Latest news with #psychologicalSafety
Fast Company
2 days ago
- Business
- Fast Company
High-performing teams all have this one thing in common
As a manager, it's easy to get caught up in the day-to-day grind of fixing processes, eliminating bottlenecks, and streamlining workflows. We focus on reducing friction—the things that get in the way of people doing their best work. And sure, that's important. But here's the thing: Reducing fear is just as, if not more, important. A comprehensive two-year study by Google identified psychological safety as the most important factor in high-performing teams. This environment allows team members to take risks and be vulnerable without fear of negative consequences. Harvard Business School professor Amy C. Edmondson emphasizes that psychological safety enables employees to speak up, make mistakes, and learn from them, which is essential for innovation and growth. Let's face it. The best processes in the world won't help much if your team is afraid to speak up, take risks, or challenge the status quo. Fear can stunt creativity, shut down communication, and make people avoid the very risks that lead to growth. So, as leaders, we need to think beyond just fixing processes. We need to also focus on creating an environment where people feel safe and confident enough to act—even if it means making a mistake along the way. Why Fear Matters More Than You Think Fear is a powerful force. It can make people double-check their work, avoid taking risks, and be extra cautious. But when fear becomes the driving force behind decisions, it also leads to silence. When people are afraid to speak up, they hold back good ideas, overlook problems, and avoid making necessary changes. Neuroscience backs this up. When we experience fear, our brains go into 'fight or flight' mode, which limits our ability to think clearly and make rational decisions. When we're scared, we become reactive instead of proactive. This is why a culture of fear isn't just uncomfortable—it's downright unproductive. As a leader, it's your job to create a culture where people feel safe to speak up, ask questions, and challenge the status quo. That's why reducing fear should go hand in hand with reducing friction. Fixing Processes Doesn't Fix Everything Let's look at a real-world example: the United States Postal Service. In the early 2000s, the USPS faced a significant drop in productivity, rising operational costs, and declining employee morale. To address these issues, management introduced new technology, upgraded processes, and streamlined workflows to improve efficiency and reduce errors. They invested in automated sorting systems and revamped scheduling to make operations run more smoothly. However, despite these process improvements, the results weren't as dramatic as expected. Productivity wasn't increasing, and employees still seemed disengaged. The reason? Fear was still very much present in the workplace. Employees were afraid to speak up or share concerns about the new processes. If workers noticed something wrong with the new systems or had ideas to improve efficiency, they didn't feel comfortable offering suggestions or challenging the way things were done. This is a perfect example of how reducing friction—by fixing processes—didn't have the full impact it could have had because fear was still holding back the team. How could USPS have tackled both issues at once? They could have started by actively working to reduce fear within the organization. Management needed to create an environment where employees felt safe to make mistakes, raise issues, and offer constructive feedback. Employees who feel safe and supported are more likely to speak up when something's not working and more likely to suggest creative solutions. They become partners in progress rather than passive participants. Balancing Both: Reducing Friction and Fear SEB, a Nordic financial services group, implemented a five-month training program focusing on psychological safety and perspective-taking for its investment banking leadership team. This initiative aimed to overcome transformation challenges and foster open communication. As a result, the team achieved revenues 25% above their annual targets in a strategically important market segment. A multi-industry case study followed businesses whose team members were hesitant to voice concerns. All participants implemented psychological safety workshops emphasizing active listening and constructive feedback. This initiative led to improved conflict resolution, enhanced communication, and increased productivity, positively impacting the company's bottom line. To be an effective leader, you can't just focus on fixing processes. That's a quick fix, but it doesn't address the deeper issues that impact team dynamics. Reducing friction is important, yes. But reducing fear is essential if you want to create a truly high-performing, innovative, and engaged team. Simon Brown, global learning and development leader at EY, has spent years building critical skills and behaviors in high-performing teams. He shares: 'You can't automate courage. While systems help things run smoothly, it's the culture that inspires people to run toward challenges instead of away from them.' Real-world application So, what does this balance look like in practice? • Reduce friction: Simplify workflows, cut out unnecessary steps, and ensure your team has the tools and resources they need to do their jobs efficiently. • Reduce fear: Foster a culture of psychological safety, where mistakes are treated as learning opportunities, where feedback is welcomed (not feared), and where team members feel confident enough to take risks and innovate. • You/me/we: Adopt a decision-making framework that defines what decisions employees can make on their own without fear or reprisal. This cuts down on back-and-forth decision-making bottlenecks and helps people feel more empowered in their roles. • Model a hands-off approach: Is your leadership decreasing the number of mandatory meetings but still attending themselves? Making outdated rules 'optional' instead of obsolete? Without buy-in from the top, team members will be too afraid to take action on simplification initiatives that can free up time and decrease unnecessary mental distress. Leadership isn't just about improving processes—it's about improving people's ability to act within those processes. If you want your team to truly thrive, you've got to focus on both reducing friction and reducing fear. When you do, you'll create an environment where people feel empowered to make decisions, try new things, and speak up when something's not working. That's when the real magic happens.
