The acute phase of COVID-19 was a time of cultural magnification and transformation in emergency medicine. It was a time when we could see who we are, recognized what aligned with those values and identified what conflicted with them. #ACEMWS21@Qemerg
A group of clinicians @Qemerg@KingstonHSC engaged in a rapid cycle collaborative ethnography by gathering >50,000 words in field notes and >40 interviews with staff during 12 week period (March-May 2020). Weekly we reported the "pulse" of the ED to department + hospital leaders.
This work highlighted aspects of pandemic reality that aligned with our core values, beliefs, and practices. For example, managing uncertainty is core to emergency medicine. Many thrived in doing so in the early days.
On the other hand there were significant threats to identity - the biggest of which was the ability to provide patient and family centred care. A mismatch between practice and values/beliefs is extremely problematic in the longterm.
As we move forward we must strive to align realities of practice with core values. Choices at individual, departmental, and organizational levels must strive to maximize overlap. This is relevant to ongoing COVID response but also in normal times. Try asking simple questions.
The impending disastrous efflux of staff from emergency and critical care in Canada is certainly complicated but I am confident mismatches (predating but magnified by Covid) between core values and realities of practice are at the heart of why good people are leaving.
Thrilled to share our latest research on ED teams.
Psychological safety - the ability to take interpersonal risks - is critical to team performance across industries...we have put a spotlight on the concept in emergency medicine.
To help, we MUST apply the best evidence from teamwork science with the same fervour we apply evidence for interventions for conditions like sepsis/STEMIs.
Our teams and patients deserve it.
Psychological safety is a great place to focus attention because the evidence for its importance across industries (and in healthcare) is well documented. Just read anything @AmyCEdmondson or @roisinODonovan4 have written.
I am simultaneously 1) amazed by the work of ED teams - they are the primary buffer in our system and 2) troubled by tensions and threats posed to our specialty.
We harnessed the power of clinicians (ED physicians and nurses) on the ground to understand the impact of COVID-19 on our department.
The department used the data to guide real-time decision making and we used the data to better understand EM culture and the impacts of COVID.
We found that in the early response to COVID the resources mobilized gave a glimpse of how EM could and should work. This highlighted problems predating the pandemic.
Psychological safety - a shared belief that the team is safe for interpersonal risk taking – has been a focus for sim facilitators. Giants have shown how psych safety can be fostered in the confines of the simulation space.
But psychological safety is even more critical in real workplaces. It is central to how teams accomplish complex work, how they learn together, and how they grow.
Emergency medicine is basically just navigating uncertainty together.
Patient after patient.
Shift after shift.
We are quite familiar with good team behaviours that allow us to do so.
We train for things like…
Closing the loop
Recaps
Graded assertiveness
Communication
But as a community we have spent less energy on understanding and deliberately supporting the type of organizational and team culture that is a necessary pre-requisite for those good behaviours to happen.
Things like…
Moments of crisis, like #COVID19, are moments of cultural compression...Moments when values and beliefs of a group are more easily identified and then shaped.
Moments that can tell organizations an awful lot about who we are, what matters most, and who we might become. #EDAC2020
It turns out that psychological safety, the ability for team members to take interpersonal risks, is critical for groups to do their work. In moments of crisis we can clearly see when psychological safety is intact....and...when it is not.
So...how might we shape an organizational culture that fosters psychological safety so that we can be our best during crisis, but perhaps even more importantly during normal times??? #EDAC2020