Episode 6: Psychological Safety for Healthcare Professionals

Leigh Steiner:

Welcome to the Vitals and Vision podcast. I’m your host Leigh Steiner, a Partner for Behavioral Health Solutions at Relias. In this episode, we will be talking about workplace psychological safety and specifically exploring its role in creating a positive and resilient work environment for healthcare professionals. Recently, I was preparing for a flight, and I was being moved from the parking lot to the airport by the shuttle, and it became pretty obvious that because of these extremely long lines that they were down shuttle drivers. One driver took charge and was redirecting different shuttles that were available to go to different places and was handling the protocol in a very different way that just made it more efficient. But he was just a driver. And I thought to myself, well, this guy is either going to be fired for taking initiative or he might even be promoted to a supervisor. But what really struck me is that this man felt safe — he felt safe to take action and make decisions that were in the best interest of the company, and most importantly, in the best interest of the customers. So this scene got me to thinking about my conversation that we’re about ready to have with doctor Rola Amar. Rola is an experienced marriage and family therapist who has focused her research on vulnerable populations and the importance of treatment alliance. As a Partner for Behavioral Health Solutions at Relias, she utilizes her clinical and operational knowledge to support clients and improving clinical performance and patient health outcomes through data driven consulting. So Rola, we are really happy to have you with us this morning.

Rola Aamar:

Thank you, Leigh. I’m so happy to be here. And I just wanted to comment on that story because I think when I think about psychological safety, a hallmark of it is staff feeling empowered, staff feeling like they have a sense of ownership within the organization, that they’re not just there to kind of check off a list of tasks to do that they are empowered to see situations where they need to step up and own those situations. And I think that story really highlights what psychological safety can do for your staff, for your workforce, if… and… and so if staff have the opportunity to be in an environment where psychological safety is prioritized, they can become leaders even without leadership titles attached. They can take on big situations, problematic situations, and navigate them without having to go through 15 layers of leadership to figure out what the next steps should be. It really helps organizations function efficiently and makes the experience, I’m thinking, especially within health care systems, make the experience better for the people receiving services. I just think that that’s a wonderful example of what psychological safety can do for your staff.

Leigh Steiner:

Great. Thank you, Rola. Let’s continue on from there as we have our conversation about psychological safety, its importance in the workplace, and its importance in the retention of our health care staff. So go back and create sort of a frame for us, Rola. You’ve talked a little bit about, but talk again about psychological safety, what it means and why is it important.

Rola Aamar:

So talking about psychological safety, there’s a parallel I like to draw when I bring up psychological safety. Think about within your health care organizations how much time, energy, and effort goes into building out protocols for physical safety: it’s physical safety for your staff, it’s physical safety for your patients, there’re fire evacuation procedures, and safety with needles, or, you know, spills. There’s all these protocols developed to make sure that the physical environment is safe for staff and patients. Psychological safety is… I see that kind of as being a set of intentional, you can call it protocols, actions, whatever you want to call it, but a set of priorities around making sure the environment is emotionally and psychologically safe for patients and staff as well. And so I like to draw that parallel because working in health care, we all know how important those physical safety protocols are, and especially over the past three years, I think organizations are starting to realize more and more that psychological safety should play just as big a role in what the feeling of the environment is like. And so psychological safety would include things like making sure employees know how to set healthy boundaries around their work schedules or around the type of work that they’re doing.

Being able to have supervisors who are empathetic understand that the staff member in front of them is a whole person, that they can’t just compartmentalize the different parts of themselves, right? They don’t walk through the doors and stop being a parent or a sibling or a neighbor that they bring all those roles in with them. So having supervisors that are empathetic to the whole person, creating an environment that prioritizes things like time off self-care strategies that are actually realistic and allow for rest and reset. So when I think about psychological safety, I’m thinking about, not just this sort of nebulous term that’s about making people feel comfortable or, you know, not hurting people’s feelings, thinking about a real actionable, you know, set of resources that are available to make the environment equally psychologically safe as it is physically safe.

Leigh Steiner:

So as you talk about that Rola, I think about those of us who come into the workforce who may have experienced some type of trauma in their life, including just having worked at an organization that maybe where you didn’t feel psychologically safe, much less personal trauma, which may have happened. How does that play into an organization’s responsibility? Or maybe that’s too strong of a word, but an organization’s intelligence at creating an environment where individuals feel psychologically safe. Because it would seem to me that if you didn’t, you wouldn’t stay.

