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Psychological safety

The term psychological safety was first coined by Amy Edmondson.  It means to build an environment where people feel accepted and respected. That people are able to challenge when they have concerns or question, without any fear of repercussion.  Timothy Clark has expanded this further and his view is that there are four stages of psychological safety:

  • Inclusion safety
  • Learner safety
  • Contributor safety
  • Challenger safety

This is where psychological safety is achieved which human beings feel included, safe to learn, safe to contribute, and safe to challenge.  It is where safety become intricately linked to equality, inclusivity and diversity.  Inclusion safety helps members of the team to connect and belong. Everyone wants to be accepted and have a sense of shared purpose.  If we include everyone then we hear from everyone.  Sadly, at the moment, those that are different are often treated differently; whether that be because of gender, ethnicity, colour, ability or sexuality.  They are more likely to be investigated and suspended and more likely to feel silenced.  Learner safety builds on inclusion safety and helps us learn and grow.  It allows us to feel safe to ask questions, give and receive feedback.  Who hasn’t hesitated to raise their hand to ask a question in a meeting or at handover or in a huddle? Those around us need to help provide us with the opportunity and permission to ask questions.

The next stage is contributor safety where we feel safe to contribute as a full member of the healthcare team, using our skills and abilities to participate in all activities. This helps our desire to make a contribution, to make a difference.  This requires us to encourage others to contribute their ideas.  The final and hardest is challenger safety.  This is achieved when people are supported to speak out and have the confidence to ask questions about why things are done that way or to even stop someone doing something they think might be unsafe.  All of which is crucial for effective escalation.