Covid-19 is a threat to most teams and particularly to those delivering health care. Healthcare systems depend on teams working interdependently to coordinate safe care within a complex, high stakes work environment. So what gives some teams an edge over others?
To understand this, we need to open the black box and recognise the nuances and complexities experienced by team members. Psychological safety, while not a new construct, is increasingly recognised to be the secret weapon for better team engagement and performance.
What is psychological safety?
Psychological safety is being able to show and employ one’s self without fear of negative consequences to self image, status or career (Khan, 1990). At a team level, it’s a shared belief that the team is safe for interpersonal risk taking.
Particularly noteworthy is the finding from Google’s four-year landmark study on team effectiveness. To their surprise, psychological safety was the #1 predictor of team success. Who was on a team mattered less than how the team members interacted, structured their work, and viewed their contributions.
But the absence of psychological safety can have grave consequences, especially in healthcare teams. A poignant example is that of Elaine Bromiley who died as the result of clinical error during a routine sinus operation. In Elaine’s case, two of the nurses present in the operating theatre had recognised the seriousness of the clinical risk during the procedure but medical colleagues had not listened. There was no culture of valuing team member contributions. (As an aside, as a result of his tragedy, Elaine’s husband, Martin, founded the Clinical Human Factors Group – www.chfg.org – which is well worth visiting.)
Current threats to psychological safety in teams
As we navigate the third wave of the Covid-19 pandemic, frontline staff are dealing with copious amounts of anxiety, fear and uncertainty never before experienced by most. Amy Edmondson, who coined the term psychological safety, has signalled the importance of psychological safety for teams to function, especially where uncertainty and interdependence exist.
Beyond the frontline, many healthcare professionals are working remotely, isolated and communicating virtually with their teams. Such environments can also undermine psychological safety, since social cues and non-verbal agreement are almost impossible. Colleagues can find themselves reluctant to offer ideas, critique the status quo or even ask questions and less trusting team relationships further reduce psychological safety.
Now, more than ever, is the time for questioning, sharing and inspiration while we deal with unprecedented challenges which require new thinking and approaches. Now is the time to optimise psychological safety in order to enable our talented healthcare staff to do their best work.
Creating the conditions for increased psychological safety in healthcare teams
I have chosen four aspects which leaders can apply to raise psychological safety in teams. Of course, these are not practices that apply to managers alone – everyone delivering healthcare is a leader.
- Foster a culture of transparent communication
When the horizon is uncertain and complex, being honest about what you know and don’t know paradoxically increases psychological safety in teams. Honesty takes courage on the part of the leader and in return, trust, as the foundation in work relationships, can flourish.
2. Share power and model humility
In times of crisis, our tendency can be to exert control to make ourselves feel safer. Ironically, it is letting go of power that ultimately creates safety. A fully inclusive approach involving all team members cultivates collective leadership and in turn, enhances perceived psychological safety. When psychological safety is high in teams, people demonstrate two important key behaviours:
3. In times of uncertainty, let values be your compass
During uncertainty and in the absence of a clear plan, stay closely connected to your values while you sit with the mess. The role of leaders is to amplify the values of the team (Edmondson, 2020) so as to ensure they influence all decisions. By focusing on values, people are motivated to engage.
4. Foster psychological safety in virtual teams
Spending more time coming together as a team is associated with increased psychological safety. Online platforms therefore play a key role in these difficult times. Agile functionality such as polls, chat tools and break out rooms can be helpful but be wary of false positives when you invite feedback. Survey monkey can make it safer for team members to give voice to their views. Most of all, inviting engagement is key and works best when the leader is clear about the information needed and from whom. After meetings, managers can reach out to team members who were less vocal, creating the opportunity to give or seek feedback. We all need to be proactive and work much harder to maintain connections and optimise teamwork in a virtual world.
This Blog was written by Alison Enright, HSCP Development Manager, National HSCP Office.