Building a culture of trust: Why psychological safety matters in healthcare

Article by:

• Dr Anu Obaro – RadReach Steering Group Chair and Co-founder
• Georgina Charlton – Associate Director of Delivery, Guy’s and St Thomas’ NHS Foundation Trust

Clinical radiology and clinical oncology are demanding specialties. Every day, we navigate challenging cases, deliver critical diagnoses, and plan and deliver increasingly complex treatments for our patients. In such a high-pressure environment, fostering a sense of psychological safety is critical for patient safety, and essential for individual and team wellbeing. 

At our recent RadReach Engagement Day we talked to our current and prospective mentors and mentees about the importance of safe and inclusive environments. We discussed how simple actions can promote psychological safety and are essential in enabling doctors and their colleagues to speak up. Examples included making sure new staff during inductions are given a named person they can speak up to and regular explicit permission that they can speak up - a one off ‘open door’ offer isn’t enough.

Psychological safety describes a team climate where individuals feel comfortable taking risks, speaking up with questions or concerns, and offering new ideas without fear of judgement or negative repercussions. It's about feeling valued and respected for your unique contributions, regardless of your experience or seniority.

Psychological safety at work can lead to:

• Improved patient care: Open communication allows for early identification and correction of errors therefore leading to a culture of continuous improvement
• Enhanced innovation: Diverse perspectives and a willingness to challenge assumptions drive better solutions.
• Reduced burnout: Feeling supported and valued reduces stress and increases job satisfaction, contributing to the retention of doctors in the workforce for longer.

A psychologically safe environment benefits everyone – doctors and patients alike. In this type of environment, doctors should feel more empowered asking questions, admitting mistakes and offering alternative opinions. It also serves as a platform for information to be freely shared, promoting active listening and building a space in which people feel supported by their colleagues.

It’s important to look out for red flags, as they may not always be clear to the untrained eye. Here’s a few signs to watch for among your colleagues.

• Silence or hesitation to speak up: Doctors avoid asking questions or raising concerns for fear of being ridiculed or seen as incompetent. This can be made worse if they have witnessed a colleague being subjected to this behaviour.
• Information silos: Knowledge is not freely shared and communication is stifled.
• High levels of sickness and turnover: Dissatisfied doctors may have long periods of sickness absence or leave, leading to a loss of valuable expertise and a potential strain on the remaining staff.

Although we recognise that some colleagues will face greater barriers than others in seeking to take these actions, there are several practical steps you can take to build an inclusive team. These include:

• Leading by example: Demonstrate openness to feedback, admit your own mistakes (and share what you’ve learned from them) and actively listen to others.
• Encourage open communication: Create opportunities for discussion and actively solicit feedback. Give people explicit permission to regularly contribute their questions, ideas and concerns, and take the opportunities available to you to contribute your views.
• Practise civility and kindness: Raise concerns and make proposals for change from a position of respect and kindness. Your colleagues will respond more positively when they are confident you are making your suggestions in good faith.
• Say ‘Thank you’: It takes courage to speak up, so when someone raises a concern or an idea, publicly thank and acknowledge their contribution. This shows the team that its safe to speak up here.
• Recognise and celebrate diverse perspectives: Value different viewpoints and encourage respectful debate. A team is stronger than the sum of its parts.
• Focus on solutions: When errors occur, focus on learning opportunities rather than blame.

If you find yourself in an unsafe environment, here are some options to consider:

• Open conversation: Talk to your manager or colleagues about your concerns. If you do not feel heard, you can escalate your concerns to a more senior manager, Clinical or Educational Supervisor.
• Seek independent advice: All NHS organisations have a named Freedom to Speak up Guardian (Find My FTSU Guardian - National Guardian's Office) who can provide confidential and independent advice if you are struggling to speak up.
• Seek allies: Find colleagues who share your values and create a support network – or access a mentor for advice and encouragement.

A psychologically safe team environment not only benefits doctors, but also the patients we care for. Ultimately, fostering a culture of trust and respect creates a space where everyone feels empowered to contribute their best, leading to better outcomes for all.