Psychological Safety on Teams

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

In a new book examining research on psychological safety, teamwork, and well-being, authors Maben, Ball, and Edmondson point out that how the staff works together, how safe they feel about raising concerns, and their well-being has a significant impact on patient care outcomes and effective care delivery. Working on teams, by its nature, involves interpersonal risks. Because healthcare delivery is rarely scripted and many unexpected things happen, team members must be able to ask questions, offer ideas and coordinate their actions in real-time.

Yet, if anything, healthcare staff today feel less and not more psychological safety as they work together. Recent Deloitte research indicates clinicians have low trust in whether organizations will do the right thing for patients and them.

Frontline nurse leaders are working hard to provide psychological safety for new nurses entering a turbulent healthcare environment with high stress and anxiety.  So many tell me they feel like therapists now dealing with panic attacks and clinical depression at unprecedented levels.

Dr. Amy Edmondson is an expert on psychological safety in the workplace.  She provides the following description: “psychological safety describes the individuals’ perceptions about the consequences of interpersonal risk in their work environment.” It consists of taken-for-granted beliefs about how others will respond when you put yourself on the line, such as asking a question, seeking feedback, reporting a mistake, or proposing a new idea. We weigh each potential action against a particular interpersonal climate, as in, “If I do this here, will I be hurt, embarrassed, or criticized?” An action that might be unthinkable in one workgroup can be readily taken in another due to different beliefs about probable interpersonal consequences.

Continued mask-wearing and social distancing in healthcare environments have made fostering psychological safety more difficult. One nurse leader recently said that sometimes even the leader’s office is not perceived as safe by team members, so he moved one-to-one conversations outside where he can take off his mask and walk with his fragile staff members.

Just like individuals assess the psychological safety of their environments, the same is true with teams. On a team where staff feels psychological safety, staff has confidence that they will receive respect and consideration from others. A group with a culture of psychological safety encourages open discussion of challenging issues. It not only tolerates disagreement, but it also nurtures contrasting points of view.  Nurse leaders can help create these environments by developing and reinforcing the following team behaviors:

• Model Inclusion – modeling inclusion for the team fosters psychological safety by including all team members in huddles and team rounding.
• Argue with Respect – demonstrate civility when navigating team conflicts and encourage tolerance of diverse points of view.
• Provide Team Backup – design team processes to make it easy to ask for help and an expectation to provide it.
• Recognize Gifts and Talents – utilize the gifts and talents of team members.
• Encourage Discussion of Tough Issues – be willing to tackle challenging issues and thank the staff who dare to surface team problems.

Building psychological safety in nursing teams is foundational to improving the work environment. When nurse leaders ask me where to start rebuilding stronger cultures, I recommend they start by rebuilding psychological safety.

References

Maben J, Ball J & Edmondson, AC. Workplace Conditions: Improving Quality and Safety in Healthcare. London: Cambridge University Press; 2023.