Creating Psychological Safety in the Learning Environment: Straightforward Answers to a Longstanding Challenge

BackgroundHospital organisational culture affects patient outcomes including mortality rates for patients with acute myocardial infarction; however, little is known about whether and how culture can be positively influenced.MethodsThis is a 2-year, mixed-methods interventional study in 10 US hospitals to foster improvements in five domains of organisational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. Outcomes were change in culture, uptake of five strategies associated with lower risk-standardised mortality rates (RSMR) and RSMR. Measures included a validated survey at baseline and at 12 and 24 months (n=223; average response rate 88%); in-depth interviews (n=393 interviews with 197 staff); and RSMR data from the Centers for Medicare and Medicaid Services.ResultsWe observed significant changes (p<0.05) in culture between baseline and 24 months in the full sample, particularly in learning environment (p<0.001) and senior management support (p<0.001). Qualitative data indicated substantial shifts in these domains as well as psychological safety. Six of the 10 hospitals achieved substantial improvements in culture, and four made less progress. The use of evidence-based strategies also increased significantly (per hospital average of 2.4 strategies at baseline to 3.9 strategies at 24 months; p<0.05). The six hospitals that demonstrated substantial shifts in culture also experienced significantly greater reductions in RSMR than the four hospitals that did not shift culture (reduced RSMR by 1.07 percentage points vs 0.23 percentage points; p=0.03) between 2011–2014 and 2012–2015.ConclusionsInvesting in strategies to foster an organisational culture that supports high performance may help hospitals in their efforts to improve clinical outcomes.

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Does Psychological Safety Impact the Clinical Learning Environment for Resident Physicians? Results From the VA's Learners' Perceptions Survey

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00719.1 ◽

2016 ◽

Vol 8 (5) ◽

pp. 699-707 ◽

Cited By ~ 18

Author(s):

Karina D. Torralba ◽

Lawrence K. Loo ◽

John M. Byrne ◽

Samuel Baz ◽

Grant W. Cannon ◽

...

Keyword(s):

Learning Environment ◽

Response Rate ◽

Learning Experience ◽

Care Facility ◽

Psychological Safety ◽

Teaching Hospitals ◽

Clinical Learning ◽

Resident Satisfaction ◽

Clinical Learning Environment ◽

Resident Physicians

ABSTRACT Background Psychological safety (PS) is the perception that it is safe to take interpersonal risks in the work environment. In teaching hospitals, PS may influence the clinical learning environment for trainees. Objective We assessed whether resident physicians believe they are psychologically safe, and if PS is associated with how they rate satisfaction with their clinical learning experience. Methods Data were extracted from the Learners' Perceptions Survey (LPS) of residents who rotated through a Department of Veterans Affairs health care facility for academic years 2011–2014. Predictors of PS and its association with resident satisfaction were adjusted to account for confounding and response rate biases using generalized linear models. Results The 13 044 respondents who completed the LPS (30% response rate) were comparable to nonpediatric, non–obstetrics-gynecology residents enrolled in US residency programs. Among respondents, 11 599 (89%) agreed that “. . . members of the clinical team of which I was part are able to bring up problems and tough issues.” Residents were more likely to report PS if they were male, were in a less complex clinical facility, in an other medicine or psychiatry specialty, or cared for patients who were aged, had multiple illnesses, or had social supports. Nonpsychiatric residents felt safer when treating patients with no concurrent mental health diagnoses. PS was strongly associated with how residents rated their satisfaction across 4 domains of their clinical learning experience (P < .001). Conclusions PS appears to be an important factor in resident satisfaction across 4 domains that evaluators of graduate medical education programs should consider when assessing clinical learning experiences.

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Psychological Safety and Support: Assessing Resident Perceptions of the Clinical Learning Environment

Journal of Graduate Medical Education ◽

10.4300/jgme-d-18-00286.1 ◽

2018 ◽

Vol 10 (6) ◽

pp. 651-656 ◽

Cited By ~ 3

Author(s):

Nital P. Appelbaum ◽

Sally A. Santen ◽

Brian M. Aboff ◽

Ryan Vega ◽

Jose L. Munoz ◽

...

Keyword(s):

Medical Education ◽

Program Evaluation ◽

Learning Environment ◽

Graduate Medical Education ◽

Organizational Support ◽

Perceived Organizational Support ◽

Psychological Safety ◽

Clinical Learning ◽

Clinical Learning Environment ◽

Graduate Medical

ABSTRACT Background Assessments of the clinical learning environment could allow early interventions to improve graduate medical education. To date, measurement tools for this have not been identified. Objective We established the concurrent validity of 2 instruments that assess cultural facets of the clinical learning environment by correlating them with external program evaluation data. Methods In 2017 we surveyed residents across 19 training programs on their perceptions of organizational support by using the Short Survey of Perceived Organizational Support (SPOS), and psychological safety by using the Psychological Safety Scale (PSS). Data were aggregated to the program level and correlated with results from the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey. Results Of 511 residents, 322 (63%) completed the survey, and 496 of 516 residents (96%) completed the ACGME Resident Survey. Perceived organizational support correlated positively with overall program evaluation score (r = 0.75, P < .001); faculty (r = 0.72, P < .001); evaluation (r = 0.73, P < .001); educational content (r = 0.52, P = .022); and resources domains (r = 0.55, P = .014). Psychological safety had a positive correlation with overall program evaluation (r = 0.57, P = .011); faculty (r = 0.50, P = .028); and evaluation (r = 0.62, P < .005). Conclusions The SPOS and PSS correlated with key ACGME Resident Survey domains. Programs showing greater support of residents were likely to show more positive ratings on program evaluation metrics. Teaching institutions may benefit from actively monitoring and improving aspects of their learning environment through internal assessments.

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