Forbes
3 days ago
- General
- Forbes
5 Signs You Feel Truly Safe In Your Relationship, By A Psychologist
When most people evaluate their relationships, they focus on love, loyalty, chemistry or compatibility. While these are all important, they don't guarantee emotional well-being. What truly makes a relationship sustainable and nourishing — whether it's romantic, familial or just a meaningful friendship — is psychological safety. Psychological safety means you feel safe to be fully yourself. Unfiltered, messy, vulnerable, always changing, all without fear of being shamed, belittled or emotionally punished. It's a deep sense of trust that you can express your truth and still be held with respect. But how would you know if your relationship is psychologically safe? Here are five signs to look for, and ways to cultivate more of it in your life. In psychologically unsafe relationships, saying 'no' often comes at a cost. For example, saying no may be met with guilt trips, emotional withdrawal or a lingering sense of tension in the air. Over time, this teaches you to say 'yes' just to avoid conflict, even when it means ignoring your own needs. In contrast, psychologically safe relationships respect your 'no' as an essential part of who you are. It's not taken personally, nor is it seen as a rejection. Whether you're declining an invitation, asking for space or expressing disagreement, your partner holds space for it. They don't need you to mirror them in order to feel secure. This balance between a connection and independence is highlighted in a 2019 study that explored two foundational psychological needs in relationships: relatedness (feeling emotionally close to others) and autonomy (feeling free to act in alignment with your own values). The study found that people were more likely to respond constructively during conflict (a behavior known as accommodation) when they felt not only close to their partner, but also free to be themselves — independent and self-directed. In other words, healthy closeness doesn't require losing yourself. In fact, relationships where both people feel safe to say 'no' tend to be more resilient. They can tolerate difference without turning it into distance. So, what can you do when faced with this dynamic? Begin with small, honest assertions. Try saying, 'I won't be joining this weekend,' or 'That doesn't feel right to me' — without sugarcoating it with apologies. Then observe if the other person stays emotionally present and responsive. If so, you're likely in a space where both your need for connection and need for autonomy is being respected. One of the most telling signs of a lack of psychological safety in a relationship is a constant, nagging tension. It's that feeling that you have to watch your words, manage your tone or suppress your feelings to avoid setting the other person off. This emotional tiptoeing may not always involve loud conflict, but it breeds a quieter kind of distress which manifests as a chronic state of self-monitoring. Over time, you may begin to withhold joy, hide disappointment and shrink parts of yourself to avoid emotional backlash. A 2012 study published in The American Journal of Family Therapy, examining the relationship between PTSD symptoms, perceived emotional safety and relationship health found that feeling safe in a relationship fully mediated the impact of trauma symptoms on how well the relationship functioned. In other words, even when someone carries deep relationship wounds, what most determines the health of their relationship isn't the trauma itself but it's how safe they feel with their partner. Emotional safety, then, isn't a relationship accessory; it's really the foundation of a relationship. When a relationship offers consistent empathy and non-defensiveness, it allows both partners to lower their guard. They don't have to 'perform' emotional control. They can be real, even when that means being confused, vulnerable or not at their best. In safe relationships, there's room for full expression. You can have a bad day. You can bring up hard topics. You can even disagree without losing closeness. And if it's ever difficult to establish emotional safety, try this: Notice the next time you hesitate before sharing something good or bad. Ask yourself, 'Am I afraid of how they'll react?' Choose one thing you've been holding back. Could be an opinion, a request, a