Thread by @WillBynumMD

A thread on #psychological safety at #aamc19

Not surprised 2hear that @AmyCEdmondson “stumbled into psychological safety while studying learning organizations.”

Perhaps that’s b/c psychosocial safety is a basic human need that must be satisfied to fully engage w/ learning

https://twitter.com/willbynummd/status/1194281086173368321

“I found that better teams were making more mistakes. Or maybe they were just better at talking about them” @AmyCEdmondson

But there are numerous barriers to doing so, which are called intrapersonal risks. These risks keep us quiet and disengaged and drive impression management

“We choose self-protection over growth.”

In medicine, why do we feel such pressure to protect our egos? B/c they are constantly under duress?

#aamc19

The nature of the intrapersonal risks increase as the complexity and uncertainty of the work increases. This is where we live in medicine

These intrapersonal risks are destructive in the effort to learn and innovate #aamc19

#psychologicalsafety = the belief that the context is safe for risk-taking.

What it is NOT:

Thus, psychological safety is a specific tool through which we can push learners farther WITHOUT pushing them over the edge #aamc19 @AmyCEdmondson

“The psychological experience of not being able to speak up in a hierarchy is almost as if your vocal cords don’t work. That speaking up is just not possible.” -@AmyCEdmondson #aamc19

“How you handle your high status as a leader matters.” @AmyCEdmondson

Brings up the notion of a “lowerarchy.” Can we drop the hierarchy in medicine when it isn’t absolutely needed? I’ve seen this work best within the military special operations community #AAMC19

“The leaders in the middle shape the climate. The intrapersonal climate is quite a local thing.“

I take this 2mean that even in a toxic culture, mid-level leaders have⬆️ agency than we believe. Is it possible that local climate can overcome/change institutional culture? #AAMC19

This @AmyCEdmondson slide says it all.

What is the role of #shame in this paradigm? Our research suggests that high degrees of shame exist with low levels of psychological safety and high expectations #aamc19 @LaraVarpio

“You have to speak up. It is the heroic thing to do. The right thing to do.” @AmyCEdmondson

If speaking up in our environments requires heroism, we have a lot of work to do. What would patients think if they knew it takes valor & courage 2simply advocate on their behalf?#aamc19

High stakes, uncertain decisions require disagreement first. Psychological safety is required to facilitate this healthy disagreement. Ensuring diverse voices also critical #AAMC19 @AmyCEdmondson

Within an environment of psychological safety, honest feedback is a positive experience.

One way to facilitate this is to actively manage the potential for shame in the feedback exchange #AAMC19 onlinelibrary.wiley.com/doi/10.1111/me…

Great summarizing slide from a fantastic talk from #AAMC19

Thank you @AmyCEdmondson and @AAMCtoday for bringing this critical topic of #psychologicalsafety to #meded

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Credit to @AmyCEdmondson for this quote