Elevating Team Psychology to ‘Safe’ Levels

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Lori Shifferd By Lori Shifferd 
Director of Education and Implementation, Change Healthcare
Elevating Team Psychology to Safe Levels

Patient safety is a mantra in healthcare, but another type of safety deserves our attention: psychological safety for our care teams.

A recent article on the New England Journal of Medicine Catalyst blog reports on a study of Google teams that involved 200 interviews and a series of analyses. It found there are five key dynamics to successful teams—and that psychological safety is the most important by far.

Think about how the teams in your home care organization stack up.

  1. Psychological safety is the feeling that you can share ideas and made suggestions without feeling insecure or embarrassed. When this attribute is in place, team members feel supported and don’t fear their teammates will try to undermine them.
  2. Dependability is the knowledge you can count on other team members to perform their jobs effectively. When you ask someone to do something, it will get done, and if you need help, you’ll get it.
  3. Structure and clarity is a clear understanding of everyone’s roles, responsibilities, and individual accountability.
  4. Meaning of work is the idea that the team is working toward a goal that is personally important for each member and that all members have a sense of personal and professional fulfillment.
  5. Impact of work is a team belief that the work it is doing matters for a higher-order goal.

Google found that teams with high psychological safety exceeded their targets by 17% on average. Those with low psychological safety missed their targets by 19% on average. That’s partly because feeling safe creates an atmosphere in which the other four key team dynamics can occur.

Psychological safety in healthcare

The article authors are Jessica Wisdom, PhD, People Analytics Manager at Google, and Dr. Henry Wei, Benefits Medical Director at Google. They point out that clinicians often work in a culture of poor psychological safety.

Home health executives can certainly relate to the surveys they cite in which frequent uncivil behavior is reported, as well as lower levels of team engagement when some physician leaders assume their voices are valued more than those of nurses.

Wisdom and Wei suggest the following steps to improve team performance and psychological safety in healthcare organizations.

  1. Make sure you’re really a team. If a team is more than 15 people, it should be broken into sub-teams. Make sure each team shares a common goal and the responsibilities for achieving those goals. If that’s not the case, you have a working group or some individuals who report to the same manager, rather than a team.
  2. Watch team meetings. Make a video recording of team meetings and watch them, looking for what people are doing well when it comes to engendering psychological safety, what they could be doing better, and what you would have done if you were in the meeting.
  3. Watch for warning signs. Gossiping about team members who are not in the room, strong personalities that marginalize other people or perspectives, hesitance in expressing divergent ideas, and fear of asking for constructive feedback are all signs a team needs to improve psychological safety.
  4. Ask the right questions. Ask team members if they feel comfortable brainstorming in front of each other; if they feel they can discuss mistakes and learn from them; if they think others try to undermine them deliberately; and how conflict could be better managed.
  5. Huddle up. Consider a daily clinical team meeting. A VA study assessed how “huddles” improved teamwork experiences and found that even respondents who did not find huddling to be very helpful reported higher psychological safety.

Putting this type of framework around an idea involving behavior and emotions is a terrific first step in finding and fixing problem teams. In home health, where teams often include strong personalities and clinicians of different education and experience levels, it’s a way to elevate this type of safety to the level it deserves.

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