silly story, anything. Then share it gently but directly. Then observe: do they lean in, shut down, deflect or become defensive? Their reaction reveals how safe the space between you really is. More than conflict itself, it's often a lack of resolution that harms relationships. In psychologically unsafe dynamics, disagreements quickly spiral into blame or withdrawal. But in safe relationships, conflict doesn't mark the end of connection. It's simply seen as what it's meant to be — a moment to pause and look into ways of repair. A 2015 study by John Gottman and colleagues found that the most effective conflict repairs are emotional, not logical. They happen early, often within the first few minutes, and aim to shift the emotional climate through warmth, empathy, humor or vulnerability. These small cues say, 'We're still okay, even if we disagree.' When repair becomes part of the relationship culture, missteps feel less threatening. Partners don't fear conflict or tiptoe around hard feelings. Instead, they return to each other with care and curiosity, even if that return begins with an argument. The core idea is that you don't wait until emotions boil over. Reconnect early. Try saying, 'I've been thinking about what happened earlier, can we talk?' or 'I care more about us than about being right.' Early repair softens tension and steers the conversation away from escalation. Based on Gottman's research, repair doesn't have to be complicated. It just needs to be timely, genuine and emotionally aligned. Here are six tools to help achieve this: Remember, the goal isn't to avoid conflict. It's to make space for it and meet it with compassion. One of the hallmarks of relationship safety is that you feel expanded. You speak more freely, laugh louder and bring your full, layered self into the room. There's room for your contradictions: the thoughtful and the silly, the confident and the unsure. You're not filtering yourself to fit into a version you think will be more palatable. You're simply you, and that feels easy. Research on relational self-change supports this experience. It shows that in close relationships, our self-concept can shift in meaningful ways. People in supportive relationships often experience self-expansion (gaining positive traits) and self-pruning (letting go of negative ones). These changes are linked to greater satisfaction, more empathy and a stronger capacity for forgiveness. In short, the right relationship helps you grow into a better version of yourself. Unsafe relationships, on the other hand, lead to self-contraction where you shrink, suppress your voice or mold yourself to avoid tension. Over time, this chips away at your confidence and desire to stay in the relationship. So, try this check-in: After spending time with someone, ask yourself: 'Do I feel more like myself — or less?' If you feel clearer, lighter and more at ease, chances are you're in a relationship that supports your evolution rather than stifles it. Healthy relationships don't require performance. They welcome your becoming. As humans, we're not meant to stay the same. As we grow, our preferences, boundaries and beliefs will most definitely shift. Psychologically safe relationships allow space for that evolution without any guilt or resistance. A 2020 study published in Personal Relationships found that people who adapt their thoughts and behaviors in response to life changes experience greater well-being and relationship quality. Their openness also benefits their partners, deepening mutual connection and resilience. In unsafe dynamics, however, change is seen as a threat. You may be stuck in rigid roles like always being agreeable or emotionally available. Any attempt to redefine yourself is treated as confusing or disloyal. Your growth becomes a problem to solve, not a transformation to support. But safe relationships welcome your evolution. You're allowed to be dynamic. You're encouraged to set boundaries that reflect who you're becoming. So, whenever you notice yourself changing, name it. Point it out by saying, 'I know I used to be okay with this, but I've realized I'm not anymore.' Watch for whether you're met with curiosity or criticism. The answer speaks volumes about your relational safety. Do you also experience psychological safety outside of your relationship? Take the science-backed Psychological Safety Scale to find out.
