By: Tiffany Lindsey, EdD, LPC-MHSP

Chapin Hall at the University of Chicago

Have you ever made a mistake at work—maybe even one that could have affected you, your teammate, or a client’s safety?

If you’re a human who helps other humans for a living, the answer is a prevailing yes. None of us do the work perfectly. Mistakes aren’t intentional, but it’s hard to get it right every time. Clinicians and human service professionals, in general, are tasked with making high-consequence choices at alarmingly fast rates. So I have another question:

Did you tell anyone about your mistake?

If you didn’t, you’re not alone. A healthcare study found, when confronted with a patient’s adverse outcome, most physicians are unwilling to admit an error (Gallagher, Garbutt, & Waterman, 2006). It’s hard to imagine disclosing mistakes to teammates would be much higher, even though processing a mistake and receiving feedback and support is crucial to professional development and gives teammates an opportunity to learn too.

There are lots of reasons why we aren’t prone to vulnerable disclosures—liability concerns, fear of seeming “less than” or incapable; in modern Western society, we tend to view colleagues as competitors. We’re hard-wired as children to think this way (remember those Spelling Bees?) not to mention Super Bowls wouldn’t be nearly as fun if we weren’t rooting for one team to win over the other. In Western society, we celebrate achievement over others and sweep our failures under a rug.  

While our competitive spirit isn’t all bad, spending time “saving face” is both dangerous and unhealthy. Talking about concerns, being honest about personal experiences, and processing undesired outcomes is central to innovation. Safe, engaged, reliable teams have to innovate to succeed in an increasingly complex and dynamic environment. Not only that, but consensus-based decision-making is a foundational element of TCOM. Such consensus involves reflection, engagement, and even some productive debate as the care team (which includes the client) reaches an understanding of the family’s story and shared vision for transformation. True, informed, consensus—without psychological safety—would be quite a challenging achievement, arguably an impossible one.

Psychological Safety: A Shared Experience

Psychological safety is a shared belief that people are accepted, supported, respected, and free to take interpersonal risks (Edmondson, 2019). While trust is about whether or not we believe others will behave supportively when we take an interpersonal risk, psychological safety is about a shared practice that others actually do behave supportively when those risks are taken.

Psychological safety seems simple, but the nuances are relevant. Consider the following attributes of psychological safety (Frankel, Haraden, Federica, & Lenoci-Edwards, 2017):

Google’s well-publicized study, Project Aristotle, was about identifying team factors central to successful innovation. For years, the research team investigated an array of variables (e.g., educational credentials, personality, gender, supervisor’s management style, professional experience) without an emerging theme. Then they stumbled onto psychological safety—it ended up being the single factor most predictive of a team’s success. Despite wide variations in the groups’ demographics, psychologically safe teams would brainstorm, test things (often failing but always while learning and progressing) and, therefore, arrive at successful ideas sooner. Such teams demonstrated situational humility and conversational turn-taking—meaning every member spoke (albeit unintentionally) about the same amount throughout the week (Duhigg, 2016).

Psychological safety is the cornerstone of a Safety Culture—the attitudes, values, behaviors supporting a safe and engaged workforce. Though sometimes coined by other related names, like High Reliability Organizing, Human Factors, or Resilience Engineering, the pursuit of Safety Culture has a tremendous amount of evidence in high-risk industries. In healthcare, the presence of behaviors indicative of Safety Culture (see my last blog post for a list of those behaviors) correlates to fewer patient readmissions, patient falls, and medication errors (Vogus & Sutcliffe, 2011).

In child welfare, growing evidence suggests team-based Safety Culture behaviors correlate to the entries, exits, and re-entries of children in state care. In short, teams may experience more entries into state care but also might experience a higher percentage of exits, and fewer of those children re-enter (Lindsey, 2017).  Not surprisingly, psychological safety has an evidenced connection to burnout; in an analysis of child welfare professionals, higher psychological safety correlated to less emotional exhaustion (Cull, 2018).

In considering whether or not the culture of your workplace supports psychological safety, think through these statements (Edmondson, 2019):

You might find the answers are different as you consider different teams or hierarchies within your organization. Some people feel psychological safety among their small cohort (i.e., a team of counselors reporting to one supervisor, a single unit within a psychiatric hospital) but unsafe among another unit or perhaps a group of leaders.

Cultivating Psychological Safety

Psychological safety is a shared experience. We can all support it, but none of us can singlehandedly accomplish psychological safety alone. It’s not an intrapsychic experience; it’s an interpersonal one. Leaders are capable of the most widespread change, but all people are responsible for culture. And like most cultural phenomenon, it’s a journey of improvement and not a single stroke destination.

If you’re looking for some ways to improve psychological safety to advance a safety culture in your workplace, consider these possibilities:


References

Cull, M. (2018). Casey Family Programs: Child safety convening. Keynote Speaker.

Duhigg, C. (2016). What Google learned from its quest to build the perfect team. Retrieved from: https://www.nytimes.com/2016/02/28/magazine/what-google-learned-from-its-quest-to-build-the-perfect-team.html.

Galler, T., Garbutt, J., & Waterman, A. (2006). Choosing your words carefully: How physicians would disclosure harmful medical errors to patients. Arch Intern Med, 166: 1585-1593.

Edmondson, A. (2019). The fearless organization. Wiley: New York, NY.

Frankel, A., Haraden, C., Federica, F., & Lenoci-Edwards, J. (2017). A framework for safe, reliable, and effective care. White Paper. Healthcare Improvement and Safe & Reliable Healthcare: Cambridge, MA

Lindsey, T. (2018). The effects of safety culture on the outcomes for children in state care. Available from ProQuest Dissertations & Theses Global (10750794).

Vogus, T., & Sutcliffe, K. (2011). The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Journal of Nursing Administration, 41 (7/8), S25.

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