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.
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.
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.
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.
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