Psychological Safety in Healthcare

There has been an increased interest in psychological safety in recent years as people become increasingly aware the role it plays in team effectiveness. This was borne out by the popularity of a recent workshop delivered at the annual patient safety conference in Copenhagen. To follow, are some of my reflections from coordinating a one-day workshop focusing on ‘Psychological Safety in the Healthcare Sector’. It was delivered as part of the 2019 Patient safety conference (Patientsikkerhedskonference) held in Copenhagen on April 9th. 

In the last few years there has been an increased focus on the importance of psychological safety as a means of predicting learning behavior and as an objective measure of performance in teams. However, the subject is far from new, people like Edgar Schein were writing about psychological safety back in the 1960’s. However, in the last few years, Professor Amy Edmondson (Harvard Business School) has emerged as the leading figure in this field. In her recent book, ‘Fearless Organizations’ Edmondson defines psychological safety as

“the belief that the work environment is safe for interpersonal risk taking” clarifying that “the concept refers to the experience of feeling able to speak up with relevant ideas, questions, or concerns. Psychological safety is present when colleagues trust and respect each other and feel able – even obligated – to be candid.” (Edmondson, 2018).

A key insight from the research in this area is that psychological safety is not a personality difference, but rather a feature of the workplace that leaders can and must help create.

The concept gained mainstream public attention as a result of the research undertaken by Google (Project Aristotle, 2016) which aimed to answer the question: “What makes a team effective at Google?”. The research team identified 180 teams to study which included a mix of high- and low-performing teams. The study tested how both team composition (e.g., personality traits, sales skills, demographics on the team) and team dynamics (e.g., what it was like to work with teammates) impact team effectiveness. The researchers found that what really mattered was less about who is on the team, and more about how the team worked together. Most importantly, ‘Psychological safety’ was fundamental for team effectiveness.

In the field of healthcare quality and safety, the Institute of Healthcare Improvement released a white paper titled ‘Framework for Improving Joy in Work’ (Perlo et al., 2017). The document was intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?”, enabling them to better understand the barriers to joy in work, and co-create meaningful, high-leverage strategies to address these issues. The primary component of the ‘system for ensuring joyful, engaged work’ is psychological safety.

It is against this backdrop, that I invited colleagues from various organisations across Denmark to share their knowledge, insight and experience on this subject with participants at the annual patient safety conference organized by the Danish Society for Patient Safety (Dansk Selskab for Patientsikkerhed). With the shared belief that high quality and safe healthcare requires a psychologically safe workplace, we presented to a group of curious and engaged participants from across Danish healthcare how psychological safety influences our work.

After a brief introduction to the concept of psychological safety based on the work of Professor Amy Edmondson by me, the speakers took the audience on a journey across theoretical, clinical and personal landscapes. 

Ivar G. Petersen (Patient Ambassador) shared his personal story which included not only the very moving experience of his 17-year-old son dying of meningitis, but also his perspective on how the health system learnt from the incident. Through his own expertise, he shared his perspective on how psychological safety influenced the actions of the clinical staff working in the hospital at the time of his son’s treatment, and how it influenced the system response.

The role and function of trust in our workplaces was covered by Mille Mortensen (Copenhagen University) who shared her ethnographic fieldwork on how humor can be used to influence our sense of psychological safety, both positively and negatively. In the later case, as a form of bullying. Interview data helped to shine a light on the subtleties of this mechanism.

The importance of training and habit in the development of safety dispositions was shared by Kirstine Zinck Pedersen (Copenhagen Business School). Specifically, the question of how we organize staff in healthcare so that in the best possible way, we ensure that safety dispositions are recognized, maintained and backed up by organizational, managerial and political arrangements.

By providing an insight into how the ‘Inner Voices’ model can be used as a tool to understand interpersonal dynamics, Peter Dieckmann (Copenhagen Academy for Medical Education and Simulation) helped participants understand better their own reactions to work-based situations, as well as the reactions of others.

Drawing on the work of Edgar Schein amongst others, Solvejg Kristensen (Aalborg University Hospital - Psychiatry) focused on the role of leadership in healthcare settings and the importance of asking humbly as a foundation for a psychologically safe patient safety culture.

As a group, this was the first time we had worked together, so it was encouraging for us that our session was so popular that we had to (politely) ask some people who hadn’t booked a place to leave so that those who had booked could take a seat. It was also reassuring, that the feedback after the workshop was overwhelmingly positive.

I must also reflect on the importance of honest and open communication in the development of the program. It was critical to have differing perspectives on this important aspect of patient safety culture, in particular, the voice of the patient ambassador, who was critical in keeping us focused and grounded. It goes without saying, I’m excited by the possibilities of future collaboration… But this is where I would ask for your input:

Would you be interested in a larger event dedicated to the issue of psychological safety in health and social care? If yes, what other areas would you be interested in that are linked to psychological safety?

For example:

• Joy in Work / Burnout
• 2nd victim
• Learning from errors
• Leadership
• Organisational change
• Innovation
• Speak-up
• Arbejdsmilj?
• Simulation
• Bullying

I look forward to your responses.

Of course, you can also contact me directly via email: [email protected] or via twitter @simontulloch

If you are interested in other professional news from Dansk Selkab for Patientsikkerhed try our news letter 'Fagligt Nyt'.