Two papers exploring the relationship between psychological safety and safety culture were published this month. Although the articles approach the subject from contrasting perspectives and applying different methodological approaches, both come to the same conclusion; the relationship between psychological safety and cultures of safety in healthcare settings is strong and foundational.
Kathryn Adair and colleagues explored how to measure and improve psychological safety using a newly developed tool and assess the relationship between psychological safety and other safety culture domains (1).
Importantly, the authors highlight “Ideally, a good scale would be brief, specifically designed for HCWs [Health Care Workers], diagnostic and actionable, psychometrically sound, able to identify work settings in need of improvement, and responsive to interventions”.
Based on data from almost eleven thousand staff, the results indicate that the new tool can differentiate between group settings, i.e., it is sensitive and accurate. Furthermore, work setting levels of psychological safety were significantly associated with all other safety culture scales in expected directions.
In conclusion the authors state “As part of a safety culture assessment or as a standalone assessment, the PS scale [new tool] provides insight into team members’ comfort with speaking up and learning from safety events, as well as the efficacy of PS [psychological safety] initiatives to improve patient safety”.
En sand sikkerhedskultur
The second article by Jenifer Cartland and colleagues (2) focuses on what factors support High Reliability Organisations (HROs) and how to measure this over time.
Four elements relating to safety culture are examined in detail: ‘Local learning activities’, Trust in colleagues’, ‘Trust in leadership’, and ‘Motivation’ (to engage in non-core activities which relate to improvement).
The authors identify various demographic factors which correlate with these four safety culture elements, but crucially they conclude: “the model we have explored presupposes that an organisation’s culture can change in a purposeful way, and that specific types of activities that foster psychological safety will advance it towards a true culture of safety, and thus will enable a highly reliable organisation”.
Fagligt Nyt om patientsikkerhed er et nyhedsbrev, der udgives af PS!, og som udkommer ca. 6 gange årligt. Det formidler nyt om de seneste nationale og internationale forskningsresultater, begivenheder, trends og meninger inden for patientsikkerhed.
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Adair, Kathryn C. PhD?; Heath, Annemarie DNP, CNM†; Frye, Maureen A. MSN, CRNP, ANP-BC†; Frankel, Allan MD†; Proulx, Joshua BSEE†; Rehder, Kyle J. MD, CPPS?,‡; Eckert, Erin MPA, CPPS?; Penny, Caitlin BS§; Belz, Franz BS§; Sexton, J. Bryan PhD?,?. The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings. Journal of Patient Safety: September 2022 – Volume 18 – Issue 6 – p 513-520 doi: 10.1097/PTS.0000000000001048
Cartland J, Green M, Kamm D, et al Measuring psychological safety and local learning to enable high reliability organisational change
BMJ Open Quality 2022;11:e001757. doi: 10.1136/bmjoq-2021-001757