Forbes
21-05-2025
- General
- Forbes
How To Feel Comfortable Asking The Most Important Question At Work
How To Feel Comfortable Asking The Most Important Question At Work Since my work focuses on helping people develop curiosity, I get asked a lot whether there is such a thing as a bad question. Technically, there can be. If a question is meant to trap someone, push an assumption, or make another person feel under attack, it's not helpful. But more often, the good questions never get asked at all. People hold back. A study in the Harvard Business Review showed that employees are far more likely to speak up when they feel psychologically safe. Without safety, people stay quiet or rely on safe, scripted questions that don't move the conversation forward. There's one question everyone should feel comfortable asking: "What are we not asking?" It gives people permission to bring up what they've been thinking but haven't said out loud. It slows things down in a good way and opens the door to a more honest, thoughtful discussion. That question is a great place to begin. Getting more comfortable with asking questions starts by understanding how they land, what holds people back, and why tone and timing matter. What Types Of Questions Develop Conversations? When I hosted my radio show, I learned quickly that a yes or no question could stop a conversation in its tracks. If I asked, "Do you like your job?" and the guest said "yes," there wasn't much to follow. But if I asked, "What part of your work keeps you up at night?" or "What made you take that role in the first place?" I'd hear real stories and insights. The same thing applies at work. Some questions feel safer than others. Closed-ended ones, like "Did you finish the report?" are simple, but they can shut down a deeper conversation. If the answer is more nuanced, it gets lost. That kind of question might get a quick response, but it doesn't offer much clarity. Try asking something like, "What do you still need to get done today?" That gives the person space to share where things really stand. Closed questions are useful when you need a clear answer. But when you're trying to understand what someone is thinking, open questions work better. They make it easier to have a real conversation. They also help the person asking feel more engaged, because the dialogue feels less like a checklist and more like a connection. Why Do Some Questions Come Across As Confrontational? Tone, timing, and phrasing matter. A question like, "Why didn't you speak up in that meeting?" might come from a good place, but it rarely feels that way. A better approach would be, "Was there anything that made it harder to speak up earlier?" That feels softer, making it more like an invitation than a challenge. Even a good question can be delivered badly. When tone feels sharp or the question lacks context, people can feel backed into a corner. That's when the conversation you intended can turn into more of a reaction. This happens often in email. I've had people read me an email aloud in a snarky tone, hoping I'd confirm how awful the sender was. But without knowing the person, I don't hear it that way. We tend to fill in tone based on past experiences. If the last interaction with someone was tense, even a neutral question can feel terse. That's why questions in writing need extra attention. It helps to go back and read what you wrote several times to look for how it might be received. What Happens When Questions Are Used Just To Fill The Silence? Some questions are asked just to break the silence. No one knows what to say, so someone speaks up to keep things moving. But when a question has no clear purpose, people notice. Those kinds of questions don't go anywhere. I've been interviewed by people who asked empty or canned questions. The worst is when someone asks something, ignores the answer, and jumps to the next topic like they're reading from a script. It's better to ask fewer questions that matter. As an extravert, I understand that dead air gives people like me some anxiety. However, sometimes pausing can be the best thing you can do. Giving people space to think usually leads to better answers. Instead of avoiding silence, ask yourself, "What do I actually want to know right now?" Then stop and let people have time to answer without you filling in the blanks for them. How Do Assumptions Get In The Way Of Asking Good Questions? Assumptions can sneak into how we phrase things. A question like, "How are you adjusting to the new system?" assumes the person is already adjusting. A better version might be, "What's working with the new system, and what's still a challenge?" When a question carries a built-in assumption, people are less likely to respond openly. It feels like the answer has already been decided for them. Dropping that framing gives others more room to respond honestly. Curious questions come from a place of wanting to learn what hasn't been said yet. What Do Comfortable, Useful Questions Sound Like? A good question feels like an opening. It's clear, simple, and open enough to take the conversation in different directions. Questions like, "What's getting in the way right now?" or "What's something we might be missing here?" tend to spark more real answers. People respond to tone. When someone hears a question that comes from genuine interest, they're more likely to share. That kind of trust builds momentum. And the more often someone has a good experience asking or answering a question, the more likely they are to keep going. How To Build Comfort With Asking Hard Questions If you're not used to speaking up, start small. You don't have to ask the hardest question in the room right away. Begin with clarifying questions that show you're engaged, like "Can you walk me through the thinking behind that decision?" or "What's the main goal we're trying to reach here?" These feel natural and nonthreatening but still move the conversation forward. Practice rephrasing tough thoughts into open-ended prompts. Instead of saying "I don't think this will work," try asking "What challenges do you think we might run into?" It keeps the door open without putting people on the defensive. What Are Some Of The Most Important Questions That Often Go Unasked? Some of the most powerful questions are the ones people aren't sure they're allowed to ask. These include: When questions like these are welcomed, people start to feel safer being honest. Why Do These Questions Matter So Much? Most people have been in a meeting where the right question could have changed the direction of the conversation. But no one asked it. Sometimes it's fear. Sometimes it's habit. And sometimes it's just easier to stay quiet. Getting more comfortable asking questions like "What are we not asking?" takes practice, awareness, and a willingness to make room for whatever might come next. Asking a good question is what leads to better conversations, builds trust, and makes work feel more open, more thoughtful, and more productive.
