Applying LEGACY Research: Developing a Culture of Psychological Safety

Organizations that make a meaningful difference in people’s lives create a culture of psychological safety. Employees in such organizations believe that they can respectfully express their thoughts, feelings, and suggestions without fear of reprisal. Harvard Professor Amy Edmondson has demonstrated that in psychologically safe workplaces, learning and innovation are enhanced—including in hospitals.11

Putting her hypothesis to the ultimate “life-and-death” test, Edmondson studied how eight hospital units handled medication errors. Some units enforced a zero-tolerance policy for making mistakes, sending the message they would not be tolerated. On other units, the healthcare professionals worked in a culture where their errors would be forgiven.

The American Psychological Association's meta-analysis of research results on the definition of forgiveness concluded: "Forgiveness is a process (or the result of a process) that involves a change in emotion and attitude regarding an offender. This process results in decreased motivation to retaliate or maintain estrangement from an offender despite their actions, and requires letting go of negative emotions toward the offender."10

Note that the function inherent in forgiving involves releasing negative emotions. As you've learned, negativity automatically focuses your brain on primitive fight-f light-freeze reactions when confronting dangerous situations, thereby restricting your mind's ability to envision adaptive solutions.

Based on the ratings of amount of psychological safety staff members perceived to be present, the number of medication errors reported was higher on those units where staff members felt safe to report their mistakes. Was this proof that tolerance caused the medical professionals to become complacent? Did safety for the staff members translate into unsafe conditions for the patients? No, and no.

Edmondson delved into the more objective, independent data reflecting the number of medication errors made. She found that the higher the level of psychological safety reported by staff members, the fewer mistakes they made. Those professionals felt it was safe to report errors, learning from them and preventing the same mistake from occurring in the future. The data demonstrated that higher psychological safety resulted in fewer mistakes, lowering the risk to patients of receiving ineffective treatment or experiencing adverse reactions.

Staff members on units with the lowest amount of psychological safety were hiding their errors in fear of retribution. Those units did not learn from mistakes, perpetuating their problem of preventable errors.

Edmondson states: “It appears that nurse manager behaviors are an important influence on unit members’ beliefs about the consequences and ‘discuss- ability’ of mistakes. In addition to the influence of what is said by the nurse manager, the ways past errors have been handled are noticed, and conclusions are drawn, which then are strengthened by ongoing conversations among unit members. In this way, perceptions may become reality, as the perception that something is not discussable leads to avoidance of such discussions. These kinds of perceptions, when shared, contribute to a climate of fear or of openness, which can be self-reinforcing, and which further influences the ability and willingness to identify and discuss mistakes and problems. These climates are characterized in part by the nature of relationships within and between professional identity groups.”12

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