Psychological safety - a view from the hospital bed

March 25, 2024

‘No, that’s not what I said,’ the nurse snapped. Her sharp, curt voice made me—the patient in the bed—and the student nurse she was speaking to instantly on edge as he fumbled the task of reattaching my IV line.

I have had two stints in hospital in the past three months, and this exchange at my bedside post-surgery was a small lens into the finding of Purdy et al (2022) that ‘newer team members and those with less hierarchical power are less likely to feel like they can contribute freely or speak up’ in healthcare teams. Purdy’s study into psychological safety and team performance found that familiar interactions with colleagues and leaders was the primary force shaping psychological safety in ED health teams.

In a large landmark hospital teams communication study, Leonard, Graham and Bonacum found that 70% of unanticipated adverse events were a result of team communication failures—specifically exchanges that made team members feel they were not safe to speak up and ask questions, stay clear-headed or raise concerns (2004).

Even mild displays of rudeness, found Riskin et al, reduce diagnostic and procedural performance of health teams (2015 & 2019).

Riskin also found in a 2021 study that patient gratitude increased health-carer performance by 40%.Indeed, grateful I was last week during my second hospital stay—observing my nurse guide her two student nurses through their observation and treatment steps throughout my stay. Both students were utterly calm, relaxed, focused—their composed demeanour a mirror of the nurse instructing them.

In fact that is precisely what it was. Their mirror neuron networks, firing in their limbic and mid-brain regions, were picking up the confident, trustful emotional state of their senior nurse and her supportive intention towards them. Mirror neuron networks directly impact ‘our ability to grasp new skills, acquire knowledge, and form deep emotional connections with those around us, even helping us understand why people do what they do’ (Cook et al., 2014). You might consider these neural networks the cells of psychological safety. The interpersonal signals we transmit to and through those networks are the essential grey matter of a psychological safety culture. And in the healthcare sector, they are also the essence of physiological safety.

So, in the spirit of gratitude: We are privileged to benefit from incredible, life-changing healthcare teams, expertise and systems in this country. My huge thanks and respect goes to all the many health professionals like my nurse working to foster psychological safety in every interaction—and in so doing significantly increasing safety and health outcomes for their patients.