Forbes
20-05-2025
- Health
- Forbes
Why Psychological Safety Drives Performance In High-Stakes Industries
LONDON - NOVEMBER 03: Production staff. (Photo by) To call psychological safety a strategic imperative across industries is no exaggeration. It is a proven driver of high-functioning teams, yet it remains one of the most misunderstood concepts. In complex, high-reliability sectors like healthcare and technology, where outcomes hinge on rapid decision-making, cross-disciplinary coordination and adaptive learning, creating an environment where ideas and people feel safe to speak, challenge and contribute is vital to cultivating a resilient and high-performing culture. Peer-reviewed studies consistently link psychological safety to greater innovation, more effective leadership, enhanced collaboration and measurable improvements in team performance. But widespread misconceptions often dilute its impact, framing it as comfort over honesty or consensus over constructive tension. This article examines the influence, common misconceptions and high-stakes applications of psychological safety, particularly within the evolving landscapes of healthcare, technology and modern organizational leadership. Psychological safety refers to an individual's perception of the consequences of taking interpersonal risks in a particular context, such as the workplace. It is the belief that one can speak up, offer ideas, ask questions or admit mistakes without fear of punishment or shame. This concept, introduced by Amy Edmondson in 1999, has since been recognized as a cornerstone of effective team dynamics across multiple industry sectors. A prevalent misinterpretation is equating psychological safety with comfort or the absence of conflict. However, proper psychological safety fosters an environment where challenging the status quo and engaging in constructive dissent are not only accepted but encouraged. It's not about creating a conflict-free zone, but about ensuring that team members and employees feel secure enough to express diverse viewpoints and take calculated risks. As a health journalist, I've spent years tracing the ripple effects of emotional environments on the workplace. What I've learned is this: Psychological safety is a significant multiplier of well-being. When people feel unsafe expressing themselves, asking for help or communicating discomfort, the stress follows them into the other areas of their lives; it settles in the nervous system and accumulates gradually over time. The body and mind respond to social threats in the same way they respond to physical threats. It spikes cortisol, disrupts sleep, suppresses immune function and erodes the capacity for recovery, emotional resilience and self-regulation. Research from the International Journal of Environmental Research and Public Health (2022) suggests that low levels of psychological safety in the workplace are significantly associated with increased rates of burnout, anxiety and emotional exhaustion, particularly among healthcare workers and employees in high-demand industries. Conversely, when psychological safety is present, teams perform and function more effectively. Individuals report increased levels of self-efficacy, greater emotional resilience and improved job satisfaction. Over time, this translates into better health and well-being outcomes, including lower inflammation, a more stable mood, enhanced relationships and a greater ability to self-regulate under pressure. If we want to future-proof our workforces and protect collective mental health, psychological safety is key in a world that increasingly runs on speed, precision, and pressure. The most humane and high-performing environments will be the ones that make it safe to be human. A study published in Frontiers in Psychology emphasized that healthcare professionals who feel psychologically safe are more likely to voice concerns, ask questions and deliver feedback, leading to improved patient safety and overall care quality. Further, fostering psychological safety can mitigate burnout and enhance job satisfaction among healthcare workers. In the fast-paced tech industry, psychological safety is equally vital. Research indicates that teams with high psychological safety are more innovative, as members feel empowered to share ideas and admit mistakes without fear of retribution. An analysis in PLOS ONE found that psychological safety has a positive influence on employee innovative performance through enhanced communication behaviors. While psychological safety flourishes within teams, its foundation is built by leadership. Business leaders are more than strategic architects; they are cultural stewards. Their behaviors set the tone for what is spoken, what is silenced and how people relate to risk. In psychologically safe environments, for instance, leaders model intellectual humility and leadership competency by inviting dissent, acknowledging uncertainty and rewarding sincerity, even when their ideas can be challenged. A 2023 study in the European Management Journal suggested that leaders who display transformational and servant leadership qualities, such as empathy, empowerment and active listening, inspired their followers to lead themselves. Conversely, fear-based leadership and