By Pete Hanlin, ABOM
August 9, 2023
Do you know why staff leave you? It may be because they don’t feel psychologically safe with you. Here’s how to fix that.
Impact of Poor Work Environment
“The Great Resignation” refers to an ongoing trend of workers voluntarily leaving their employment (aka “quitting”).1 It is a global situation many blame on the pandemic, but in reality, the trend was in place prior to 2020- particularly in the healthcare industry (one-in-five healthcare workers quit their jobs in 2020-2021).2,3 Small businesses have been hit especially hard.4
“Poor work environment” is one of the reasons often mentioned by workers who have left their employers, which raises the issue of psychological safety. This term was coined by Dr. Amy Edmondson in 1999 and refers to the ability of workers to feel they can express opinions and be their true selves in their work environment.5 To understand its importance, think about a situation where you feel uncomfortable- perhaps the dentist’s office, at a funeral or visiting your in-laws. Now imagine being in that environment eight hours a day five days a week, and you begin to understand why employees leave workplaces that make them feel uncomfortable!
Since optometric practices are typically small businesses in the healthcare industry, making the practice environment more psychologically safe can go a long way toward reducing staff turnover. A 2017 Gallup poll found environments in which the majority of employees felt psychologically comfortable enjoyed a 27 percent reduction in turnover.6
Components Of Psychological Safety
Just as with physical safety, psychological safety is comprised of several components which affect different individuals to different degrees. For example, high places make me physically uncomfortable, but I am perfectly comfortable in small places. My younger brother (who replaces roofs) is the opposite. Four of the primary components of psychological safety are:
Predictability– Generally, our brain likes predictability because it allows our brains to relax (predictable things require less attention).7 For example, while driving to work you find yourself behind a truck with stickers reading “Vehicle makes sudden and frequent stops,” and “This vehicle makes sudden lane changes.” Chances are you try to move away from that truck! Then you arrive at the office, where you have a co-worker who can be pleasant one day, and irrationally irritable the next (i.e., a co-worker who makes sudden unexpected stops and lane changes). Over weeks and months, the unpredictability of this co-worker becomes increasingly uncomfortable and unavoidable.
Approval– One of the largest studies into human behavior concluded: “At present, it seems fair to conclude that human beings are fundamentally and pervasively motivated by a need to belong.”8 Individuals in situations (work or home) where they feel excluded or a lack of approval score lower on intelligence tests, have behavioral issues and even have reduced immunity (white cell count).9 Feeling “part of the team” is fundamental to feeling a desire to be ON the team! Individuals with a high need for approval are easily spotted- they’re the ones who strive to please, but easily become defensive or disengaged when criticized.
Control– When an individual feels a lack of control over their environment, the results mimic those of clinical depression (sadness, fatigue, ambivalence, sleep disorders).10 Conversely, people who feel “in control” tend become more resilient and have a more positive outlook. For example, patients who control their own pain medication after surgery tend to give themselves less than they would have been given by a practitioner.11 Giving a staff member the authority to act on their own initiative conveys trust, and people feel comfortable in environments where they are trusted.
Equity– Humans inherently desire fairness. We quickly learn to identify unfairness toward ourselves (try giving a 4-year-old the small piece of cake), and by age 8, we typically develop a sensitivity to unfairness toward others.12 Even children recognize a “teacher’s pet,” and a certain level of hostility often results. When we perceive the game as being unfair, we’re more likely to “take our ball and go home.”
For practice owners/managers, creating a “psychologically safe” environment can be tricky because each employee has their own level of sensitivity to each component. For example, John may crave predictability (he probably parks in the same spot in the parking lot, takes his coffee the same way every day, and can be depended on to always follow the protocols), while Debbie may have a low need for predictability (nothing bores her more than being asked to do the same thing the same way every day). Let’s say you decide to move to a new practice management system that changes the way patient data is entered and retrieved- who is more likely to feel stressed out (obviously John)?
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Making Your Practice Psychologically Safe
Fortunately, there are a few steps you can take to make your practice more psychologically safe:
First, “Know Thyself!” It is important to know your own sensitivities to each component of psychological safety because we all suffer from consensus bias (the belief that everyone sees things the way we see them).13 Knowing the things to which you are sensitive (and those which you are not) will help in understanding the other members of your team.
Second, “Know your team!” There are numerous assessments that can be taken to identify areas of psychological sensitivity. One example can be found HERE.
Third, “Identify actionable areas for improvement.” Consider asking each staff member to rank- from one to five (5 being “I completely agree” 1 being “I completely disagree”) each of these statements:14
- On this team, I understand what is expected of me.
- We value patient outcomes more than the volume of output.
- If I make a mistake on this team, it is never held against me.
- When something goes wrong, we work as a team to find the systemic cause.
- All members of this team feel able to bring up problems and tough issues.
- Members of this team never reject others for being different and nobody is left out.
- It is safe for me to take a risk on this team.
- It is easy for me to ask other members of this team for help.
- Nobody on this team would deliberately act in a way that undermines my efforts.
- Working with members of this team, my unique skills and talents are valued and utilized.
Hopefully, you’ll find that many of those statements have an average score of 4 or above. For those that are 3 and below, form teams tasked with working to answer the question, “What do we do to make this a 5?” As a leader, be open to recognizing the opinions of your team and provide the resources (when possible) to enact changes.
Finally, survey the team again every 3-6 months to track how your environment is progressing (or regressing) and continue to work together to create an environment everyone enjoys! People who work in environments that make them feel comfortable tend to stay with the practice (and are actually more productive).
References
1 Lambert, Thomas E. (January 2023). “The Great Resignation: A Study in Labor Market Segmentation”. Forum for Social Economics. doi:10.1080/07360932.2022.2164599
2 Morgan, Kate (August 18, 2022). “Why workers just won’t stop quitting”. BBC Work Life. Retrieved September 19, 2022.
3 Yong, Ed (November 16, 2021). “Why Health-Care Workers Are Quitting in Droves”. The Atlantic. Retrieved January 4, 2022.
4 David, Javier E. (September 3, 2022). “The paradox of entrepreneurship”. Axios. Retrieved September 21, 2022.
5 Edmondson, Amy C. The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. Hoboken, NJ: John Wiley & Sons, 2018.
6 Herway, J. https://www.gallup.com/workplace/236198/create-culture-psychological-safety.aspx, Dec 7, 2017.
7 https://www.quantamagazine.org/to-be-energy-efficient-brains-predict-their-perceptions-20211115/
8 Baumeister, R., Leary, M., The Need to Belong: Desire for Interpersonal Attachments as a Fundamental Human Motivation, Psychological Bulletin, 1995, Vol. 117, No. 3, pp.497-529.
9 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273021/
10 Maier SF, Seligman ME. Learned helplessness at fifty: Insights from neuroscience. Psychol Rev. 2016 Jul;123(4):349-67.
11 Pastino A, Lakra A. Patient Controlled Analgesia. [Updated 2022 Jul 19]. https://www.ncbi.nlm.nih.gov/books/NBK551610/
12 https://www.washingtonpost.com/news/to-your-health/wp/2015/11/19/how-culture-shapes-our-sense-of-fairness-kids-everywhere-cant-stand-getting-less-but-in-some-places-they-dont-like-getting-more/
13 https://www.simplypsychology.org/false-consensus-effect.html
14 https://psychsafety.co.uk/is-your-team-psychologically-safe-the-ten-statement-quiz/
Pete Hanlin, ABOM, is Vice-President of Professional Services at EssilorLuxottica. To contact him: www.linkedin.com/in/pete-
