Creating psychological safety and multidisciplinary team engagement for patient safety: A leadership challenge for health professionals

Speaking up is a necessity for patient safety but remains a dilemma for multidisciplinary healthcare teams. We continue to hear of tragic outcomes that could be avoided if only someone in the team had spoken up, or listened.

The considerable literature on speaking up favours interventions such as graded assertiveness to assist staff to raise their concerns. While these may help, assertiveness training doesn’t seem to have solved the problem. We consider the responsibility lies with senior staff to create a psychologically safe environment1 where team members don’t hesitate to raise their concerns, knowing their contributions are valued, and vital for patient safety.

In a previous study2 we explored perspectives of senior operating theatre health professionals on ‘being spoken up to’ i.e. their reactions when another staff member voiced concerns about their decision or actions. We identified key factors influencing this response including current emotional state, existing relationships with the speaker, culture and past experiences of fallibility. The resulting model of the ‘speaking up interaction’ from the senior leader’s perspective, formed the basis of a reflective survey which we have pilot tested with a wider audience of health professionals.

In this presentation we will describe our story so far, and present our plan to explore potential drivers for change in the culture of healthcare. Our ultimate aim is to ensure all voices are willing and able to contribute to best outcomes for patients.