Psychological Safety for Surgeons: Building Trust, Teamwork, and Well-Being
A psychologically safe culture must be actively cultivated by an organization’s leadership, while also relying on the everyday efforts of all healthcare team members.
Psychological safety is the idea that everyone should feel empowered and enabled to speak up, voice dissenting opinions, and/or raise concerns without fear of humiliation, criticism, or being retaliated against. The reason this is such an important concept in any business, but especially in healthcare, is that literature reveals that it leads to improved patient safety outcomes, clinician engagement, and creative thinking. It’s also an imperative for overall physician well-being.
On Monday, four expert panelists—Nausheen Jamal, MD, Jo A. Shapiro, MD, Michael J. Brenner, MD, and Cecelia E. Schmalbach, MD, MSc—discussed psychological safety and more before a large audience of Annual Meeting attendees. According to the panel, the work required to achieve a culture of psychological safety relies on both high-level organizational input and acceptance, as well as a conscientious effort on the part of the individual healthcare provider.
But why should healthcare providers be concerned about psychological safety? Dr. Schmalbach shared a statistic that one in 10 of surveyed physicians said they had considered or attempted suicide. She said it was important to consider that 4% of those surveyed chose not to answer the question at all.
Otolaryngologists may also tend to think of themselves as a relatively stable specialty of healthcare providers, but according to the Doctors’ Burden: Medscape Physician Suicide Report 2023, otolaryngology was ranked number one—at 13%—for suicidal thoughts among physicians by specialty, followed by psychiatry and family medicine.
Dr. Schmalbach went on to describe that the most important components for psychological safety include:
- Bidirectional communication
- Asking open-ended questions
- Encouraging team members to speak up
- Having and expressing clear goals and expectations for everyone
- Feeling a personal connection between team members and their mission
- Seeking and providing feedback
- Having formal and informal programs and policies
Direct or indirect unprofessional behavior such as physical threats, yelling or screaming, refusing to answer questions or return calls, refusing to perform assigned duties, using belittling or condescending language, discrimination, and/or misconduct all threaten psychological safety.
Dr. Jamal presented five major categories of behavioral approaches to workplace conflict:
All can be appropriate at times, but learning to compromise and collaborate yields the most effective workplace environment.
Dr. Jamal also explained to the audience the key principles for understanding and managing conflict, especially in a healthcare setting, including:
1. Recognize that conflict is inevitable, it’s going to happen.
2. When you do recognize that it’s happening, don’t be afraid to actively engage with it to find a creative solution. It’s okay (and natural) to have disagreements.
3. Be motivated to share opinions while encouraging others to share their opinions.
4. New skills can be acquired even in uncomfortable situations.
5. Having self-awareness and recognizing your own behavioral tendencies are key.
6. Psychological safety includes feeling free to admit errors, ask questions, voice concerns, be creative, and suggest new ideas.
Much was talked about regarding the importance of diversity and the inclusion and expression of minority voices, particularly in this specialty, but Dr. Jamal postulated, “If people are afraid to speak up, what’s the purpose of having diverse thoughts in the room?”
Dr. Brenner addressed the audience on the topic of emotional intelligence (EI), popularized by Daniel Goleman’s best-selling book, Emotional Intelligence: Why It Can Matter More Than IQ. EI is defined by the capacity to recognize and acknowledge one’s own emotions as well as the emotions of others. Leveraging that emotional information helps us adapt our thinking and behavior to our work and personal environments to achieve new goals, build relationships, foster teamwork and communication, defuse conflict, and navigate crises safely.
In the healthcare setting, according to Dr. Brenner, low EI and psychological safety can have an adverse effect on patient outcomes. “Disrespectful behavior is associated with medical error, patient dissatisfaction, and preventable harm,” he said. This can also lead to surgical site infections, stroke, and cardiac arrest in patients under the care of an unprofessional clinician.
Dr. Shapiro explained the importance of having leadership buy-in for all these strategies in order to effectively promote psychological safety. “You can’t punish people for not doing something if you haven’t taught them how,” she explained. “You have to have an accountability program. You cannot go around telling people you care about psychological safety, professionalism, and trust if the high rollers are exempt.”
Dr. Shapiro also stressed the importance of recognizing and honoring those team members who are consistently trustworthy and competent, providing feedback and appreciation for positive behavior. The panel wrapped up its discussion with questions and feedback from the audience.