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Psychological Safety in Healthcare
Have you ever been afraid to ask a simple question in a team environment?
Was your solution to continue without clarification in order to avoid being perceived as ignorant?
If so, youâre not alone. We need to discuss the overarching problem: psychological safety.
âThe whole is greater than the sum of its partsââââAristotle
For the past few months, Iâve been fascinated by what Google researchers have deemed the most important factor for a teamâs effectiveness, outlined in their âProject Aristotleâ.
What is Psychological Safety?
Amy Edmondson first introduced the construct of âteam psychological safetyâ and defined it as:
âA shared belief held by members of a team that the team is safe for interpersonal risk-taking.ââââAmy Edmondson
Itâs a belief that no one will be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.
The results of a psychologically unsafe environment are striking:
We donât want to appear ignorant, so we donât ask questions.
We donât want to come across intrusive, so we stop offering ideas.
We donât want to appear incompetent, so we donât admit our weaknesses or mistakes.
We donât wish to come across negative, so we donât critique the status quo.
The lack of psychological safety, particularly in high stake team environments, is a recipe for disaster.
Why Do We Need It?
Any team that is interdependent and experiences moments of âuncertaintyâ needs a psychologically safe environment.
Individuals within teams are often so focussed on creating impressions that they forget to help better their organisation and work culture.
Each time a question is withheld because of âno one else is askingâ, every person in the room is robbed from small moments of learning.
In order to foster a climate of âopennessâ, teams need to actively discuss their mistakes and be able to challenge each other fearing the consequences.
A case study in Healthcare: Just a Routine Operation
In 2005, a routine operation on Elaine Bromiley went horribly wrong.
After being anaesthetised, the anaesthetists and surgeons failed to successfully intubate her for a prolonged period of time.
She was severely deprived of oxygen and suffered irreparable brain damage, sadly passing away 13 days later.
This was a landmark case study with a wealth of learning points, particularly on the topic of âhuman factorsâ.
There were two specific interactions which highlighted the importance of psychological safety:
One nurse had recognised the emergency early on and informed the anaesthetists that she had made a bed available in intensive care for Elaine. After being given âa lookâ from the consultants as if to say âwhatâs wrong, youâre overreactingâ, she went and cancelled the bed.
Another two nurses stated at the inquest that they knew exactly what needed to happen in the emergency, but âdidnât know how to approach the subjectâ, implying that they werenât comfortable enough to voice their thoughts to their senior colleagues.
The environment wasnât psychologically safe for the nurses to challenge their colleagues. So they held back.
Even in the best of healthcare and aviation teams, psychological safety can save lives.
How Do We Achieve It?
In her TEDx talk, Amy Edmondson offers three simple things that individuals can do to foster team psychological safety:
Frame the work as a learning problem, not an execution problem.
Acknowledge your own fallibility.
Model curiosity and ask lots of questions.
If you were to openly acknowledge your mistakes in a team setting but your boss scolded you, you probably wouldnât do it again and neither would your colleagues.
Fear sticks.
As with any hierarchical organisation structure, a healthy work environment has to be championed from the top down in order to see widespread adoption.
The key is to move towards a work culture that frees people to be open about their mistakes, ask for help, suggest ideas and challenge others without backlash or judgement.
A team that aggressively upholds individual accountability may lead to big mistakes from an anxious workforce.
That being said, an excess of psychological safety without accountability creates a comfort zone, something that would dwindle the excellence seen in high-performance teams.
Accountability and psychological safety are not two ends of a spectrum, they run parallel.
Juggle them correctly, and we get effective teams whilst creating a healthy work climate of trust and openness.
If you liked this article, you might like this one too: Itâs time the NHS placed its staff before its patients
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âď¸ About the Author:
đ¨đ˝ââď¸Faisal is a Junior Doctor working in the NHS, new Youtuber and Founder of YoungAcademics.
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