Two sentences make your team safer

You start huddle and you can feel it.

Everyone’s moving fast. The ED is backed up. 12 patients are waiting on placement. Somebody mentions a “situation” with a high-risk psych patient, then trails off. You sense there’s more underneath… but no one says it out loud.

That gap—between what people see and what they’re willing to say—is where patients get hurt and teams burn out.

This article is about fixing that gap with something so small it feels almost silly:

Two sentences you can ask in every huddle:

“What’s one risk we’re carrying today that we haven’t said out loud?”

“If this goes sideways after 5 pm, who do we call first?”

They look simple. They are not soft. They are built on a big body of research on psychological safety and speaking up in healthcare—and on what happens when we don’t have it.

For context on how hidden risks show up operationally, see the clinical tax of ED boarding and why visibility (not payments) shortens LOS in AKS rules and LOS.

Why psychological safety is not fluffy (and why CM directors should care)

Psychological safety is the shared belief that “this team is safe for interpersonal risk-taking”—safe to say “I’m worried about this,” “I think we’re missing something,” or “Can we slow down?” without being punished or humiliated. 1

• A 2025 systematic review found that in 5 out of 9 quantitative studies, higher psychological safety was significantly associated with better patient safety outcomes (e.g., fewer ventilator-associated events, fewer reported medical errors). 2
• A 2025 nursing review concluded that teams with strong psychological safety report fewer preventable adverse events, lower burnout, and higher retention. 3 5
• Studies of nurses and physicians repeatedly show that higher psychological safety → more speaking up and error-reporting intention. 8 [9] 10

Flip that around: low psychological safety means silence, “workarounds,” and staff who carry worry home. In one qualitative study of hospital teams, staff described knowing about problems but staying quiet because they feared being seen as difficult or incompetent—even on teams that scored “high” on a psychological safety survey. 6 7

As a Director of Care Management, that’s your world:

ED case managers who see a dangerous discharge but feel like “they’ll just think I’m blocking flow again.” Social workers who hear a caregiver quietly say, “I don’t think I can do this,” and feel like there’s no airtime to bring it up. Call-center nurses who handle post-discharge calls, notice a pattern, and don’t think anyone wants to hear “bad news” in the throughput meeting. You can’t fix all of that with one tool. But you can change the default of your huddles—from “move the list” to “say the risk.” That’s where the two sentences come in.

Why these two questions?

“What’s one risk we’re carrying today that we haven’t said out loud?”

“If this goes sideways after 5 pm, who do we call first?”

These are a distilled form of what the research says good leaders do:

• Actively invite input (“What are we missing?”)
• Make it about the work, not the person (“What risk are we carrying?”)
• Normalize uncertainty and fallibility (“We know some things will go sideways; let’s plan for it.”) In classic cardiac surgery and ICU research, teams whose leaders explicitly invited input and questions had significantly higher psychological safety and better learning behaviors than those whose leaders didn’t. 11 1 Let’s unpack why each question matters.

Question 1: “What’s one risk we’re carrying today that we haven’t said out loud?”

This question does three powerful things in one breath.

1. It tells people you expect hidden risks

You’re saying: “Of course there’s something we’re worried about that isn’t on the whiteboard yet.” That shifts the norm from “Everything’s fine unless you can prove otherwise” to “Risks are normal; let’s find them together.”

Research on “speaking up culture” shows that people are more likely to voice concerns when they believe their input is expected and valued, not exceptional. A 2023 study of nurses found that stronger “speak-up climate” was strongly associated with more frequent safety voice behaviors (raising concerns, asking clarifying questions). 8

2. It lowers the bar: “one” and “we”

You’re not asking, “Anyone see any catastrophic threats?” You’re forcing the group to find one thing, shared by we. That makes it safer for a case manager to say:

“We’re carrying a risk with Mr. Jackson. We’re sending him home on IV antibiotics with a PICC, and his daughter works nights. She hasn’t said no, but she looks terrified.”

That’s the kind of detail that never shows up in LOS dashboards—but absolutely shows up in readmissions. In qualitative work, healthcare staff described “little worries” they kept to themselves because they didn’t feel serious enough. Those “little worries” are exactly the precursors to events. 6

3. It creates a ritual of naming the thing

Every time you ask, you create a micro-habit: we name one risk before we go crush the day.

Over time, this: Trains ED CMs to bring that one patient they’re most worried about. Trains CMs & SWs to speak up about home safety or caregiver capacity, not just placement. Trains discharge assistants and call-center nurses to elevate patterns (“we’ve had 3 calls about oxygen vendors this week”).

The systematic review on psychological safety & patient safety notes that interventions which facilitate regular, structured reflection on risks and errors are among the most promising ways to lift both. 2

Question 2: “If this goes sideways after 5 pm, who do we call first?”

On the surface, this is logistics. Underneath, it’s another psychological safety move.

1. It assumes things can go wrong without blame

High-reliability organizations talk openly about “when, not if” things deviate. This question says: “We know some plans will fail after hours. That doesn’t mean you failed. It means we need a clear rescue plan.” That reduces the shame and fear people associate with “bothering” a physician, director, or on-call leader.

