SafetyInsights.org

The below abstract was a short poster presentation from a team including Amy Edmondson. There’s nothing else to add (that I can find) besides what’s provided below.

It’s interesting that the relationship between psychological safety and use of the incident reporting system was inverse: higher increases in psychological safety was linked with proportionally lower usage rates of the incident system.

However in unpacking this finding, it’s suggested that the incident reporting system allows an improvement pathway not requiring high interpersonal interactions. They found that those with lower perceived psychological safety there therefore more likely to use the formal incident reporting system.

Importantly they also conclude that psychological safety was found to be lower among staff with the lower clinical decision-making authority.

It probably supports other work (e.g. that from stop work authorities) that having both formal and informal systems and means in organisations provide a greater degree of requisite variety for influencing performance.

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ABSTRACT/POSTER

Purpose/Objective(s)

Psychological safety, which is a shared belief that interpersonal risk taking is safe, encourages healthcare workers to raise concerns regarding patient safety. We hypothesize that psychological safety is correlated with use of the Radiation Oncology Incident Learning System (RO-ILS).

Materials/Methods

A validated psychological safety survey was administered in an academic radiation oncology department and scored on a 1 to 7 Likert scale, representing least to greatest perception of psychological safety respectively. Differences in psychological safety by role were assessed by ANOVA and pairwise correlations. The relationship of psychological safety to RO-ILS submissions was assessed with logistic regression. Qualitative, structured interviews were performed with a sample of 24 radiation oncology department staff to explore relationships between psychological safety, role within the healthcare team, and incident reporting.

Results

The psychological safety survey yielded 89 of 127 responses (70%). Mean psychological safety scores differed by role (ANOVA p = 0.0022): therapists (3.56), nurses (4.25), physicist/dosimetrist (4.5), administrative (4.93), attending physician (5.67). Specifically, psychological safety for attending physicians was significantly greater than that of therapists (p = 0.001). Surprisingly, psychological safety and actual RO-ILS use were inversely related: one unit increase in psychological safety resulted in 41% lower odds of actual incident reporting (p = 0.025). Structured interviews revealed that RO-ILS solicits improvement opportunities in a way that does not require interpersonal interactions. Consequently, those that perceive lower psychological safety (e.g. therapists and nurses) were more likely to use RO-ILS to report incidents and near misses than those who perceive high psychological safety (e.g. physicians).

Conclusion

Psychological safety is lower among radiation oncology staff with lower clinical decision-making authority. However, incident learning systems can empower these team members to speak up and thereby enable organizational learning from incidents.

Link in comments.

Authors: Kundu, P., Jung, O. S., Hegde, J. V., Agazaryan, N., Rose, K., Khaothiemsang, A., Edmondson, M.L., Steinberg, Raldow, A. (2020). International Journal of Radiation Oncology, Biology, Physics, 108(3), e201-e202.

Study link: https://doi.org/10.1016/j.ijrobp.2020.07.1440

Link to the LinkedIn article: https://www.linkedin.com/feed/update/urn:li:ugcPost:6931721954215305216?updateEntityUrn=urn%3Ali%3Afs_updateV2%3A%28urn%3Ali%3AugcPost%3A6931721954215305216%2CFEED_DETAIL%2CEMPTY%2CDEFAULT%2Cfalse%29