Building a Culture of Psychological Safety in Healthcare to Achieve Zero Preventable Harm

As an expert in clinical and medical environments, Cognosante helps healthcare organizations become High Reliability Organizations (HRO). HRO principles originate from high-risk environments such as aviation and nuclear power, and they are increasingly applied in healthcare settings across the nation. The key principles of HROs include leadership commitment, a culture of safety, and continuous process improvement to enable healthcare organizations to achieve the goal of zero preventable harm. 

In this interview with Cognosante’s HRO Executive Leader Coach for our High Reliability Organization Support team, Dr. John S. Murray, PhD, RN, CPNP, CS, FAAN, USAF, NC (Ret Col.) shares his insights on how organizations can improve patient outcomes by creating a culture of psychological safety among employees.  

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Dr. Murray, you recently co-authored an article in Military Medicine on the importance of psychological safety. Why is it such an important part of the journey toward becoming a High Reliability Organization?

In the healthcare setting, High Reliability Organizations focus on achieving system-wide excellence in patient quality and safety. This requires constant vigilance and the engagement of personnel across the organization, all of whom must feel empowered to voice concerns. 

In the article, our team cited evidence that shows individuals who feel psychologically safe can speak up and act without fear of reprisal, risk to reputation, or being seen as disruptive. When staff in a healthcare organization feel safe and empowered, especially on the frontlines of patient care, they feel comfortable asking questions, raising concerns, pointing out mistakes, and offering suggestions for improvement. All of this decreases the potential for safety concerns and potentially life-threatening errors. 

What aspects of psychological safety does your team focus on?  

We focus on two challenges:  

1) Creating a psychologically safe work environment in which employees feel comfortable voicing concerns; and 2) Creating a just culture, in which organizations identify the root causes of mistakes and fix systemic problems, rather than simply assigning blame to an individual.  

For example, if a nurse makes a medication error, an organization with a just culture focuses not only on the error itself, but on the systemic problems (such as improperly stored medication) that contributed to the error in the first place. This allows organizations to prevent similar errors from occurring in the future.  

How do healthcare organizations benefit from the coaching that your team provides? 

We help our customers implement evidence-based strategies, share best practices, and assess culture change over time. This is challenging because organizational culture change can take years to achieve. Our HRO team assists the organization in identifying strategies that will yield small, but impactful results, so they see the progress that is being made throughout the process.  

Psychological safety in the healthcare setting creates far-reaching, remarkable results. For example, our team recently learned about a junior hospital employee who saw a hospital administrator visiting an acquaintance without following the precautions that the patient’s condition required. The junior employee felt psychologically safe enough to ask the more senior leader to follow the protocols and put the patient’s health and safety first. Stories like this tell us–and our customers–that their efforts to create a healthcare setting that values psychological safety are making a difference, one patient at a time.  

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Learn more about how Cognosante helps healthcare organizations in their pursuit to become High Reliability Organizations.