micro-management can be correlated with team withdrawal, silence and reduced innovation. For executives navigating high-pressure sectors such as healthcare and technology, the implications are profound. When team members feel secure enough to challenge inadequate systems, report ethical concerns or propose unconventional ideas, organizations become more agile, transparent and resilient. And the benefits aren't abstract. Companies that prioritize psychological safety report lower turnover, faster problem-solving and stronger employee engagement. For example, Google's landmark Project Aristotle study on effective teams implied that psychological safety was the most critical factor driving team performance, surpassing expertise, intelligence or even tenure. In brief, psychological safety encompasses not only how people feel and behave, but also how they interact with others. It's about how leaders lead and inspire others to do the same within their organization while welcoming their teams' voices, input and feedback. Psychological safety is a biological, emotional and cultural imperative. In industries like healthcare and technology, where lives are saved and systems are built in real-time, the ability to speak up without fear is a key difference between innovation and inertia, between resilience and risk. And the data is clear: teams that feel safe to share unpolished ideas, ask questions and admit mistakes outperform those that don't. They adapt faster. They solve more complex problems. They build stronger cultures of trust where performance doesn't come at the expense of human fulfillment. Ultimately, leaders who cultivate psychological safety are raising the bar for relational excellence. They understand that creativity is fragile, feedback is transformational and psychological safety is the fertile soil in which both flourish. Whether you're a hospital executive, a tech founder, or a team lead navigating daily pressures, the boldest act of leadership today may be about listening more deeply, inviting more voices and making it safe to fail forward. Because the future of work and well-being depends not only on what we build, but also on how bravely we allow others to co-create it with us.
Mail & Guardian
20-05-2025
- Health
- Mail & Guardian
Fatal oversight: Systemic negligence and leadership failure took a young doctor's life
Junior doctors across provinces report fear of victimisation which breeds a culture of silence. (File photo) The On anonymous online platforms, fellow healthcare workers have broken their silence, echoing stories of exploitation, burnout and fear. Dr Alulutho Mazwi was only 25 years old. His death must not be dismissed as a singular failure of compassion or miscommunication. It must be recognised as a systemic collapse where the absence of leadership competence, ethical decision-making and safety planning results in preventable deaths. This situation also reflects failure of psychological safety and workplace health standards. Managing staff requires leadership credentials, emotional intelligence and human resource training. Yet in healthcare, leadership is often conferred through clinical rank, not capability. Holding an MBChB or specialist degree does not make one a competent manager. Yet those titles are all too often treated as de facto licences to supervise and discipline junior staff without any oversight into how those responsibilities are carried out. Assigning power without competency and oversight is negligence. Section 24 of the Constitution states: 'Everyone has the right to an environment that is not harmful to their health or well-being.' When interns are left to continue working despite being ill, this potentially puts the doctor and patients at risk, which is in direct violation of Occupational Health and Safety Act; the OHS and Labour Relations Act requires employers to ensure a work environment free from physical or psychological harm. Leaving interns unsupported, overworked, working while ill and fearful of speaking up because of reprisals creates conditions that are not only unsafe, but legally and ethically indefensible. Dr Mazwi's death raises the question: who was the senior who allegedly forced him to work while ill? If they lacked the skill to assess risk or show professional empathy, who appointed them? What criteria were used? And where was the head of department, and the hospital chief executive? If they were aware, why did they not intervene? If they were unaware, why are they in those positions? The answer lies in a health system that rewards tenure and titles, not leadership competency, ultimately giving rise to institutional structures without substance. The health department maintains a vast array of administrative units including monitoring and evaluation offices, HR departments, wellness strategies and intern management protocols. On paper, this architecture suggests a system of support and oversight, but in practice, it is failing at every level. If internal systems functioned as intended, red flags about burnout, toxic culture and unsafe practices would have been identified and acted upon. Instead, junior doctors across provinces report fear of victimisation, grievance processes and a culture of silence. Interns often fear speaking out because