Psychological Safety: The Achilles'? heel amongst health allies and healthcare

Psychological Safety: The Achilles' heel amongst health allies and healthcare

My name is Alexandre Messager, I have been working for the Faculty of Medicine at the University of Ottawa for the past 10 years supporting the growth of north American and European clinicians in the area of leadership. During this rewarding experience I witnessed firsthand how eager clinicians are to improve their work environment, become better leaders and ultimately improve healthcare.

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However, one thing that stroked me from having discussions with over 400 clinicians and hear about their experience is the lack of working as a team. By team, I don’t mean working next to each other, I mean having respect, trust and caring for one another. We take for granted that people will become naturally a team but if nothing is being done to create the condition for this to happen even when some have been working next to each other for 5 or 10 years they still know very little about their colleagues. How often have I heard from clinicians that they don’t feel seen for who they are as a person or that they only wish that their colleagues take the time to acknowledge them in the morning and get to know them.?

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Is this surprising? Not really when you think about it. Clinicians have been conditioned to be the best of the best, their environment is based on strong competences that will judge you on the precision, accuracy and quality of your work. In order for clinicians to thrive, they need clear structure and standards, they want to be correct and be seen as an expert. You can only imagine then when one make a mistake or fail how they will feel and how the environment they have grown into sees it as a sign of weakness, but mistake are inevitable not only because they are human but because of how a lot of them are already exhausted and facing burnout due to increase workload and decrease resources.

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So in an environment where errors are seen as a weakness and where emotions should not be shown, there is actually no surprise that clinicians have a hard time working as a “real” team with each others and with other health allies. It then became quite clear for me that one of the roots issues why our healthcare system whether be in Canada or in France is in disarray is due to the lack of Psychological Safety which ultimately leads to not optimal performance and ultimately impact patient care. According to Dr. Amy Edmondson (one of the world expert in the field of Psychological Safety), psychological safety can be define as a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.

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On top of that, healthcare is still very hierarchical and so is its leadership. Therefore, the fear of being perceived from others as being "a difficult person to work with" because we challenge ideas or share disagreement can lead to catastrophic outcomes. Take the case of a nurse, resident or a junior clinician where they notice an error in the type of drug being administered to a patient by a more senior staff member. Based on their previous direct or indirect experience where they noticed that when one brought a different opinion forward to a more senior staff member and witnessed reprimand, reprisal and belittling. Do you think they will feel comfortable pointing out the error? If you answered yes, think twice!

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My original background is the hospitality industry and it’s quite clear that if you want to provide exceptional service to guests, you have to first take care of your employees and this regardless how luxurious your amenities are. The difference will always be about how caring employees are with guests and it all start with how we care for our employees. So why would this be different in healthcare? It’s not! If we want to provide the best patient care possible, it’s time to take care of our clinicians and other health allies first. Whether you are a clinician, a nurse, a resident or a medical student, regardless of your status in the hierarchy, you need to feel valued, seen and heard.

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If we don't start to demystify the need to be perfect how could Psychological Safety be alive and thrive in this environment. Without a strong culture of psychological safety, burnout amongst healthcare workers will only continue to rise and patient safety near misses and adverse events will rise without the opportunity for others to learn lessons from their peers.

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Time for change, time to "humanized" the healthcare environment and to not only talk about psychological safety but concretely implement actions to address healthcare's Achille's heel. It's time for a wakeup call and to address the elephant in the room by concretely measuring the level of psychological safety in healthcare departments. Once done, concrete action plans can be developed which will improve patient care.

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I will leave you to reflect on the following questions: What have you done this past week to enhance psychological safety in your unit? How often other health allies provide you with comments or suggestions that are different than yours?

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Let’s start to enhance the Psychological Safety journey together!

For more information and to start your journey contact me on LinkedIn.

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