Thread by @purdy_eve

After studying ED teams, I am thrilled to share insights about how they work and some simple hacks to make them even better.

Spoiler alert: psychological safety is what it’s all about - thanks @amyCEdmondson @RoisinODonovan4

#RCEMasc @RCEMevents @SocraticEM

A thread…

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…

Trust
Familiarity
Feeling valued

Case in point. Jane.

Early in the pandemic Jane noticed resus teams doffing incorrectly. I asked her if she told them…she said,

“Well I wouldn’t say anything to anybody…I am just a janitor.”

Ooof. Hierarchy, power, fear – getting in the way of doing our best.

But COVID intubations aren’t special.
We need to be able take interpersonal risks – big and small.

The nurse challenging the drug dose.
The consultant seeking feedback on a tough case.
The orthopaedic tech suggesting a different management.
Jane telling me I am doffing wrong.

The ability for members of the team to take interpersonal risks is known as psychological safety. It is critical for teams to perform at their best.

Read anything and everything @AmyCEdmondson has written about it.



hbs.edu/faculty/Pages/…

More recently @roisinODonovan4 has added to our understanding of the concept of psychological safety in healthcare teams and organizations.

pubmed.ncbi.nlm.nih.gov/32867762/

frontiersin.org/articles/10.33…

academic.oup.com/intqhc/article…

academic.oup.com/intqhc/article…

Many have worked to flatten hierarchy and we value collegiality. But my research – and many stories like Jane’s – make it clear that we have a long way to go.

The trouble is those who have the greatest power to change culture are least likely to realize there is a problem.

Jane taught me that my team is not as safe as I think it is.
.
.
.
…..neither is yours.

There is some good news.

My team may not be as safe as I think it is… but it can be!

And it’s simpler than you think.

We have found that psych safety in the ED is generated through familiarity.

SMALL MOMENTS that inject familiarity can be woven into our everyday work.

The Shift Huddle.

Taking 5 minutes to gather the team, learn names, and chat at the beginning of the day sets up expectations for teamwork and lowers the threshold for future communication. It’s a clear demonstration of respect for the team.

A small moment that matters.

The Team Briefing.

Briefing the team in advance or on the arrival of a patient is a critical moment to build familiarity. It creates shared knowledge of roles, goals, mutual respect, and teamwork expectations.

pure.bond.edu.au/ws/portalfiles…

A small moment that matters.

The After Action Review.

A quick convo after a shift, after a transfer, after a resus etc etc etc - is a powerful way for the team to grow together.

It’s evidence of psychological safety, and a way to build it!

A small moment that matters.

The small moments matter…

And the big decisions matter too.

Departments must commit to prioritizing familiarity for their teams in decisions they make – think rostering, geographic podding, staff orientation, meetings etc.

So…
Your team is not as safe as you think it is.
But it can be.

shorturl.at/ijIT2

Thanks to @Socratic_EM @WarwickIsaacson and the @QEmerg and Bond and @GC_Health research teams.
@EMFresearch

And you can watch the whole talk here:

vimeo.com/609694802