Recent times have shone the spotlight on care workers, rightly recognised by many as heroes through a rapidly evolving crisis. The wider community’s support and attitude of gratitude is valued, but it’s also timely to address care workers’ level of ‘psychological safety’ and the impact it can have on their health, as well as the outcomes of teams and patients.
Recent times have shone the spotlight on care workers, rightly recognised by many as heroes through a rapidly evolving crisis. The wider community’s support and attitude of gratitude is valued, but it’s also timely to address care workers’ level of ‘psychological safety’ and the impact it can have on their health, as well as the outcomes of teams and patients.
“Psychological safety,” is a term made popular by Amy Edmondson of Harvard Business School, whose research shows that designing a culture built around trust and assurance, rather than fear and retribution, has widely positive outcomes for any organisation. Concerns about ‘impression management’ (potentially being laughed at for asking a silly question, rebuked for calling out improper behaviour) can be massively detrimental to teams, especially for those whose work is both uncertain and interdependent. Fearful people within an organisation can have devastating effects on just about every KPI.
So, how safe have care workers felt since the pandemic began? They are on the front line, doing tremendous things and put under considerable pressure; so strong teamwork, compassion and resilience are three attributes that underpin their success.
Edmondson refers to the term “Teaming” or “Teamwork on the fly” and its relevance to the healthcare industry. Medical staff in a hospital often have different colleagues working alongside them on different shifts. They are thrust into situations where they have to work together almost like a dance, and more than likely, a fast Cha Cha. Their choreographic expertise is essential to the success of patient outcomes. However, if they don’t speak up for fear of being wrong; don’t question a senior who has just done a double shift and is exhausted; it can lead to potentially fatal mistakes.
Consider which hospital you would prefer to be treated at one that has 50 reported drug errors per 10,000 patients, or one that has or 5 reported drug errors per 10,000 patients. Surely fewer reported errors must be a good thing, right?
Though that isn’t necessarily the case As mentioned in Leadership In Healthcare and Public Health, by Hilary Metelko Rosebrook, “Many organizations give contradictory messages by having a benchmark of safety standards that must be met while also making error reporting of these processes a priority. Employees may fear punishment for not meeting the safety standards and, therefore, may not report the related safety errors.”
The lower incidence of error reporting may indicate a culture lacking in openness and psychological safety. For errors to be reported, people have to notice them, but also voice them. When people are encouraged to speak up, with a team mindset of solving these problems, means that fewer incidents will occur in the long run.
Is there a metric for measuring psychological safety? Peter Russian from Turn the Ship Around Institute talks about two ways people might respond to questions in an organisation where they feel psychologically unsafe:
What do we actually need them to do? Speak UP. However, that is only going to happen in workplaces where staff can say what they see and share what they think without fear of retribution, retaliation or ridicule. Where psychological safety is nurtured, people are more likely to ask questions, report mistakes or make suggestions for improvement. This leads to greater opportunities for learning and innovation.
The medical profession is known for long hours and a constant barrage of demands, with work days that become marathon-like in nature. How do healthcare workers moderate their emotions and feel psychologically safe when lives are on the line? Resilience through trying times requires emotional regulation.
Barbara Fredrikson’s broaden-and-build theory of positive emotions offers some insights. What we deem ‘negative emotions’ such as fear tend to prompt narrow, immediate survival-oriented behaviors (fight, flight or freeze) including mean freezing one’s voice or response when it is most needed. According to Fredrickson, the resources gained through positive emotions build up over time and increase the individual’s overall well-being, resulting in more positive emotions which lead to higher resilience.
It’s unhealthy to be expected to check emotions at the door. Psychologically safe workplaces freely permit employees and talk about their challenges and associated emotions, which are essential elements for healthcare workers.
This challenge is addressed in The Compassion Paradox faced by Health Care Workers (Leif Hass, 30 July 2018). Continual investment in patients’ health outcomes can lead to feelings of stress and burnout, paradoxically undermining care workers’ ability to remain compassionate. In searching for how to address this, Hass found wisdom in Buddhist philosophy, supported by psychological research. “The Buddhists say that limitless compassion requires detachment from the outcome of the object of compassion.” In other words, rather than jumping straight into problem-solving mode, the approach required is to “fully bear witness to suffering, feel moved to alleviate it, but don’t be attached to the outcome.”
A study conducted at Stanford medicine showed that there is a correlation between psychological safety and position within a hierarchy. Seniority in the healthcare profession demonstrated greater psychological safety whereas those lower down in “the food chain” had considerably less psychological safety. So how could one reinforce a sense of psychological safety across the healthcare industry, or in any other industry for that matter?
Amy Edmondson’s excellent TEDx Talk goes into greater detail around these three key factors.
Do you believe your organisational culture may have issues regarding psychological safety? Talk to a Keogh Consultant about diagnosing the level of psychological safety in your organisation and team, and implementing initiatives to improve it. Or read more about why psychological safety is so valuable.
