Psychological Safety and Healthcare
Kaitlan Bryant
Abstract
Enhancing teamwork in high stress, high risk healthcare environments, such as the operating room and the emergency department, is a long-standing challenge. These environments leave very little room for error, so it is critical that healthcare providers are willing and able to speak up when they notice a mistake, or the potential for larger error, even if doing so means questioning the behavior of a leader. Accordingly, creating the right teamwork culture is critical, especially in a culture built on psychological safety across all healthcare professionals. Psychological safety reflects the collective perception that a team is safe for interpersonal risk taking. Additionally, team psychological safety is an important component for team well-being and reducing burnout; it reduces stress surrounding communication, and it encourages team members to seek feedback from others. However, little is known regarding the challenges that exist when trying to establish and sustain psychological safety in high risk, high stress healthcare contexts, where teams are dynamically changing. The current research project applies a mixed-methods approach to understanding what factors might reduce or enhance team psychological safety in two different contexts: surgery and emergency medicine. Integrating current literature with observations and interviews will offer important recommendations for healthcare providers and their teams.
Introduction
Psychological safety is a shared belief that all members of a team are safe for interpersonal risk taking. This includes being able to show and employ one’s self without fear of negative consequences of self-image, status or career. It is crucial to have psychological safety in high risk situations such as in the emergency department or in the operating room because human lives are at stake and the circumstances are constantly dynamically changing. It is imperative for medical providers to feel confident in themselves and their judgement. It is also important for medical providers to be able to speak up when they see a mistake being made in the care of a patient, even if speaking up compromises the judgement of one of their leaders. Leaders, even with extensive experience must be aware that they, too, could make a mistake and therefore must make sure that their entire team feels comfortable communicating.
Materials and Methods
Much of this information on factors to enhance psychological safety in the surgery and emergency medicine was gathered through reviewing current literature. Also, observations in both the operating room as well as the emergency room at Greenville Memorial Hospital we’re conducted in order to watch teams members interact with each other as well as with other teams in these high stress situations. Through this, observations and suggestions were made on what might help to increase psychological safety within these teams. Finally, interviews were conducted with surgeons as well as emergency room physicians to get their thoughts on what really makes for successful psychological safety within their specific teams. Combining these three methods, critical recommendations were compiled for healthcare providers and their teams regarding psychological safety within their teams.
Results
There are several factors that have been found to affect psychological safety in both the emergency department and the operating room. A lot of these factors overlap between the two environments as well as there being some factors that are individual to each. Specifically for the operating room, there is often larger teams with more team members as well as more teams working together simultaneously to take care of the patient. This is compared to most often just a physician and a nurse working to take care of patients in the emergency room. Therefore, there is more opportunity for tension to arise between teams in the operating room. This can worsen particularly if these teams are made up of leaders with strong personalities who are particular about the way they want things done. This can erode psychological safety because team members with less experience are more likely to feel this tension and not feel like they can communicate their opinions freely, compared to a leader who is personable and invites opinions from all team members, which in turn enhances psychological safety.
Leadership approach can also affect psychological safety in the emergency department as well, as medical students and resident physicians may not feel as though they can express themselves freely if their leader is not open to others opinions or takes a more authoritative approach to leading. Something else that can hinder psychological safety in the emergency department is an improper balance of working quickly and being thorough with the patients. It is important to work quickly in the emergency department as there are constantly people coming in to be seen, but this can often be at the cost of thoroughness and patients can often be left not fully understanding their path of care. Not only can this cause the patient to be confused but this sense of urgency can also cause team members to feel like expressing their opinions might slow the process, therefore hindering psychological safety.
There are several other factors that might affect psychological safety in the emergency department as well as the operating room. The first of these factors is hierarchy. Higher-status team members believe that there is lower risk in expressing their opinions often because they have no worries that their opinions are valued. Conversely, lower-status individuals have more fears about expressing their opinions, especially during interactions with higher-status individuals. Familiarity is another factor that can enhance or hinder psychological safety in both the ED and the OR. Psychological safety is often lower for individuals who are interacting with people they aren’t as familiar with whereas teams made up of individuals who work together often and are familiar with each other tend to have higher psychological safety because of a greater sense of trust.
Conclusions
The factors found that most greatly affect psychological safety in high risk, healthcare environments such as the operating room and the emergency department include leadership personality, particularly in the operating room, work pace, particularly in the emergency department, and hierarchy and familiarity in both situations. The best environment to optimally enhance psychological safety in the operating room seems to be one where the leaders of the teams are not defensive but are personable and open to the opinions of all team members, as this reduces tension and hierarchical differences. Psychological safety will also be higher in the operating room when the teams consist of individuals who are familiar with each other and work together often, as this reduces tension and increases a sense of trust. The optimal environment for psychological safety in the emergency department is very similar to that of the operating room. A personable leader who is open to the opinions of others, low hierarchical tension and high familiarity all are important factors. An appropriate work pace is also crucial for psychological safety in the emergency department. It is important to work quickly and effectively but not too quickly that the members of the team feel like they can’t express themselves without interpersonal risk.
References
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Acknowledgements
I would like to thank Marissa Shuffler Porter, Riley Mccallus and Jordan Smith for helping with coordination and conduction of observations at Greenville Memorial Hospital.
I would also like to thank all of the physicians that allowed me to observe and question them in the emergency department as well as in surgery at Greenville Memorial Hospital.
