Am I Safe if I Speak Up?

Premier Pulse     April 2022

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

When I was working in the NICU, a nurse came to me with a concern about an infant on the day of discharge. What she described to me was a normal phenomenon in many infants, and I explained this to her and thanked her for her concern. She returned to the charting area about 20 minutes later and stated that she was just not comfortable. I thanked her again and ordered a test. Indeed, there was a result that we needed to investigate prior to discharge. Why did this nurse feel comfortable returning to me a second time? I was the medical director, an expert, and my initial explanation was accurate 99 percent of the time. But not this time.

In the book “The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth,” author Amy Edmondson explains how individuals must be allowed to voice half-finished thoughts, ask questions out of left field, and brainstorm out loud to create an environment and culture that is safe and innovative. She calls this psychological safety, which is defined as the knowledge and belief that one will not be humiliated or embarrassed for speaking up with ideas, questions, concerns, or mistakes. This belief is shared by all in the workplace, whether this be across an organization or in certain departments or units. Truly, people need to feel safe asking what may seem like naïve questions, expressing concerns, and even sharing disagreements. Tragic health care errors can often be traced back to someone’s unwillingness to or fear of speaking up, or the misguided belief that the expert must know what he or she is doing.

How do we build psychological safety? It is a culture. Cultures are created by leaders. Physicians are generally viewed as the leader of the health care team, and whether we choose this role or not, we are leaders. So it starts with us, and how we respond, one person at a time, one day at a time, over and over and over.

How safe is our organization? In May, a safety survey will be sent out. Physicians that work in the hospital environment will be emailed a link to this survey. Your honest feedback will help us in our journey to safety. I encourage you to participate.

Back to the April 2022 issue of Premier Pulse

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