Why Psychological Safety Matters in Healthcare

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Portrait of sad, tired nurse holding her head while sitting on the edge of a patient bed.

Imagine you’re attending a department meeting when your manager proposes an idea for a process change. You have strong feelings about this proposal because it may create a documentation issue that has not been discussed yet. However, the last time you spoke up with a dissenting view, your contributions were dismissed, and your manager treated you differently in the following weeks. This time, you decide to nod along as the group forms a consensus to move forward with your manager’s idea.

In this example, an opinion was suppressed due to fear of dismissal or retaliation. This can happen due to a lack of psychological safety, which refers to the shared belief held by team members that it is safe and acceptable to express ideas and concerns, speak up with questions and admit mistakes. If a healthcare employee does not feel psychologically safe, substantial consequences could follow.

Workplace Bullying Makes a Bad Situation Worse

Peer-to-peer bullying has created a detrimental work environment for U.S. nurses in particular, from the patient floor to the C-suite. This health-harming mistreatment can take the form of abusive language, sabotage that affects your work, and actions that aim to intimidate or humiliate you. In a 2019 study in the Journal of Nursing Management, 60% of nurse managers surveyed reported bullying in the workplace, with 26% of participants considering the bullying severe.

To ensure psychological safety at work, bullying cannot be allowed to persist. In addition to causing low morale and mental health effects, it can also compromise patient safety. Studies suggest that speak-up culture is statistically related to fewer adverse patient care events and more accurate reporting. It’s time for healthcare providers to establish—and most importantly, enforce—policies that address bullying, reduce fear of retaliation and outline disciplinary actions.

Behaviors That Undermine Psychological Safety

Creating a psychologically safe culture won’t happen overnight, but healthcare leaders can take action to eliminate the behaviors that drive it. Here are some red flags to look for:

  • Outspoken team members who dominate most discussions
  • It is normal / acceptable for colleagues to ignore or speak over each other
  • After a discussion or meeting, gossip ensues about what was said
  • Team members rarely admit mistakes (and may attempt to disguise errors)
  • Established norms are rarely challenged; there are few ideas for improvement
  • Employees form cliques or circles that create obvious division
  • Important business decisions are made privately by leaders, leaving staff to speculate

Behaviors That Foster Psychological Safety

Inclusivity, trust and mutual respect are crucial for the numerous working relationships that clinicians must manage each day. Here are some markers of a healthy work culture:

  • Colleagues can disagree without using abrupt or aggressive language with one another
  • Team members prompt each other for ideas, i.e. “I’d love to hear your thoughts on this.”
  • It’s easy to ask colleagues and leaders for help, even with difficult problems
  • Leaders appreciate what can be gained from diversity of thought and perspectives
  • Colleagues express appreciation for each other instead of comparison and competition
  • Colleagues socialize freely with one another rather than in fragmented circles
  • Employees are well-informed; there are few veiled secrets that fuel gossip

How to Own This Issue as a Leader

If you’re in a healthcare leadership position, start by checking in frequently with your staff. The more connected you are to their daily work experience, the easier it will be to spot signs of distress or burnout. Show your support both professionally and personally. In meetings, establish the expectation that every team member should contribute to discussions, reinforcing that you’d like to hear from everyone before the meeting ends.

Model vulnerability by admitting your shortfalls and encouraging staff to approach their errors and failures as learning opportunities for the entire team. Be visible and available (i.e., not constantly rushed or closed up in your office), so staff have ample opportunity to approach you with questions and concerns, especially related to sensitive or vulnerable topics. Lastly, avoid favoritism. Unequal treatment in the workplace can create power imbalances that inadvertently protect the people who are causing harm and alienate those who need help.

How to Advocate for Yourself

Newer nurses may not know what to expect from a new job, but rest assured that it’s not normal to feel disrespected or threatened in the workplace. Try confronting the issue directly by speaking frankly with human resources or your manager. Making the problem known—and ensuring your complaint is documented—is the first step toward a resolution. In addition to disciplinary actions, your HR and risk-management leaders may be able to arrange peer support groups, behavioral and mental health resources, relationship-building activities, and leadership training sessions on conflict resolution, workplace violence prevention and the principles of active-listening.

At Encompass Health, we know that everyone deserves a positive work experience and we are committed to creating a supportive, inclusive, and caring environment. A toxic work environment exacerbates the stress of an already-demanding profession and drives talented people out of the healthcare field. Remember that psychological safety doesn’t mean you have to avoid conflict altogether. It’s OK to raise problems and share concerns for the betterment of your mental health, the company and, ultimately, your patients.

The content of this site is for informational purposes only and should not be taken as professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding any medical conditions or treatments.