier ML, Fainschimdt S, Klinger RL, Amir Pezeshkan, Veselina Vracheva (2017) Psychological safety: a meta-analytic review and extension. Personnel Psychology 70: 113-165.
11. Nordquist J, Hall J, Caverzagie K, Saleem Razack, Ingrid Philibert, et al. (2019) The clinical learning environment. Med Teach 41(4): 366-372.
12. O’Donovan R, McAuliffe E (2020) A systematic review of factors that enable psychological safety in healthcare teams. Int Journal Qual Healthcare 32(4): 240-250.
13. Kahn WA (1990) Psychological conditions of personal engagement and disengagement at work. Acad Manag 33(4): 692-724.
14. Clark TR (2025) The four stages of psychological safety.
15. Kessel M, Krataer J, Schultz C (2012) Psychological safety, knowledge sharing and creative performance in healthcare teams. Creativity and Innov Management 21(2): 147-157.
16. Lateef F (2018) Grace under pressure: leadership in EM. Journal of Emergencies Trauma and Shock 11: 73-79.
17. Deng H, Leung K, Lam CK, Xu Huang (2019) Slacking off in comfort: a dual pathway model for psychological safety climate. Journal of Manag 45(3): 1114-1144.
18. Nichol H, Tumnidge J, Delgarno N, Jessica Trier (2024) Navigating the paradox: Exploring residents’ experiences of vulnerability. Med Edu 58: 1469-1477.
19. Agarwal P, Farndale E (2017) High performance work systems and creativity implementation: the role of psychological capital and psychological safety. Human Resource Manage 27930: 440-458.
20. Newman A, Donohue R, Eva N (2017) Psychological safety: a systematic review of the literature. Hum Resource Manag Review 27(3): 521-535.
21. Eldor L, Hodor M, Cappelli P (2023) The limits of psychological safety: non linear relationships with performance. Org Behavr and Human Decision processes 177: 104255-104265.
22. Yuan YJ (2021) Does cultural distance energize employees. The moderating role of psychological safety. PLoS ONE 16(6): e0252406.
23. Lyman B, Gunn MM, Mendon CR (2020b) New graduate registered nurses experience with psychological safety. Journal of Nursing Manag 28(4): 831-839.
24. Lateef F (2018) IPE, IPP and team science: learning together, working together. Edu in Med Journal 10(4): 81-91.
25. Chou E, Gravey T, Paige JB (2023) Psychological safety as an industrial value in inter-professional health education. AMA Journal of Ethics 25(5): E338-E343.
26. Nielsen S (2010) Top management team diversity: a review of theories and methodologies. Int Journal of Management Review 12(3): 301-316.
27. O’Donovan R, Van Dyne D, MaAuliffe E (2020) Measuring psychological safety in healthcare teams: developing an observational measure to complement survey methods. BMC Med Research Methodology 20(1): 203.
28. Thorgren S, Caiman E (2019) The role of psychological safety in implementing agile methods across cultures. Research-Technology Management 62(2): 31-39.
29. Peltokorpi V, Hasu M (2014) How participative safety matters more in teams’ innovation as team size increases. J Bus Psychol 29: 37-45.
30. Carmeli A, Gittell JH (2009) High quality relationships, psychological safety and legacy from failures in work organization. J Org Behav 30(6): 709-729.
31. Lateef F (2020) Maximizing learning and creativity: understanding psychological safety in simulation-based learning. Journal of Emergencies Trauma and Shock 13: 5-14.
32. Baer M, Frese M (2003) Innovation is not enough: climate for contribution and psychological safety, process innovation and performance. J of Org Behv 24(1): 45-68.
33. Brown SP, Leigh TW (1996) A new look at the psychological climate and its relationship to job involvement, effort and performance. J of Applied Psychol 81(4): 358-368.
34. Davis WD, Mero N, Goodman JM (2007) The interactive effects of social interaction and accountability on task performance. Human Perf 20(1): 1-21.
35. LePine JA, Van Dyne L (1998) Predicting voice behaviour in work groups. J Appl Psychol 83: 853-868.
36. Zhou W, Zhu Z, Vredenbugh D (2020) Emotional intelligence, psychological safety and team decision making. Team Perf Manag 26(1/2): 123-141.
37. Appelbaum NP, Lockerman KS, Orr S, Tanya A Huff, Christopher J Hogan, et al. (2020) Perceived influence of power distance, psychological safety and team cohesion on team effectiveness. J Interprof Care 34(1): 20-26.
38. Lackie K, Hayward K, Ayn C, et al. (2023) Creating psychological safety in inter-professional simulation for health professional learners: A scoping review of the barriers and enablers. J Interprof Care 37(2): 187-202.
39. Nembhard IM, Edmondson AC (2006) Making it safe: The effects of leader welcomeness and professional stake on psychological safety and improvement efforts in healthcare teams. J Org Behv 27(7): 941-966.
40. Castro DR, Anseal F, Khuger AN, Lloyd Karina J, Turjeman-Levi Yaara (2018) Mere listening effect on the mediating role of psychological safety. Psychol Aesthet Great Arts 12(4): 489-502.
41. Franco PM, Adams LR, Booth SC, Grace M Arteaga (2024) Building a safety centric culture that foster psychological safety from onboarding ponwards. From Book: Contemporary Topics in Patient Safety 3.
42. Sherf EW, Parke MR, Isaakyan S (2021) Distinguishing voice and silence at work: unique relationships with perceived impact, psychological safety and burnout. Acad Manag 64(1): 114-148.
43. Belghit AG, Husser J, Dardour A (2019) Logisticians ethical decision making: Does the psychological safety term matter? Supply Chain Forum 20(3): 215-227.
44. Lateef F (2017) Does culture eat strategy in debriefing: which one wins? Global J Emerg Med 1(1): 1-4.
45. Sarner B, Bunderson JS (2015) When feeling safe isn’t enough: contextualizing models of safety and learning in teams. Org Psychol Review 5(3): 224-243.
46. Detert JR, Burris ER, Hamson DA, Sean Martin (2013) Voice flow to and around leaders: understanding when units are helped or hurt by employees voice. Administrative Science Quarterly 58(4): 624-668.