Am I Psychologically Safe

Premier Pulse     September 2022

Belcastro_336x336By Marc Belcastro, DO, system chief medical officer, Premier Health

As professionals and health care providers, we have a sacred and privileged duty.  We are responsible for the health and lives of our patients, their families, and caring for our teams. This care is essential to psychological safety within our sphere of influence.

Schein and Bennis first mentioned psychological safety in the 1960s.  Amy Edmondson coined the term “psychological safety” in a 1999 journal article exploring its relationship to team learning and performance. Edmondson defined this as “a shared belief held by members of a team that the team is safe for interpersonal risk-taking.”  The question in the title of this article is like a coin with two sides. One side is, Do I feel safe with my team? The other is, Am I safe to others on my team?

Psychological safety is more than “being nice.”  There are cultural and implicit (unconscious) bias influences as we interact on teams to provide care. These cultural norms and implicit biases were demonstrated in two tragic accidents in the airline industry.  Korean Air Flight 801 crashed on August 6, 1997, killing 229 of the 254 people aboard. Avianca Flight 052 crashed on January 25, 1990. Eight of the nine crew members and 65 of the 149 passengers were killed. These crashes have been blamed on aspects of the national cultures of the crews.

How can this play out in medicine? While I was practicing as the medical director of the NICU, an experienced nurse I knew approached me regarding concerns with the discharge of an infant. The findings were normal for an infant, and I reassured her. She returned about 30 minutes later with continued concerns. A test was ordered, and we canceled the discharge. What conditions and perceptions had the potential to influence this interaction? What about the organizational hierarchies of nurses? What about implicit biases of males or females?  Why would one question the “medical director”? Was she comfortable returning because we had worked together for so long? If yes, then our past interactions were presumably safe.  Was I convinced to act because of her experience? What would my reaction have been if she were a new nurse?

How do you want to be known on your team?  Are you, as operators, leading the time-outs for surgeries and procedures and encouraging anyone in the room to speak up at any time, even if incorrect?  Do staff in the regional referral center experience fear when they see your name? These are important questions to face and honestly answer as we work to provide the safest care possible to every life we touch and every team member we lead. 

If you are interested in digging deeper into this subject, you can watch Amy Edmondson’s TED talk or even check out her book.  

Back to the September 2022 issue of Premier Pulse

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