“Saying ‘we care about you’ then gaslighting us when we tell you our concerns completely destroys our trust and faith in you as an organization” ~Anonymous Doctor

I am often asked what does psychological safety in healthcare have to do with health equity and health quality? What does psychological safety have to do with workforce?  In the Surgeon General’s Report on Creating a Thriving and Well Workforce put out in 2022, psychological safety and trust were named as two factors that contribute to burnout and moral injury in physicians and healthcare providers today. Furthermore, a JAMA study found that 1 in 5 physicians said they plan to leave their place of employment in the next 3 years, and a Mayo Clinic study quoted that “if physicians and nurses carry out their plans to leave medicine over the next 5 years we will not have enough healthcare providers to meet the needs of patients.” Psychological safety and trust are foundational to creating a workforce that thrives, and that wants to stay in any organization. However, these factors are often overlooked.

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.

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

So what are a few insidious things that we often see in organizations (and especially in hospitals and healthcare systems) that destroy trust and safety? Consider the following 5 things to examine in your organization that break trust.

1. Gossip, Backbiting or Duplicity are all acts that lack integrity and exclude others. Water cooler talk may seem “harmless” but it is a subtle (and sometimes not so subtle) act of exclusion. This lack of integrity creates an environment of fractured trust and safety. The antidote to this is to create activities that connect and allow employees to get to know each other.
2. Lack of Clear Communication: Poor or unclear communication can lead to misunderstandings, confusion, and mistrust. When people don’t know what’s expected of them or are unsure about the information they receive, it can create a sense of insecurity. When there is clear and transparent communication, it creates consistency.
3. Misalignment of Actions and Words: When there is a disconnect between what people say and what they do, it can lead to a lack of trust. Inconsistent behavior or hypocrisy can create a sense of uncertainty and insecurity similar to backbiting, and lack of transparency.
4. Lack of Accountability for All: When there is a lack of accountability for everyone in an organization or group, it can lead to a perception of favoritism or unfair treatment. This can erode trust and psychological safety as people may believe that some are exempt from consequences. Furthermore it can lead to the “multiple against one” dynamic where certain staff members are targeted, criticized, or bullied by a collective. Ultimately it creates an environment of fear and exclusion and is extremely damaging to psychological safety and trust.
5. Disrespecting Boundaries: Respecting personal and professional boundaries is essential for psychological safety. When individuals consistently cross boundaries, it can make others feel uncomfortable and unsafe. Discussing consent culture is the foundation of training leaders and staff to begin looking at where boundaries are being repeatedly violated. Ultimately, training and coaching may need to happen to develop the skills of consent culture, setting, communicating and respecting boundaries.

While these may seem simple, recognizing these trust destructive behaviors when brought to the awareness of leaders allows the organization 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.

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