For after‑hours safety on the patient side, pair this with the 24‑hour post‑discharge call so small problems don’t become 7‑day revisits.

Studies of “second victims” show that after an adverse event, nurses and other staff report shame, anxiety, loss of confidence, and fear of colleagues’ reactions—and often a lack of support from leaders. 13 14 15

Designing in an after-hours plan signals: we expect complexity; we’ve got your back.

2. It clarifies escalation, which increases speaking up

Speaking up isn’t just about courage; it’s about knowing who to go to. A 2021 study found that nurses with higher psychological safety were more willing to report errors and speak up when they knew how the system would respond. [9]

By asking, “Who do we call first?” you force the team to:

• Name a real person, not “the service”
• Agree on a single first step (not 4 competing phone numbers)
• Reduce the cognitive load of ED CMs and night-shift staff, who already juggle a dozen tasks. 16

Now when the SNF bed evaporates at 7:15 pm, your ED social worker isn’t wondering, “Am I allowed to escalate this?” They’re thinking, “Okay, we agreed to call Dr. Singh or the hospitalist lead first.”

3. It closes the loop in people’s minds

We know from safety science that anticipating failure + pre-planning the response is a hallmark of safer teams. A cross-sectional study of Swiss hospitals found that units with a strong “speak up–supportive climate” had significantly more staff reporting safety voice behavior and fewer unaddressed concerns. 10 This question makes that process explicit: name the risk, then name the response path.

“Do two sentences really make us safer?”

On their own? No. They’re not magic. But when used consistently by leaders, they:

• Increase speaking up and error reporting, which we know is associated with better safety outcomes. 8 [9] 10 6
• Reinforce psychological safety—which systematic reviews now link to fewer adverse events and safer care. 2
• Model leader inclusiveness, the behavior repeatedly shown to distinguish high-safety teams from low-safety ones. 11 12 Think of them as a tiny, daily intervention on the two variables you actually control as a CM Director: The questions you ask The way you respond to the answers If people bring you a risk and you: Thank them Clarify the next step Circle back later with “Here’s what we did” …you are literally doing what the literature calls “leader inclusiveness”—and it’s that pattern, repeated over time, that builds psychological safety. 11

A realistic story from your world

• Imagine an afternoon ED huddle.

• The board is red.

• Boarding list is long.

• Everyone is tense.

You ask:

• What’s one risk we’re carrying today that we haven’t said out loud?

Your ED case manager, Mia, speaks up:

• We’re carrying a risk with the 72-year-old in bed 18. He’s technically stable to go, but his wife is showing signs she can’t manage the new oxygen and wound care. She hasn’t said no, but she looks terrified.

In another huddle, that might get eye-rolls: “We don’t have beds. He has to go.”

You follow with:

• Thank you. What’s the smallest thing we can do to make tonight safer for them?

The team decides:

• Move transportation a few hours later,
• Get RT and wound nurse to do a joint teaching session with the wife,
• Confirm a next-day home health start with the right vendor.

For safer first days at home, see getting the first 48 hours right and Meds‑to‑Beds.

Then you ask:

• If this goes sideways after 5 pm—if the wound starts bleeding or she panics—who do we want them to call first?

The answer:

• Our transitions call-center nurse. Let’s put that number on the paperwork and on a fridge magnet.

You just:

• Surfaced a risk that would have turned into a scary re-admit.

• Created a plan that made home safer.

• Modeled to Mia that her worry is welcome, not annoying. Next time, she’ll bring the concern sooner.

That’s psychological safety in action, in exactly the group you manage: ED CMs, SWs, discharge assistants, call-center nurses.

Is there a “better” way?

You can absolutely layer more structure on this:

• Anonymous input (index cards, Teams/Slack form) for sensitive concerns
• Psychological safety pulse (3 items from Edmondson’s scale quarterly) 1
• Formal training on speaking up and listening, as recommended in expert statements from AHA and others. 12

But many CM directors are drowning in initiatives. The strength of these two sentences is:

• You don’t need a new tool.
• You don’t need a new meeting.
• You don’t need a consultant.
• You just need to ask them consistently and respond in a way that rewards the answer.

Key takeaways for Care Management leaders

• Psychological safety isn’t a buzzword; multiple reviews now show measurable links to patient safety, lower burnout, and better retention. 2 3 5
• Speaking up about safety concerns is one of the most direct ways frontline staff protect patients—but fear and unclear escalation paths keep people silent. 8 9 10 6
• Leaders who actively invite concerns and input have teams with higher psychological safety and stronger learning behaviors. 11 12 Two simple questions in your daily huddles can become a repeatable ritual that surfaces hidden risks, clarifies after-hours rescue, and signals to your CMs, SWs, and nurses: “It’s safe to tell the truth here.”

If you’re building a broader playbook, connect this with tactical wins like Meds‑to‑Beds and the 24‑hour post‑discharge call.