If you want a high-performing, efficient, and happy workplace, it’s essential that you draw from the knowledge and perspective of everyone on your team. You need to know what’s working, what isn’t working, and how your processes can be improved.

For that reason, every team member must believe their feedback is welcomed and valued. And this occurs only when people feel psychologically safe.

If team members feel belittled, ignored, or threatened when they speak up, they will not feel psychologically safe and quickly learn to keep their mouths shut. Their valuable perspective will then be forfeited. And the price you will pay is lost efficiency, lost innovation, and, in medicine, perhaps even lost lives.

Creating psychological safety—empowering team members to speak up and make authentic contributions—is one of the chief jobs of a leader. But to create psychological safety, psychological size must be factored in.

Psychological size refers to the relative status of one team member to another. To paraphrase George Orwell, some team members are more equal than others. This is particularly true in medicine, where physicians have traditionally been accorded a great deal of status.

I'm five-seven and 160 pounds soaking wet, but because of the MD after my name, the credentials I carry, and my gray temples, my psychological size tends to be magnified. People often see me in a way that differs from what I intend to project.

Physicians, let’s face it, are placed on pedestals to some extent, and it’s hard to relate to people on pedestals. One thing I do to combat this is to always introduce myself as “Leon,” not “Dr. Moores,” but few people are willing to use my first name, and that number shrinks the grayer my hair becomes.

Fortunately, there has been some progress in recent decades. Today, there's more communication and a team milieu in medicine. But it’s important to realize that, at the one-on-one level, the psychological size of doctors is still a factor.

Psychological size does have some advantages. Team members will respond to our clinical decisions without hesitation. Patients will follow our recommendations. But some disadvantages come along with the status mismatch.

Folks might not be willing to speak up around us, and that can be an issue. If a team member sees something that doesn’t feel right and they’re uncomfortable speaking up because they don’t want to question the doctor’s authority, this limits the ability of the team to come up with the best solution.

Psychological size affects off-the-field interactions with the team as well. We may think we're just “one of the guys and gals,” but we’re not. We might, for example, make a teasing comment about a teammate, intending to be playful, without realizing that our remarks can cut more deeply than those of others.

And of course, our power and status differential must be weighed carefully when considering personal relationships with team members.

Even your peers may have trouble seeing you equally due to psychological size. If you’re a senior physician with graying temples and years of experience, fellow doctors may give you a level of deference you’re not necessarily seeking.