Rola Aamar:

Everyone has stuff they’ve dealt with in the past, right? We all bring something to the table. Maybe not everyone has trauma, but everyone has issues that, you know, may have… may cause increased sensitivity. You know, I don’t want to use the word triggering because it really has this negative connotation now socially. But, you know, everyone has something that makes them feel unsafe. And the responsibility for organizations, for leaders is to know that everyone has something. And it may not be trauma for every person, but if you can look at across all your staff and say, okay, well, maybe not everyone has survived a mass shooting, or maybe not everyone, you know, has experienced a horrific car accident and is sensitive to loud sounds. But everyone brings something to the table that they need compassion and understanding around that shifts the perspective from, well, what do I do for a handful of folks that might have experienced trauma? To what do I do to make sure that this environment accommodates the needs of everyone?

Leigh Steiner:

Yes. Well, it sounds like Rola, what we’re talking about is a… a foundation of a healthy organization that creates a psychologically safe environment for… for everyone and… and… and move on into talking a little bit about how you create an environment where someone feels safe enough to reroute the bus routes like that, that he’s not going to be fired. You know, you talked about that a little bit in your opening comments that you feel empowered to make decisions that are probably in your lane and good for the persons that you’re working with. How… how do you do that in an organization.

Rola Aamar:

When you think about it through the lens of psychological safety, you think about the interaction between the different levels of a hierarchy. Now we know that hierarchies exist in the workplace. We know that they’re particularly important within health care for a variety of reasons. And, you know, making sure patient care happens is kind of at the top of that list of reasons for why hierarchies exist. And, so, when I think about psychological safety and how it ties into empowerment, especially in organizations where hierarchies are so structured, it’s about the type of interaction that happens between those hierarchies. So does leadership micromanage every aspect of someone’s job? Do supervisors respect the opinions and needs and values of their individual staff members when mistakes happen? What… how… how are mistakes navigated? Right. Is it… are individuals being reprimanded and belittled in front of others? Are there opportunities to grow, ways to either have resources and learn from the mistakes? Because we know mistakes happen. They happen in every situation, and it’s how an organization navigates those that – and navigates the sort of communication between the hierarchies – that help create that psychological safety.

And I think it’s that sort of… are you operating kind of from a reactionary standpoint or are you looking at your organization and thinking, this is a collection of people that I have and my goal is to make sure they have the resources to do the best job possible. And if something goes wrong, my instinct is not going to be like a knee jerk reaction to… to yell at them or to reprimand them or to fire them. And that’s how especially in this situation you were talking about, that’s how psychological safety kind of contributes to that feeling like, okay, I can take on more than maybe what’s directly my role. My role is to drive the bus, but I’m seeing other things happen. I’m going to step out of my role take on more than my responsibility because I know that my organization will value that.

Leigh Steiner:

Yeah. Rola talk a little bit about either research or statistics or your personal experience about the relationship between an environment where one feels psychologically safe and job retention.

Rola Aamar:

So I don’t have the exact statistics in front of me, but we do know that turnover rates right now, especially in the health care fields, is incredibly high. And when research has been done around sort of the relationship between turnover and, you know, the factors of turnover, pay is actually quite low on that list. People are not leaving for pay. People are leaving for opportunities for growth, for organizations that prioritize diversity, equity, and inclusion. They’re leaving for organizations that maybe have better reputations when it comes to caring for their staff. They’re leaving for opportunities where they might feel more valued and pay may be a small component of that, but pay is not the reason people are leaving their organizations. And we know, in fact, that many organizations now are trying to offer bonuses or other financial incentives for staying and it’s not working. And so the relation between psychological safety and sort of the culture of the organization is really rising to the top of the narrative right now in the research around workforce turnover.

Leigh Steiner:

Talk a little bit about what role supervisors play in promoting psychological safety.

Rola Aamar:

I think back to my experiences as a supervisor and I think about how I was the person that my supervisors interacted with the most when it came to sort of that that leadership. Right. Not only was I there support day in and day out, but I was their connection to leadership. I was the person that was able to bring their concerns back to, you know, other leaders within the organization. And I think about how… what I expected, you know, my staff to go out and provide quality care to patients. I saw my role as being there to provide that quality care to my staff. And so, I think about kind of that almost intimacy of the supervisor and staff relationship, because you get to know this individual on a level that maybe the rest of the organization won’t. Right? You get to know about their family, their problems, you know, day in and day out that they may be… that may be impacting their life.

