Paediatrics

Paediatrics Psychological Safety

Spotlight on … Psychological Safety

Speaking Out in the Right Place at the Right Time: What Makes It Safe?

“It was the SPSP Watcher’s Bundle that started me thinking about this issue”, says Christine Findlay, Consultant Paediatrician in University Hospital Crosshouse.  “This is a tool we have recently introduced to our paediatric ward and centres around how we work together as a team to identify a child with the potential to become more unwell.  It validates voicing a clinical gut feeling and made me wonder how confident all members of our team may feel doing so regardless of their experience, position or status”. 

Christine began noticing patterns in how communication worked on the ward. “I saw that people might spot a risk or have an issue they needed to voice, but not say anything at the time.  They would tend to report it to someone else, usually more senior, sometimes quite a while after it had happened.  I wondered why they didn’t speak out directly there and then”.

After attending a ‘Daring To Succeed’ workshop in November 2019, Christine realised that her question was captured in the term psychological safety.  “I decided to raise this discussion with my multidisciplinary colleagues”, she said, “and to do this using speech relatable to clinical day to day practice rather than it being perceived as management chat.  I wanted us together to think of ways to empower all members of the team to raise any concerns regarding patient care in a direct and timely way”.

Christine enlisted the help of Gemma Edwards, Paediatric Registrar and Niamh Langasco, Clinical Fellow and sent out a simple Survey Monkey questionnaire.  The results were illuminating. “63% of 56 respondents admitted to sometimes holding back from speaking up.  Not only that, in 59% they said that telling someone else later had not resolved the actual issue”, she says.  What did she learn gets in the way?  “The reasons given are varied but with a common thread”, says Christine, “from not knowing what words to use, fear of revealing a gap in knowledge, looking silly or confrontation, lack of confidence particularly if speaking to a senior colleague, to perceptions of not enough time and lack of familiarity within the team. I realised that whatever we did to address the situation needed to make everyone feel that their opinion is valued and used the questionnaire to invite suggestions of things we could do to make it easier to speak up. Ideas included lots of suggested phrases and the introduction of a team debrief at the end of the ward round.”

Since the questionnaire was issued, Christine, Gemma and Niamh have co-designed several practical ways to build psychological safety and to open communication.  The first is a simple poster entitled Are You Happy To Speak Up? “We used phrases members of the team had felt would make them feel safer to speak up”, says Christine.  “Things like “Can I please double check the plan with you?” The posters will be displayed in the department to encourage real-time voicing of what matters”.

A “Post Ward Round Pause” poster has also been designed and will be displayed beside the ward round trolley “Our aim is to promote a clear and simple framework for team communication which is centred around patient safety, and puts people first”, says Christine.

Promoting psychological safety in a paediatric multidisciplinary team of a district general hospital.

Gemma Edwards, Niamh Langasco, Sarah Coy, Christine Findlay

Paediatric Department, University Hospital Crosshouse, Kilmarnock KA2 OBE

Background:

Psychological safety is a shared belief that team members feel safe taking interpersonal risks, such as speaking up and voicing concerns. Staff within paediatric and neonatal teams nationally have a more positive perception of communication in the workplace compared to other specialties.¹ However, personal reflection of situations involving challenges raising concern, consideration of staff wellbeing and the introduction of “watcher status” to our workplace motivated us to collect multidisciplinary team data within the paediatric department of a district general hospital on how psychologically safe individual staff members feel.

Project Aims

To empower all staff to raise any concerns regarding patient care in a timely and direct manner and to promote, using practical and relatable language the ethos of psychological safety in the workplace.   

Methods

An anonymous online survey was emailed to all paediatric and neonatal staff inviting feedback of experience in voicing concerns regarding patient care and suggestions of ways in which to promote psychological safety in the workplace.

Results:

Fifty six staff members responded from all tiers of medical and nursing staff of which,

- 63% reported experience of feeling unable to raise concerns

- 59% raised a concern that they felt wasn’t listened to

- 23% acted on their concerns at the time.

Reasons given for not raising concerns included discomfort in questioning a senior colleague, fear of looking silly/ confrontational/exposing a gap in knowledge, not knowing words to use and lack of familiarity with new staff members.

Ideas of what may help included suggested phrases and a team debrief at the end of the ward round.

Outcomes:

With suggested phrases we designed post ward round debrief and “Are you happy to speak up?”posters. We have given feedback on the results of the survey, thanking all involved and inviting comments on the poster designs. We are considering strategies to address the concerns raised regarding staff familiarity, including a photo gallery and “Things I would like my colleagues to know about me” board.  After implementation of changes we shall send out a follow up survey.

Conclusions:

This project has facilitated within our department discussion around the concept of psychological safety, using speech relatable to clinical practice and has empowered nursing and medical staff to reflect on what this means at a personal level, whilst together creating innovative ideas for quality improvement changes with the aim of promoting a clear framework for team communication which is centred around patient safety.

References

1. NHS Improvement. Measuring safety culture in maternal and neonatal services: using safety culture insight to support quality improvement. 2019. Available from improvement.nhs.uk. https://improvement.nhs.uk/documents/5039/Measuring_safety_culture_in_matneo_services_qi_1apr.pdf