Why It Matters
If staff don't feel psychologically safe enough to speak up, a health care organization may not know about all the patient or workforce safety problems they need to fix.
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The Power of Speaking Up: How Psychological Safety Changes Culture

By Nancy Iversen | Tuesday, March 13, 2018
The Power of Speaking Up How Psychological Safety Changes Culture

What would it mean to hear thanks from a surgeon after you speak up to stop a wrong-site surgery?

This isn’t fantasy. It happens in health care institutions working towards creating robust safety cultures. At the Billings Clinic, where Nancy Iversen, RN, BSN, CIC, is the Director of Patient Safety and Infection Control, staff not only feel safe when raising a concern, but also know that their concerns and questions will be heard and their local leaders and organization will respond.

Iversen recently co-led a session at the 2017 IHI National Forum on how to support frontline leaders in developing environments focused on safety, clinical excellence, and learning. Local leaders are a key piece of the puzzle, especially when they have the necessary tools, such as IHI’s A Framework for Safe, Reliable and Effective Care. “IHI’s framework allows local leaders to understand the cultural and learning environments they are responsible for creating and provides a path for how to get there. Local leaders are guardians of the learning system. Learning can only occur in environments where frontline staff are psychologically safe to speak up and where non-negotiable, mutual respect exists for everyone,” says Iversen.

One of the first actions frontline leaders can take on this journey is to review and act on safety culture survey data. Analyzing their organization’s data can provide insights related to staff’s perceptions of teamwork and safety climate regarding their day-to-day work environments.

While reviewing the data, a leader should ask:

  • Do staff members feel psychologically safe enough to speak up when they have a concern?
  • What is the perception of work-life balance and burnout?
  • Do they feel their concerns are acted on by management? Are they providing improvement ideas?
  • What are their individual and team goals?

“Leaders must allow staff members to have a voice, to make sure their voice is heard, and to ensure that suggestions for improvement are acted on” says Iversen. “Once the issues are made visible, teams and leaders can begin to work on process and system improvements and address the roadblocks that get in their way.” Staff must know that when they speak up, those in positions of power will listen. Psychological safety ultimately improves patient care because it gives voice to those staff members directly involved with patients who are aware of the problems and can come up with solutions.

For example, at a recent daily operations briefing, a Great Catch Award was given to a surgical nurse for her role in preventing a wrong-site surgery. During a pre-procedure timeout, she spoke up when the surgeon began prepping the incorrect leg for surgery, despite the other leg being correctly marked. The surgeon said, “Thank you for speaking up. You used the checklist, you didn’t cut corners, and you stopped a patient from receiving an operation on the wrong leg.”

Iversen asserts that if your staff do not feel psychologically safe enough to speak up about dangers or opportunities for improvement, “You will not know what is going on and you cannot begin to fix problems.”

You may also be interested in:

A Framework for Safe, Reliable and Effective Care

IHI Framework for Improving Joy in Work

Billings Clinic video: How to Run a Huddle

IHI/NPSF Patient Safety Congress (May 23-25, 2018 in Boston, MA)

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