Defining Psychological Safety
Psychological safety is a complex concept involving individual, team and organizational behaviors including those affected by status or power dynamics. It basically means that everyone on a team or within an organization feels comfortable speaking up with an idea or concern without fears of humiliation, retaliation, or some other kind of covert or overt punishment.
Some define this speaking up to be related to work-related issues only. I think this is problematic for two reasons. One, because it leaves the determination of the validity of speaking up open to interpretation by people in power. If there is a toxic hierarchy, i.e. bullying or blaming, this could implicitly reinforce the very fears that are keeping people silent.
We want you to speak up, but it depends on what you say and who you say it to.
The second reason I don ‘t like it is because it seems to question the validity of the need for personal safety and other personal needs.
Speaking up about time off, self care, or additional resources are important to prevent burnout, occupational injuries, and mistakes, yet will they be received as relevant? Such a mindset could also compromise efforts to create a diverse, inclusive, and equitable environment where everyone feels a sense of belonging.
In my many years of practice as an RN, there has often been a mixed message, We want you to speak up for patients and for patient safety but we don’t want you to speak up for yourself!
Resources
One resource for understanding the relationship, status, and power dynamics involved in psychological safety is the book, “Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety (The Culture and Politics of Health Care Work)” by Suzanne Gordon , Patrick Mendenhall, and Bonnie Blair O’toole, with a compelling foreword by Chesley “Sully” Sullenberger.
It is fascinating to read how the aviation industry analyzed and addressed issues that were contributing to airline crashes in the late 1970s. The book argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel
Another resource is this recent Harvard Business Review article “What is Psychological Safety?“, by Journalist, Amy Gallo shares her experience of having to bring bad news to her boss as part of the process of learning about the concept. In her piece, she reaches out to Amy Edmondson, the Harvard Business School professor and author of The Fearless Organization, who coined the phrase “team psychological safety,” for insights about how it’s evolved, why it’s important, and how leaders can promote psychological safety on their teams. Gallo goes on to discuss several ideas for creating psychological safety as suggested by Edmondson.
Notice how each involve effective and respectful communication and related skills!
- “Make clear why employees’ voices matter.” (Helps set a clear expectation for speaking up and shows an interest in and willing to listen to what others have to say. )
- “Admit your own fallibility.” (In addition to expressing the need for other voices to be spoken and heard, this also demonstrates ownership and builds trust. All of which contributes to others’ developing confidence, accountability and assertiveness.)
- “Actively invite input.” (Asking for input and listening to it is a great way to promote expressive skills. Asking for input and dismissing it is a great way to diminish trust and subsequent shutting down.)
- “Respond productively.” (This involves genuine listening and consideration of others’ ideas and concerns. Validating other perspectives and showing empathy builds trusting relationships, even when conflicting solutions may persist.)
Since I’ve been teaching these kinds of skills for two decades and have seen what works, (and doesn’t) and because psychological safety is so vitally important in healthcare, I’ll add another essential strategy to this list:
- Provide safe opportunities for practice!
People Need Practice!
Improving communication is inherently linked to changing behavior and notoriously hard to change. We know this in healthcare as we see every day how hard it is for folks to quit smoking, exercise regularly, and/or change eating habits.
Change can be especially hard in high-stakes, high stress work environments where there is already so much uncertainty. If there is a history of bullying or blaming in the culture or an intimidating hierarchy there are likely implicit norms that contribute to fears of and barriers to speaking up. Mistrust within a team may also be present and a complicating factor. And let’s not forget that fear of public speaking, which could easily be related to speaking up in a healthcare setting, is very common.
Alas, not only is it important to create a psychologically safe environment, it is also a complex initiative! Like any of the lifestyle changes we frequently advise as healthcare professionals, people need opportunities to practice, learn, and practice again!
Facilitated Safe Experiences
Medical Improv is ideally suited to help with creating psychological safety because it’s YES AND philosophy requires all participants to speak up and listen to each other.
When facilitated properly, even the simplest activities provide opportunities for people to take graduated risks while developing these necessary skills needed for risk-taking while at the same time building trust and positive relationships among teams and within organizations.
Image by Keith Johnston from Pixabay
For example, “Radical Acceptance“, requires each person in a group to name three things from a category such as; fruit while the group responds with affirmation. As simple as it sounds, it can feel emotionally risky. Just not as risky as sharing an idea or concern in a toxic culture or high-stakes situation!
Such an activity gives people positive experiences taking risks, building confidence and sharing responsibility. This is exactly what psychological safety is all about.
If you’d like to learn more about integrating Medical Improv into your efforts to create psychological safety please reach out to beth@bethboynton.com or ellen.schnur@improvtalk.com. And/or join this mailing list where you’ll have access to many articles, videos, and information about programs I offer and in collaboration with former Major League Baseball Pitcher, Jim Mecir and Corporate Trainer and Improvisor Ellen Schnur. We are on a mission to improve healthcare!
AND don’t miss these upcoming online opportunities for healthcare and mental health leaders!
Free YES AND Events
Simple Activities – Profound Social & Emotional Learning
July 13th: 1-2:30 pm EST
https://sutra.co/space/sq9w6v
Yes And 101 for Healthcare & Mental Healthcare Visionaries
August 3rd: 1-2:30 pm EST
https://sutra.co/space/id85ce
