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At all times - but especially during times of particular stress - leaders at every level must foster and preserve psychological safety.
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What to Do and Say to Support Psychological Safety During the COVID-19 Pandemic

By IHI Multimedia Team | Friday, April 10, 2020

What to do and Say

Photo by Dan Meyers | Unsplash

Physicians who spend hours each night cleaning their homes to protect their children. An emergency room doctor who has removed himself from his family to spare their health. A nurse with a plan to self-quarantine from her high-risk son. Hectic and frustrating days that turn into stressful and lonely nights have become the “new normal” for health care providers serving on the front lines of the COVID-19 pandemic.

Fear, anxiety, and overwork results in significant tension for those providing and managing care. Our systems are also stressed as we continue to care for patients with existing morbidities and those affected the COVID-19. Under these conditions, people are more likely to make an error, experience loss of productivity and burnout, and will be anxious about the future. 

Believing that, now more than ever, leaders at all levels must foster and preserve a sense of psychological safety, a small group of safety and quality leaders decided to assemble some advice: Jonathan Warren, Chief Executive, Norfolk and Suffolk, NHS Foundation Trust; Barbara Balik, RN, EdD, co-founder of Aefina Partners and IHI senior faculty member; and Johnathan MacLennan, Mental Health Improvement Lead for NHS Tayside.

This group agreed that, in a psychologically safe environment, staff feel:

  • Secure and capable of changing
  • Free to focus on collective goals and problem-prevention rather than on self-protection
  • Free to speak up about unsafe conditions without retribution

The group revisited the work of Amy Edmondson, PhD, a Harvard Business School professor, and influential thinker about people and teams. Based on her analysis of Edmondson’s work, Balik offered the following list of behaviors to promote psychological safety:

  • Frame the Work. Set expectations about failure, uncertainty, and interdependence. Clarify the need to hear all voices. Use direct language. Avoid jargon and be respectfully blunt. Ask staff to speak up. Say things like: We’ve never faced anything like this before so there are a lot of gaps in what we know. We need to hear from everyone. If you’re worried, please speak up.
  • Emphasize purpose. Communicate what is at stake and why it matters. Say things like: Care of our community and each other is our critical aim — now and going forward. It will take all of us working as a team to do our work well.
  • Invite participation. Clearly articulate that all voices are valued. Ask open, honest questions and model active listening. Ask for help and offer thanks. Value your colleagues. Say things like: What are we missing? How might we do this differently? Thank you for speaking up — that’s exactly what we need to hear to help us all. Never worry alone. Thanks for sharing that idea. Let me repeat back what I heard to be sure I understood.
  • Be clear on standards. Ensure behavioral standards are shared, understood, and consistently applied. Sanction clear violations. Say things like: We always treat each other with dignity and respect, especially when things are tough.

All agreed that when colleagues raise an issue, leaders must listen. They must also reassure staff that, while they may not have all the answers, they are confident about finding solutions by working together. Leaders must also offer a safe space in which people can express their fears and remind staff of how each of them can make important contributions.

Jonathan Warren shared how he has applied these recommendations. He has put aside some of his day-to-day work as a leader to be at the point of care to support and encourage staff and provide direct patient care. He is glad he can work alongside those who are in the middle of the crisis, provide support, and help solve problems.

Jonathan McClellan has likewise returned to providing direct patient care. He noted that our health care workforce is being traumatized. They must make rapid decisions and deal with displaced patients and hectic wards. He emphasized that leaders have a responsibility to support staff and help them to stay grounded in the mission amid the chaos.

As health care leaders adapt through a period of rapid change, they can draw on foundational quality and safety work developed before the current crisis. Resources like IHI’s Framework for Safe, Reliable and Effective Care and the IHI Psychology of Change Framework, for example, can help with navigating uncharted waters as they support the health care workforce during this pandemic.

Joellen Huebner is an IHI Senior Project Manager. Frank Federico, RPh, is an IHI Vice President.

You may also be interested in:

Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy by Amy C. Edmondson

The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth by Amy C. Edmondson

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