You get to know where their strengths are as an employee and where their growth areas are. There’s a real personal and professional nature to that relationship. And so when I think about the role of the supervisor, I think about how it’s kind of the… a key part of the experience of the whole organization. You know, there is a saying, and I was recently at a conference where someone sort of shouted it out while I was presenting this. People don’t leave bad jobs. They leave bad bosses, bad managers. And it’s sort of this known truth, almost kind of that everyone holds on to. Right. Is that things about the organization may not be what you want. Things about your role may not be what you want, but if you have a supervisor who understands you, advocates for you, who’s empathetic towards your needs, that changes the whole experience. I mean, I can tell you I’ve had those experiences, right, where there’s been turmoil or uncertainty, and I have had a supervisor or manager who I just felt so safe with that I wouldn’t leave because I was like, well, I don’t know.

You know, I know that there’s uncertainty and turmoil right now, but I know I’ve got this person and they’re going to make that difference for me. And they’re going to kind of help shield me and grow me through this. And so I think about that role of the supervisor and how it can really make all the difference in terms of psychological safety, because they get to know the staff member in a way that many others within the organizations never will.

Leigh Steiner:

Mm hmm. That’s a great example. And it’s a great reminder for those of us who may be in a position where we supervise other people, what our responsibility and opportunity is to really have a positive impact on not just the organization, but on those people, each human being for which we’re responsible for supervising. Rola, I’ve heard you say that diversity, equity, and inclusion initiatives and trauma informed care or trauma informed workplace practices promote psychological safety. Can you talk a little about that for our listeners so we can connect those dots?

Rola Aamar:

Absolutely. So there are two different sets of initiatives, but I talk about them together because I think that they’re highly underutilized, especially in light of the past several years. Everything we’ve dealt with… with sort of the… the social justice movements and with COVID 19. When you look around your organization, think about what the lived experiences of each of your, you know, colleagues, staff members is like. It’s highly likely that there are no two people that share the exact same lived experience. And so when I talk about DEI initiatives, I’m not talking about this sort of nebulous buzzwordy, sort of priority that has kind of floated to the top. You know, everyone wants to do DEI, but no one’s defining it. I’m talking about looking at… looking across your organization and realizing that no two people share the same lived experience and being able to understand all the factors that make up a person’s life. So whether that’s, you know, challenges with food insecurity, whether that’s race and religion, whether that’s just access to transportation or access to health service, health care services. All of those pieces make up our lived experience. And DEI is meant to help honor and address the lived experiences of individuals.

And so when you’re looking within your organization and thinking, Oh, I want to prioritize DEI, it’s not about cultural competency courses or token diversity hires. It’s about being able to look at your staff and say, I’m going to learn who my staff are and I’m going to, you know, make sure that if someone has a religious holiday that never gets recognized, how can I honor that for them? Or if I know that transportation issues are a concern for a set of my staff who live far away and don’t have access to resources, what sort of resources can we provide to address that? On the flipside, trauma-informed practices are the recognition, like I said earlier, that everyone comes to the table with something, something that creates sensitivity or worry or fear. And how can I honor those and recognize that everyone comes to the table with something and it’s really… trauma-informed workplace practices are really about having that sensitivity and respect for what someone might have experienced or gone through. And there is for organizations that are interested in becoming trauma-informed workplaces, there are a lot of resources out there that you can peruse to assess if your organization is trauma-informed, and then what you can do to make it more trauma-informed.

Leigh Steiner:

Yeah, Rola, I’m… I’m thinking across all of this series that we’ve done and on retention and how important the role of a supervisor is in terms of knowing and demonstrating knowledge of and support for and care for the individuals that work for them. And I’m also thinking that we haven’t talked a lot about the support for supervisors themselves because we almost talk about those people as being or those of us who have been and are in those roles as being extraordinarily virtuous and perhaps not having maybe not feeling psychologically safe themselves. Yet we are relying on individuals who supervise to create that environment for other people. Any comment about that sort of cascading effect?

