3 Actions That Destroy Psychological Safety In Healthcare

 "In medicine, vulnerability is considered weak. We are told things like 'leave your feelings at the door'. There are no room for mistakes, and God forbid we do not know the answers to something… then our entire 12 + years of training is questioned. It's just not safe to be anything other than perfect as a physician" ~ Dr. C

As physicians, we are committed to providing the highest quality of care and safety to our patients. However, in an increasingly volatile and divisive time, we are seeing the safety of our patients being threatened, but also our colleagues as well. Furthermore, not all of the harm being done in the healthcare space to and among clinicians is physical. In fact, much of it is psychological and emotional. Burnout rates are continuing to be at a high and mental health in the healthcare community has not declined but risen since the pandemic. Psychological safety in healthcare is an overlooked but essential imperative that if lacking can affect not only the quality of healthcare given, but retention of quality providers and clinicians in the healthcare space. Psychological safety is defined as an environment where people feel heard, valued, and free to express themselves without fear of negative consequences. Psychological safety is crucial for a healthy and productive work environments and in medicine ultimately affects quality of care. In this series, we will talk about the things that destroy psychological safety and the antidote. Since there are many perpetuates of distrust, In this series, we will talk about the things that destroy psychological safety and the antidote. Since there are many perpetuates of distrust, this will be a 3 part series.

In Timothy Clark's book, 4 Stages of Psychological Safety, he talks about psychological safety in 4 components:

1. Safety to be Included
2. Safety to Learn (and make mistakes)
3. Safety to Contribute
4. Safety to Challenge (or report)

As we examine the behaviors that threaten and destroy safety we will view them through these four lenses.

 Let's look at the first three behaviors that threaten or destroy psychological safety.

"A colleague made several rude sexual remarks toward me, and when I went to Human resources to report it, they dismissed it and wrote me up for being disruptive" ~Dr. A.

1. Dismissive Attitudes: This is more common than one might think in the healthcare and corporate space. Dismissing concerns violates the element "Challenger Safety" When individuals dismiss the concerns, ideas, or feelings, it sends the message that they are not valued, and can create a hostile atmosphere. Furthermore, it creates an environment of unsafety because when their concerns are dismissed the behavior can continue and, in some cases, escalate with no consequences.

Antidote: Cultivating challenger safety means acknowledging concerns, and assuring that the concerns will be investigated, considered and taken care of. This must be followed with action and follow up to maintain the trust of those who have delivered the concern.

"In medical school, one of the first things I learned is that if you didn't know the answer keep your mouth shut. I can't count the number of times I saw my classmates and residents get yelled at, condescended, and belittled when they didn't know the right answer. Furthermore nothing we ever did was good enough. We were always being criticized or blamed for things that either we didn't know or didn't know to do because we weren't taught." ~Dr. M. C.

1. Culture of Blame and Criticism: A culture of blame and constant criticism can deter people from speaking up, asking for help, getting clarification, or taking risks. If individuals fear punishment or ridicule for their mistakes, they are less likely to share their thoughts or admit errors. This is especially dangerous in medicine where clarification is a vital part of learning and where mistakes could cost someone their life. Unfortunately, the learning culture of medicine has conditioned physicians and clinicians with the message that if you don't know then you are "stupid" or "incompetent". Often times this results in a "fake it" attitude which eventually turns into a defensive and even arrogance (as a defense mechanism) when the person really is unsure. This violates "Learner Safety".

Antidote: Leaders who invite questions make it safe for people to ask and learn. Furthermore, when leaders model fallibility make it safe because they are sending the message that everyone is human, and they model what to do when a mistake is made.

"When I was in residency I had to have surgery for a torn meniscus. I needed call coverage the day after the surgery and not only did my classmates refuse to help and switch call, my attendings didn't support me either. They would not give me time off and told me I had to manage my coverage myself. Ultimately, I ended up taking 24 hour call 2 days after my knee surgery. Because of the inflexibility of my schedule and having no help, I couldn't get physical therapy prolonging my recovery. As a result the knee never completely rehabilitated." ~Dr. M.C.

1. Lack of Empathy: This demonstrates a clear lack of empathy for the resident, and violates the principle of Inclusion Safety. Empathy is putting oneself in another's shoes, and acting or communicating accordingly. When one acts out of empathy, it often ends up in actions of support. Failing to show empathy towards others' challenges or difficulties can erode trust and safety and cause harm to the individual. Furthermore, when an organizational culture lacks empathy, it not only erodes trust and safety, but it wears on the emotional and psychological well being of the employees. People need to feel that their emotions and experiences matter, are understood, and are valid. If not, they will eventually disengage, disconnect and leaver.

Antidote: People have asked me if empathy can be taught. The answer is that it is not about teaching empathy, it's about reconnecting people to their own by reconnecting them to their humanity. Fostering true human connection in our healthcare spaces between colleagues helps us to see that we are all dealing with life on life's terms. When we can see our sameness (while honoring our differences) it allows for the arising and demonstration of our empathy.

The culture of psychological safety in healthcare is diminishing and these are a few things that we can begin to inspect and adjust that will help to restore trust and safety within organizations so that physicians and healthcare workers can show up as their best and most healthy selves and provide the care they are committed to for their patients.

Stay tuned for part 2!

Create Psychological Safety in your organization. When you leave your employees feeling seen, heard, understood, valued, appreciated, and respected they will stay and make your organization their career home. Want to know more? Contact Dr. Clairborne to discuss her offerings and how she can help our leaders increase trust, safety and belonging in your organization. Learn more: https://www.mindremappingacademy.com/corporate-programs