Safety Is More Than Physical

Premier Pulse     July 2022

1730166836By Matthew Kramer, MD, medical staff president, Miami Valley Hospital

Have you ever left a meeting or encounter with the feeling that “I should have said something?” Have you ever thought to yourself ‘better not mention that problem, I’ll get in trouble?’ Have you ever been afraid to speak up due to fear of looking stupid, ignorant, incompetent, or disruptive? Has the possibility of reputational or career damage prevented you from saying the right thing at the right time? Does the risk to your relationships impede your ability to speak up?  All these scenarios, which occur far too frequently, are signs of a lack of psychological safety.

Safety is more than the physical environment. People constantly manage their interpersonal risk, both consciously and unconsciously, seeking emotional and psychological safety. Speaking up in this context is viewed as ‘risky behavior’, so fear produces silence that can damage an organization. 

By contrast, psychological safety involves being able to trust others to the extent that mistakes, honest opinions, and candid evaluations can be expressed without censure. When staff and employees feel psychologically safe, exchange of ideas, creativity, and innovation flourish. Further, in a psychologically safe environment where mistakes and errors are discussed openly, true QA/QI can occur.  Remember, you cannot correct mistakes that never get reported!  A culture of silence is one of the most dangerous things that can occur in medicine. 

How can a culture of psychological safety be created?  A good start is to embrace three key concepts:

  1. Set the stage for success by clearly defining why it’s important to discuss failures and chances for improvement.  State that you expect to be confronted and challenged with ideas, and you embrace discussions about problems, not cover-ups or silence.  
  2. Employ clear, direct, candid communication, empowering staff to speak up, and entertaining all suggestions, objections and comments, to allow staff to feel valued, appreciated and part of the team.  Ask good questions that invite input and listen intently to the responses. 
  3. Respond productively, not judgmentally. Inviting participation and evaluating the issues raised in a nonjudgmental fashion shows others that they have value, and that they can speak openly, even when reporting mistakes. The former CEO of Toyota, H. Okuda, had a saying “fix the problem, not the blame,” perfectly illustrating the concept of productive response. 

The net result of setting the stage for psychological safety is a decrease in errors, more motivated and engaged staff, greater creativity and innovation, a happier workplace, and ultimately better patient care. That’s a result we can all live with!

Back to the July 2022 issue of Premier Pulse

Premier Health Logo