of opaque grievance procedures and risk of retaliation. This silence violates the Promotion of Administrative Justice Act and Protection from Harassment Act, both of which aim to ensure just, transparent and safe public administration. In psychological terms, this is a work environment that scores abysmally on psychological safety where staff do not feel safe to speak up, raise concerns or protect their own health without fear of punishment. As a country we are fast falling into a pandemic of inquiries and investigations as tick box exercises with no significant outcome, no punitive measures and, most importantly, no systemic reformation. In provinces like Gauteng, a decision was made to cut overtime for doctors, citing budgetary constraints. This is being done with little to no consultation, despite already chronic understaffing in public hospitals. Cutting overtime without increasing posts or restructuring workloads is not reform, it is risk redistribution. The burden simply shifts onto fewer hands, most often junior doctors who are least empowered to speak out. These cost-saving measures not only undermine service delivery but also violate the Basic Conditions of Employment Act, which requires fair working hours, sufficient rest periods and safe working conditions. Cutting overtime without increasing staff restructuring duties violates these principles and places employees under duress, exposing them to harm. From a legal perspective, expecting staff to work excessive hours in unsafe environments constitutes constructive dismissal risk, and from a human perspective, it is institutionalised exploitation. Despite more than 1800 unemployed qualified doctors in early 2025, hospitals continue to operate dangerously understaffed. Junior doctors are reportedly left in charge of departments after hours, because registrars and consultants allegedly leave early. These unmonitored practices violate principles of workplace safety and professional supervision. If these claims are true, then the health department has lost control of its mandate to manage the very professionals whose salaries cost billions. The department must explain: Who manages staff work times and the distribution of workloads? Who do they report to? How effective is their management? Are they earning the public salaries they're paid? These are not rhetorical questions. They demand public answers. We are cutting the lifelines of our healthcare system while preserving the scaffolding of managerial incompetence. This will undermine the South African dream for universal health coverage and equitable access to opportunities for doctors and patients alike. It is incidents like Dr Mazwi's death that highlight the misalignment of the National Health Insurance (NHI), the How can we promise universal care when we cannot protect the staff who deliver it? How can we claim to support the poor while gutting the very services that serve them? The NHI cannot succeed in a system where junior staff are abused, senior leaders are untrained and financial decisions contradict ethical care. We must confront uncomfortable truths as we unpack the fatal reality of this junior doctor and among them are the hard-hitting questions that need to be answered if we are committed to seeking justice for his life and the well-being of all the many others who have been brutalised by this system. This death is not an exception. It is a consequence of structural negligence and a culture of impunity. Dr Mazwi died working for a system that did not work for him. His death is a national failure, and we cannot afford to look away. We are not just failing patients. We are failing the people who have sworn to care for them. Failure to act decisively, in light of the evidence and outcry, would mean accepting more deaths like this one as the cost of doing business. We owe this young doctor and every healthcare worker battling this system more than memorials. We owe them justice, reform and protection. Urgent call to action Dr Mazwi's death and the collective grief shared since must lead to transformative action. We demand immediate intervention from health authorities, regulators, and political leaders. Specifically: An independent, expedited investigation at Prince Msheiyeni Memorial Hospital with consequences for all found responsible; A public outline of HR and leadership reform measures by the department of health, acknowledging the widespread suffering of interns and Junior doctors; A policy reform mandating that no one may be appointed to leadership or supervisory roles without formal training in human resource management, people leadership, and psychological safety; The department of health and Health Professions Council of South Africa must create a safe, accessible and responsive reporting mechanism for doctors in distress, separate from existing slow-moving internal systems; Budget alignment must prioritise safe staffing ratios and staff well-being; and Audit the readiness of the NHI system, especially in terms of staff safety, leadership capacity, and system accountability- before further rollout occurs. Naheedah Collins is an industrial psychologist and Haseena Majid is a Global Atlantic fellow for health equity and social justice at the Atlantic Institute, Oxford, UK.