Rola Aamar:

That is exactly why, you know, when I talk about psychological safety, one of the things that I like to promote is making sure that leadership are invested. And when I say invested, I don’t mean that they’re just going to okay it or give it a thumbs up or say, yeah, psychological safety, let’s do that. Investment from senior leadership – because again, health care organizations are a hierarchy and we know that senior leadership has the majority of the power within that hierarchy. So what that investment looks like when we’re asking senior leaders to invest in psychological safety is an investment of time and investment of resources.

Leigh Steiner:

Yeah.

Rola Aamar:

And that means that when decisions are being made about, you know, how to create trauma informed organizations or maybe an issue has come up that senior leaders are at the table, they’re not driving the conversations. They’re there as a sort of equal team member at the table, which is difficult to do. Right, Because, again, in hierarchies we tend to defer to the person above us, but that they’re at the table and so that they’re giving their time to the issue so that they can hear firsthand about the issue. The other piece is the financial and the resources initiatives around creating psychological safety, RTI or trauma informed workplaces. They can’t happen without resources. They can’t happen without the time resources, the human resources of people within the organization. And they can’t happen without funds. And it’s great for organizations to say, Yeah, yeah, we’re so committed to do this, But a lot of organizations kind of fall short on being willing to, you know, earmark funds for it. And so in order to be able to support supervisors, to help supervisors feel like they can even be successful with this, senior leaders really need to be invested. They need to show up and they need to be willing to listen to the supervisors. I think that helps create that psychological safety for them.

Leigh Steiner

Yeah. Rola, you’ve spent a fair amount of your professional career understanding psychological safety, the effects on employees, organizations, clients, and how to create a culture in which psychological safety is present. Could you share with our listeners a little bit what you find so compelling about this topic?

Rola Aamar:

So a couple of things. First, it’s a topic that’s so personal. Every single person that works in health care. I think back to some of my experiences in health care where there wasn’t psychological safety, it has really sort of painted, you know, this like cast a pall on those experiences. And so… knowing that personally it’s so important as a health care provider. But then on the other side of it, from where I sit now, consulting with these organizations, talking about financial sustainability, I think psychological safety is a business imperative.

When I think about, you know, wanting to keep your doors open, wanting to keep your service lines running, you need staff for that. You can’t do that without staff. And in order for staff to stay, there needs to be psychological safety within that organization. And so that’s a big part to me of what has made this particularly interesting within the past few years is organizations are so worried about shuttering services and closing their doors. But if you invest a little bit more in your staff, you keep them happy and safe and invested in and cared about. You can keep those service lines running because they’re not going to leave you. And so I think about it sort of in that regard as well, that it’s a business imperative and you have to want to empower and develop your staff as badly as you want to keep those service lines open, which is why I think psychological safety is so crucial.

Leigh Steiner:

I’m looking at the clock here and know that our time is running out. So let me ask you if there is something about this topic that we haven’t talked about that you want to mention, or more importantly, in leaving for our listeners, the most important thing you would like them to remember about this.

Rola Aamar:

I just want to call out burnout. We didn’t get a chance to talk about it and it’s such a big buzzword right now. Everyone’s saying, Oh, well our staff is so burnt out and our staff is sober now. And when… when I mention when I, you know, bring up psychological safety, when I talk about it, I really like to challenge this idea of burnout, because burnout really places all the responsibility on individual staff members. If they’re not taking care of themselves enough, that they’re not setting good enough boundaries. But I look at burnout and I think it is all about the system. And so just my challenge to our listeners today, if you’ve said burnout any time in the past six months or if you catch yourself saying it in the future, really ask yourself, Are my employees burned out as my or my staff burned out? Or are we not doing enough within our organization to promote psychological safety? Are we not providing enough care for or investment in our staff? And that’s why our staff are so tired. Our staff are, you know, really kind of struggling to stay in their roles. I just wanted to call that out because I think burnout and psychological safety go hand in hand. And we’re really comfortable using the term burnout. We’re a lot less comfortable challenging the psychological safety of our organizations.

Leigh Steiner:

Thank you for being with us today. This is enormously helpful to our understanding of retention in the healthcare workforce. And we’ll talk to you next time.

Rola Aamar:

Thank you for having me.

Leigh Steiner:

Thank you for listening to this episode of Vitals and Vision. We hope that our discussion has inspired you to challenge the notion of burnout and prioritize psychological safety in your own organization to better foster a healthier more supportive work environment for everyone involved. And remember, success starts with a clear vision and vital strategies. Stay tuned for more engaging conversations in our upcoming episodes.