It was during my GP training while seconded to a small metro hospital for an obstetrics rotation that one of the consultants made a comment that has always stayed with me.
He said, “Jenny, if there is one thing I’ve learned from all my years working in this field it’s this. Your patients don’t care how knowledgeable you are. They care about being treated with dignity and respect. They want to know you care about them.”
The brain is a social organ
As humans, our brain’s primary organising principle is to keep us safe. At any given moment the question being asked is “Is it safe to stay here?” Anything new, different or out of the ordinary is treated with the assumption this could be dangerous, so you had better pay attention to it. The stress response is a survival tool preparing us to leg it as fast as possible over the horizon or to put up a fight and naturally you don’t want to spend time determining the pros and cons of your actions while that freight train is bearing down on you. If the situation is found to be safe, then you know its worthwhile sticking around because there will some kind of reward on offer.
Social cognitive neuroscientists believe our need to form positive strong relationships is as important to our survival as air, food and water. As social beings hard wired to connect we seek those we consider like ourselves and who we believe like us and to avoid social pain.
Psychological safety was defined by Professor Amy Edmondson from Harvard as, “a shared belief held by members of a team that the team is safe for interpersonal risk taking.” In her early work she researched the learned behaviours in hospital nursing teams to see which were the most effective. What she didn’t expect to discover was that the best teams had a far higher medical error reporting rate. Not because they were slip shod, but because the culture made it safe to speak up when things went wrong, so lessons could be learned and potential harm to patients avoided.
But how often have you heard stories where that wasn’t the case? Junior health practitioners afraid to speak up, staying silent while observing mistakes. Or patients who didn’t like to ask the question about what was worrying them because they didn’t want to upset their doctor or surgeon?
When psychological safety goes missing in action
When first let loose onto the wards as medical students we quickly learnt that despite working for the common good, not everyone was on our side. Some nurses clearly begrudged our presence and didn’t hold back on making it known we were definitely at the bottom of the food chain. Some consultants delighted in the regular public torture and humiliation of their students on ward rounds. Whenever this happened, we were a) grateful we hadn’t been the one picked on for the day’s entertainment b) trying to mouth the answer to the question the person had been asked without being noticed by “Sir” or “Ma’am.”
What I’ve learned is that no matter your profession or job description, your overall effectiveness, job satisfaction, ability to think of your feet, solve problems quickly or come up with the best decision for the moment very much depends on the workplace environment and how safe you feel.
Work is a social context
We are capable of so much and when you are hardworking, dedicated, passionate about your work and committed to always being your best, it’s great to know you are kicking your goals into touch. For every successful person there will have been a whole array of contributors to that success. Working with others amplifies our results because we can share ideas, learn from each other and be relieved of the burden of having to know everything about everything.
Feeling part of a team, included in discussions and decision making creates a sense of being valued, acknowledged and recognised for our contribution. We know we’re part of the right tribe and we belong.
With burnout, exhaustion and anxiety on the rise in many health practitioners, the time to look at what can be done to keep each one of us safe and to promote a safe environment when interacting with our clients was yesterday.
Workplaces that enjoy higher psychological safety have the advantage in promoting robust and open discussions elevating commitment, mental wellbeing and engagement. For those working on the healthcare front line dealing with high levels of stress and life and death situations this is significant to an individuals’ health and wellbeing overall and patient safety.
Creating greater psychological safety at work
While no one sets out to be perceived as stupid, rude, arrogant or wrong, understanding how our thinking determines what we say and do and how this can be negatively influenced by feeling unsafe means that in every interaction there are a number of social drivers to be considered. Many of these are already embedded into our psyche but it’s good to be reminded of them.
S.C.A.R.E is one of a number of models used to build psychological safety.
SIGNIFICANCE
We care deeply about what others think of us. Robert A. Synder Ph.D. believes that our actions and behaviours are determined by our lens of significance, how we believe we are seen by others.
You don’t need to be told your place in the pecking order of life, you know it already. All is good until that significance is threatened by a careless comment or throwaway remark. How about that time when you were called out for making a mistake, in front of your peers or were overlooked in the email invite to a team meeting?
That threat causes social pain activating the limbic system. The depth of that threat has been likened to the fear felt when walking down a dark alleyway at night and hear footsteps coming up behind us. We become afraid and socially shut down.
AUTONOMY
I’ve yet to meet anyone who likes being told what to do all the time. Micromanagement creates massive social threat and is the fastest route to the nearest exit. Having choice (even if it’s small or just a perception) about how we do our work matters. It even determines our longevity, as evidenced by those moving to aged care facilities when allowed to choose which furniture they will bring, how it is arranged and what colours to paint the walls.
The problem is we love telling others what to do, even though we hate being given that advice ourselves! As practitioners it’s really important we give our clients and assistants sufficient autonomy when making decisions about treatment plans.
RELATEDNESS
Getting along well with others, especially those we see as being ‘different’ from us is vital to clear and open communication. Being prepared to listen rather than talked over or down to keeps the other person feeling safe. We all seek to be heard and understood. This also helps to keep your mind open to options and alternatives, meaning you are less risk averse, more tolerant and less judgmental.
EQUITY
“S’not fair!!” How many times have you heard that refrain, whether it’s a child being told in the supermarket they can’t have that packet of chips, a colleague given a better work schedule than you or witnessing the special benefits metered out to the golden child of the team?
Being treated fairly matters enormously. Its absence triggers a deep visceral sense of disgust. Witnessing someone else being treated unfairly also triggers the threat response in yourself and the relationship you have with the person you believe behaved badly will change.
Psychological safety isn’t a nice to have, it’s essential to the creation of a workplace culture that as Timothy R. Clark Ph.D.author of the Four Stages of Psychological Safety says supports inclusion, learning, contribution and adaptation to change.
And it makes work a whole lot more enjoyable and fulfilling.
Is your workplace a safe place to be? What can you do to raise your workplace psychological safety profile at an individual and team level?
This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.
Dr Jenny Brockis (FASLM) specialises in brain health and mental performance in the workplace. She works as a keynote speaker, trainer and is the author of four books.
