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Eve Purdy Profile picture
@purdy_eve
Feb 5, 2022 • 11 tweets • 8 min read • Read on X
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The sim community are leaders in the understanding of psychological safety...but its time we take the theory beyond it's "safe container"...

Expand the way you think about psychological safety by reading our new work in the area!

advancesinsimulation.biomedcentral.com/articles/10.11…

thread...
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.

journals.lww.com/simulationinhe…

@GetCuriousNow
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.



@AmyCEdmondson @RoisinODonovan4
We wanted to better understand whether there was a link between psych safety in simulation and psych safety in the real working environments...

So...we studied an existing simulation program @GC_Health - years of weekly sims with registrars and nurses.
74 participants completed narrative surveys and we conducted 19 interviews.

We coded all this data using @RoisinODonovan4's powerful framework for psychological safety in healthcare.

academic.oup.com/intqhc/article…
What did we find???

Convincing evidence that workplace psych safety impacts the simulation experience AND experience in simulation impacts workplace psych safety.

Simulation is NOT a safe container...it is a bidirectional leaky construct.
What else did we find?

Simulation was an incubator of familiarity and acted as a magnifying glass on leader behavioral integrity. It was clear that participants viewed simulation as a place where relationships are forged, with both positive and negative consequences.
The implications of the bidirectional nature of psych safety and simulation cannot be understated. It presents both opportunity and risk.

The opportunity - a sacred place to build the magic stuff that makes teams work.

The risk - a frighteningly easy place to destroy it.
So...

We must be mindful of what leaks INTO the sim space.

Consider the dynamics of the team entering, your relationship with them, and how sim fits in the broader ethos of the organization.
We should also aim to shape what leaks OUT.

STOP saying what happens in simulation stays in simulation...it just isn't true.

Instead aim to make that leak out one of increased psych safety for teams when they head back to work by tailoring your approach and debriefings.
There's lots more to the story...

Read it all here advancesinsimulation.biomedcentral.com/articles/10.11…

or get in touch with @purdy_eve @socraticEM @WarwickIsaacson

Thanks to @emfresearch @GC_Health @BondUniversity

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More from @purdy_eve

Eve Purdy Profile picture
Jul 13, 2024
Emergency physicians are the most flexible, adaptable, resilient professionals I know. The qualitative comments in this article, while not surprising, are heartbreaking evidence of a remarkable group being pushed well past a breaking point. @CMA_Docsannemergmed.com/article/S0196-…
Here are a few examples. The strength of the language used is striking.

"I feel awful about trying to provide good care for my patients in the hallway, and constantly feel like I can’t do a good job anymore and it makes me feel like a terrible doctor." - Emergency Physician
"It is morally distressing to watch elderly patients dropped off at the emergency room, with nowhere else to go, languish in our corridors, end up sicker than when they arrived as they wait for placement, and in some cases die from neglect." - Emergency Physician
Read 5 tweets
Eve Purdy Profile picture
Dec 15, 2022
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.

onlinelibrary.wiley.com/doi/full/10.11…

A thread.
Emergency medicine is hard.

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.

In the ED it manifests ALL the time...
Read 18 tweets
Eve Purdy Profile picture
Sep 10, 2022
It is with mixed emotions I share our research related to the culture of EM during COVID-19.

link.springer.com/article/10.100…

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.

1. The honeymoon period exposed a broken system.
Read 9 tweets
Eve Purdy Profile picture
Oct 5, 2021
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
Read 16 tweets
Eve Purdy Profile picture
Jul 28, 2021
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.
Read 7 tweets
Eve Purdy Profile picture
Nov 24, 2020
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.

@AmyCEdmondson:
web.mit.edu/curhan/www/doc…
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
Read 8 tweets

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