Psychological Safety in the Surgical Suite

Psychological Safety. It’s a notion that most would agree is important, but a bit elusive. The formal definition is “the degree to which people view the environment as conducive to interpersonally risky behaviours like speaking up or asking for help.”¹ In health care environments, when it is lacking, staff and patients are less likely to suggest new ideas, offer feedback, or seek assistance for fear of reprisal or embarrassment.²

Lawrence Yang is a Family Doctor in Surrey practicing in a community clinic and as a locum at Surrey Memorial Hospital. In recent years, psychological safety is a topic he has become quite passionate about.

“When I first learned about the idea of psychological safety, in both the Physician Quality Improvement program and the Council’s Clinician Quality Academy, I thought ‘Yes! We need this – like 50 years ago! We all need to be talking about it. We need to know how to facilitate it. We need to know how to create and hold safe spaces for people!’ That kicked off this journey of exploring how I could bring psychological safety into my practice,” he shared.

His enthusiasm for the subject led to his participation on the Doctors of BC Psychological Health & Safety working group, as a representative for Fraser Health. It was there that brainstorming began on how to introduce the concept to hospital-based surgical teams, in hopes of increasing staff comfort to speak up
when they feel something is wrong.

From his view, there are many contextual factors impeding psychological safety in the health care workplace, including decades of pre-existing over-work in physician cultures, a culture of martyrdom, a culture of harsh inner critics from perfectionists entering training in the health professions, as well as the added stress of the pandemic.

Most conversations and research on psychological safety focus on the well-being of health care staff, the functioning of teams and care coordination, reduction of errors and improved cost effectiveness. While important, of course, Lawrence was also curious about how and why the psychological safety of care providers, matters to patients.

Patient Engagement – A ‘Creative’ Conversation

“It is so easy for health care professionals to be provider-centric in their improvement work and lose sight of the real end goal: patient health outcomes and experience. By bringing a patient partner in, you can stay focused and have much more satisfaction at the end of a project,” said Lawrence. “Both the PQI [Physician Quality Improvement] and Clinician Quality Academy programs had really stressed the importance of patient engagement. So, I reached out to the Patient Voices Network and the Engagement
Leader, Jami Brown, connected me with three patient partners: Vikram Bubber, Lauren Hinnen and Miranda Tymoschuk.”

This was Lauren’s very first patient engagement opportunity, and she was happy to have an opportunity to share her perspectives on the system, and some pieces of her own journey of care.

“Over the past 10 years I have learned to live with a chronic illness where I’ve had hospital stays, medical procedures and countless tests. Without the health care system I wouldn’t be here today, so I wanted to use my firsthand knowledge to create positive changes for patients and health care staff. This was my first project with PVN and starting with just telling my story seemed like an easy way to start getting involved,” she said.

Without the health care system I wouldn’t be here today, so I wanted to use my firsthand knowledge to create positive changes for patients and health care staff.

Lauren Hinnen

In this project, the patient voices didn’t just inform the project, they were the project. Initially, Lawrence had hoped to invite the patient partners into the Operating Room to speak directly with surgical teams. However, with COVID-related visitor restrictions in hospitals at the time, the group instead decided to create a dialogue-based video. Appreciating that people are overloaded with email and various reading materials, they hoped that leveraging creative media might help them to reach more hospital staff.

In May of 2021, the three patient partners met with Lawrence in a 2-hour recorded Zoom session to share their perspectives on what psychological safety is and why it is important to them as patients, and how it benefits members of their health care teams. An abridged 5-minute video, and a full version, are now available on YouTube.

When you’re meeting with patient partners, be ready to listen and learn and stay curious. Don’t jump to conclusions. Know that patient partners have valuable input that could make or break your project.

Lawrence Yang

Patient Insights

Of the many ideas shared, some of the most poignant included:

• If our health care teams had more psychological safety, the patient experience and sense of security during our treatment/care would likely improve.
• If our health care teams had more psychological safety, then patients would have a greater likelihood of trusting their health professionals.
• Health care staff seem to be overwhelmed with work from the patient perspective. Staff rarely seem “present” when with patients, it feels like they are always trying to complete the next task – and because of this, they miss important information.
• Our health care teams give the impression that they do not talk to each other, patient stories are not passed on between siloed teams – communication must improve between teams and with patients and patient families.

Another idea the group chatted about was that the psychological well-being of staff can impact that of the patients. “One of the patient partners talked about doctors and nurses needing training on how to respond to patients’ suffering and emotions. How they need to be more present and have more tolerance for emotional challenges. That made a lot of sense to me. You know, all of my colleagues are good people who want to do a good job, but I’ve seen in the hospital, when people are busy and whatnot, sometimes the intensity of a patient’s emotions scare them away, and then they abandon the patient, instead of just being there. And it’s actually quite healing, to just ‘be there’. To walk away and isolate a patient in those moments because of our own discomfort is probably counter productive to their healing,” reflected Lawrence.

Advice for Health Care Teams on Patient Engagement

“When you’re meeting with patient partners, be ready to listen and learn and stay curious. Don’t jump to conclusions. Know that patient partners have valuable input that could make or break your project. They might be able to tell you ‘It’s way off! It’s not going to work!’ and that can help you too! Seeing where to redirect your resources, etc. They can really help you to level up your project to greater effectiveness,” offers Lawrence.

Advice for Patient Partners

“Come as you are. Don’t be afraid to ask questions of the health care partner. Sometimes I worry about the sense of power differential in engagements – that patients might not feel psychologically safe or able to speak freely. So, I would encourage them to be bold, and to recognize the value of their lived experience,” said Lawrence.

Next Steps: Sharing, Spreading & Learning From the Video Resource

The team is now looking for online training curriculums and opportunities to share and make use of the videos. The YouTube links can be shared with any audience embarking on a learning journey around psychological safety in the health care workplace. One program that picked it up as a learning resource is a new initiative launched by Doctors of BC and Fraser Health to provide leadership coaching and psychological safety training to physician and administrator dyads in Fraser Health.

Lawrence is hopeful that as the video is viewed by more people, it will shape many learning journeys. “When they see how eloquently these patient partners speak about their needs in health care, I think they will remember it. It is not an easily forgettable experience, watching these patient voices speak about how important it is, that their health care providers feel safe in their teams,” he said. “I really enjoyed connecting with these patient partners and I learned a lot from them. I was inspired by their level of knowledge and awareness of the system, how compassionate they were towards care providers, and how understanding they were of our challenges as health care professionals.”

Lauren reiterates the compassion that she and many patients hold for their providers. “I hope those watching the video see how grateful we all are for the health care system, and how much it needs to get better for the patients, and for the staff,” she shares.

This story was featured in our 2021/22 Annual Report.

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1. Amy C. Edmondson, Monica Higgins, Sara Singer & Jennie Weiner (2016) Understanding Psychological Safety in Health Care and Education Organizations: A Comparative Perspective, Research in Human Development, 13:1, 65-83, DOI: 10.1080/15427609.2016.1141280
2. Doctors of BC. Policy Statement. Promoting Psychological Safety for Physicians (2017). Available from: https://www.doctorsofbc.ca/sites/default/files/2017-06-promotingpsychologicalsafetyforphysicians_id_113100.pdf