“What destroys trust is when a hospital says ‘we value you’ and then in the same breath asks you to justify your worth by doing additional work unpaid” ~ Dr. A

As physicians, we are committed to providing the highest quality of care and safety to our patients. However, it is difficult for a physician / healthcare worker to bring their best self when they are operating inside of a place that doesn’t feel safe. In the first part of this article series we talked about culture of blame, constant criticism and lack of empathy as 3 behaviors that lead to lack of psychological safety in healthcare and non-healthcare organizations. In this article we will examine three more behaviors that contribute to that lack of safety.

To review, 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.

Timothy Clark’s book, 4 Stages of Psychological Safety, describe 4 elements of psychological safety through which we will continue our discussion.

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

1. “When I was in residency on my surgery rotation, I witnessed the Chief of Surgery completely belittle and embarrass his residents on multiple occasions. The following rotations I saw the OBGYN attendings doing the same thing. It was like this behavior was just normal… just the daily weather report”

Bullying and Harassment: Any form of bullying or harassment, whether it’s verbal, physical, or online, is a direct threat to psychological safety. Victims of such behavior often feel powerless and afraid to speak out. This violates the “safe to challenge” element of psychological safety at a minimum, however, depending on the circumstance both inclusion and learner safety could also be impacted.

Antidote: Leadership must first create anti-bullying policies, but what’s more important is that when harassment occurs, these reports must be taken seriously and fully investigated. Furthermore, it’s important to have a process that is unbiased for investigating to prevent biases from getting in the way of a fair and equitable investigation. When employees know that there are fair policies for such incidents in place (and that they will not be dismissed or gaslighted when they report), organizations may find more incidents than they previously realized.

2. “When leadership hires me to do a job, and then constantly looks over my shoulder micromanaging every move as if I am not capable to do the very job, they said I was qualified for, it definitely creates a sense of hypervigilance for me throughout my day”

Micromanagement: Constantly monitoring and controlling every aspect of someone’s work or life can create anxiety and a sense of mistrust. It signals a lack of confidence in the individual’s abilities. The behavior of micromanaging violates the ‘safe to learn’ and ‘safe to contribute’ components of psychological safety. When someone is being micromanaged, there is no room for them to fully express their ideas without the potential for criticism, or constant invalidation or correction. Furthermore, when someone is micromanaged, the micromanager is essentially interfering with the worker’s ability to learn and grow. Micromanagement is usually not a malicious act, but more bread out of fear or need for control.

Antidote: When micromanaging is occurring the first action is to understand the root of the action itself. Since micromanagement often stems from a lack of trust it must be determined if the lack of trust is perceived or based on actual observation. If it is perceived, then the person who is micromanaging may need some training or coaching to help them to address the root of their micromanagement tendencies. If the root micromanagement is more based in observation, there is an opportunity to evaluate the skill of the person in the role and determine whether they are in the right role for their skill or whether they simply need more training and development to be able to fulfill their responsibilities in the role.

3. “The complete and total loss of trust came when our leadership outright lied to the entire department and was caught in that lie. Transparency is vital and lack of transparency creates a negative culture from the top down.”

Betraying Trust: Trust is the foundation of psychological safety. Breaking trust by lying, not keeping promises, leaking confidential information, lack of transparency, gossiping, backbiting, being duplicitous, or violating trust in any other way can severely damage psychological safety. Trust is gained with consistent action over time and, once broken, can be hard to repair.

Antidote: Creating environments of trust in organizations is more than policy, it is culture.  Integrity, transparency, accountability and equitable treatment modeled in communication, behavior, and policy over time will create an environment of trust. Furthermore, when individual leaders operate from these characteristics it sends the message that this is what is expected of all those who work in the organization. Additionally, when trust is broken (on an individual or organizational levels) what can make a significant difference in restoring trust is acknowledging and accepting responsibility for the actions that broke trust, acknowledging the impact and creating a plan for repair and restoration. Again it’s useful to note that trust is not easily regained but with consistent action over time, the trust and safety can be restored.

While these may seem simple, recognizing these trust destructive behaviors brings awareness that allows leaders in organizations to begin to assess and make adjustments that will help to restore psychological safety in healthcare 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 3!

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