Contributor: Improving Health Care Through Psychological Safety

Burnout and resignations among US health care workers have reached a tipping point in our industry, and there are far-reaching consequences affecting health care services, patients, and public health overall. Health care employers and leaders must acknowledge this growing issue and how their actions, or nonactions, of creating a psychologically safe work environment greatly influence the results.

Psychological safety, a term popularized by Amy Edmondson, PhD, is the assurance that employees are free to speak up, ask questions, and admit mistakes without fear of repercussion, regardless of their role or identity.¹ In the 2023 American Psychological Association (APA) Work in America Survey, 57% of respondents said it was very important and 35% said it was somewhat important to work for an organization that values their emotional and psychological well-being.²

"Feeling psychologically safe helps us address the root causes of health disparities and social determinants of health, which will eventually help us turn the tide toward more culturally responsive, empathetic care."

Carolyn Tandy, senior vice president and chief diversity, equity, and inclusion officer, Humana | Image Credit: LinkedIn

As Humana’s chief diversity, equity, and inclusion officer, I shape our company’s strategy for building and maintaining a culture of belonging. This mission is linked to our larger mission of health first for our employees, customers, and communities. Psychological safety is the foundation on which these goals are achieved and should be a priority for all organizations across the health care system because of its potential to improve care and patient outcomes.

When emotional well-being and mental health suffer, psychological safety follows. If employees are focused on surviving the workday, there is little space to innovate or solve problems creatively. In the same APA survey, 31% of respondents reported emotional exhaustion, 26% felt less motivated to do their very best, 25% wanted to keep to themselves, 23% wanted to quit, 20% had lower productivity, 19% felt irritability or anger with coworkers and customers, and 18% felt ineffective.²

When employees struggle with these feelings, their work quality suffers, a company’s productivity suffers, and a lower quality product is passed on to members and patients. Beyond the value of ensuring employee well-being, psychological safety allows for the innovation and creativity that can foster medical advancements and improvements in health care delivery. When we start by fostering psychological safety within our company, we provide a model for employees to build trust and psychological safety with members and patients.

Humana recognizes psychological safety as an indispensable element of our industry, affecting the well-being of employees and the quality of care provided to patients. As health care leaders, it’s our responsibility to know the importance of psychological safety and actively promote an environment that supports emotional and mental well-being, no matter one’s position or background. By embracing vulnerability, authenticity, and inclusion, we can create a health care ecosystem that genuinely cares for all—employees, patients, members, and communities.

Although no single action or issue undermines psychological safety, some common themes include lack of transparency, bias, discrimination, and even authoritarian and fear-based management styles. Outside of the office, financial insecurity, trauma, family issues, and political and social discord can all influence a person’s security in expressing themselves authentically in the workplace.

To add, all employees are responsible for psychological safety regardless of level, but the work to improve it starts at the top. Health care leaders have significant influence over the experience of their teams—either empowering or undermining them; supporting creativity, autonomy, and openness; or micromanaging. Employees take cues from their leaders on acceptable behavior, which means one person's actions can significantly impact the psychological safety of an entire team or department.

Psychological safety should also be a primary characteristic of leadership. It's not about how much you know as a leader but how much you are willing to learn from those around you. Improving psychological safety starts with listening intentionally to learn. Ask your team how they feel, what they are concerned about, and what may hinder their personal psychological safety. Slow down enough to hear what is being said and take the time to digest it. Too often, workplace pressures make the act of listening secondary to the barrage of messages, emails, meetings, and other “urgent” items—especially in the ever-changing and challenging field of health care. Take notes on what was shared and give yourself ample time to review before attempting to provide feedback.

By giving yourself time to seek understanding, you will be better equipped to address the problems that prevent employees from feeling safe and doing their best work. When employees feel validated and respected, trust is built and better outcomes follow. This approach also provides a model for member- and patient-facing employees to listen actively, slow down, and seek a deeper understanding of the issues that may affect an individual’s health while offering solutions that holistically address barriers to best health.

Although many health care companies have a strategy for hiring diverse talent and addressing a history of cultural bias, ensuring equitable and inclusive experiences for employees once at a company, alongside standing up for an equitable and inclusive experience for members and patients, is just as important. Ongoing trainings that help employees understand bias and grow their cultural competency increase psychological safety within the company and for clinicians and patient-facing employees.

This type of training builds the knowledge and skills necessary to objectively understand how inequity impacts health and cultural considerations in providing care, and how to recognize and address bias when it arises. Feeling psychologically safe helps us address the root causes of health disparities and social determinants of health, which will eventually help us turn the tide toward more culturally responsive, empathetic care.

Psychological safety allows companies to challenge prevailing notions and collectively address the issues that act as barriers to success. Caring for it requires each of us to take stock of the well-being of our teammates, members, patients, and the health care system as a whole. As a people leader, take stock of psychological safety in your organization and be intentional about implementing and amplifying it for your employees. Real change starts with the humility to learn and the willingness to listen to and try another way.

Please read Humana’s most recent Impact Report to learn more about our commitment to best health and a culture of belonging.

References

1. Edmonson AC. Psychological Safety. amycedmondson.com. Accessed 2023. https://amycedmondson.com/psychological-safety/

2. 2023 Work in America Survey: Workplaces as engines of psychological health and well-being. American Psychological Association. Published 2023. Accessed 2023. https://www.apa.org/pubs/reports/work-in-america/2023-workplace-health-well-being