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A psychologically safe environment for healthcare teams is desirable for optimal team performance, team member well-being, and favorable patient safety outcomes. This piece explores facilitators of and barriers to psychological safety across healthcare settings. Future research directions examining psychological safety in healthcare are discussed.

Bacon CT, McCoy TP, Henshaw DS. J Nurs Adm. 2021;51(1) :12-18.
Lack of communication and interpersonal dynamics can contribute to failure to rescue. This study surveyed 262 surgical staff about perceived safety climate, but the authors did not find an association between organizational safety culture and failure to rescue or inpatient mortality.  
JN Learning. 2020.
Disruptive behavior is a recognized deterrent to safe communication, sharing of concerns and teamwork. This educational program highlights a study that measured the impact of unprofessional physician behavior on patient care and features Dr. William Cooper and Dr. Gerald Hickson as speakers.
A woman with acute myeloid leukemia presented to the emergency department (ED) with shortness of breath after receiving chemotherapy. As laboratory test results showed acute kidney injury and suggested tumor lysis syndrome, the patient was started on emergent hemodialysis. She experienced worsening dyspnea and was emergently intubated and transferred to the intensive care unit. There, her blood pressure began to drop, and she died despite aggressive measures.
Jones M, Scarduzio J, Mathews E, et al. Qual Health Res. 2019;29:1096-1108.
Simulation has been adopted as a valuable teaching tool in health care. In this study, researchers used relational dialectic theory and simulation to better understand the impact of interprofessional communication challenges on both team-based and individual disclosure of error.
Wright B, Faulkner N, Bragge P, et al. Diagnosis (Berl). 2019;6:325-334.
The hectic pace of emergency care detracts from reliability. This review examined the literature on evidence, practice, and patient perspectives regarding diagnostic error in the emergency room. A WebM&M commentary discussed an incident involving a diagnostic delay in the emergency department.
Krumwiede KH, Wagner JM, Kirk LM, et al. J Am Geriatr Soc. 2019;67:1273-1277.
Open disclosure of errors and adverse events is increasingly encouraged in health care. Researchers describe the development and impact of an educational program using simulation to promote learning regarding team-based error disclosure among medical students.
Kaur AP, Levinson AT, Monteiro JFG, et al. J Crit Care. 2019;52:16-21.
The second victim effect has been used to describe the emotional impact that providers may experience when involved in a medical error, adverse event, or unanticipated patient outcome. In this survey study, researchers found that members of a critical care society frequently admitted to experiencing negative emotions such as blame and guilt when responding to questions involving scenarios of different types of errors. Nearly 70% of respondents suggested that team debriefings and talking with colleagues could help mitigate the second victim effect.
Verna R, Velazquez AB, Laposata M. Ann Lab Med. 2019;39:121-124.
Teamwork in health care has been embraced as a key element of patient safety. This review highlights the value of creating diagnostic management teams tasked with selecting laboratory tests and interpreting test results to improve diagnostic safety. The authors highlight the potential to apply this strategy to health systems worldwide to enhance communication, efficiency, and accuracy.
An elderly man with a complicated medical history slipped on a rug at home, fell, and injured his hip. Emergency department evaluation and imaging revealed no head injury and a left intertrochanteric hip fracture. Although he was admitted to the orthopedic surgery service, with surgery to fix the fracture initially scheduled for the next day, the operation was delayed by 3 days due to several emergent trauma cases and lack of surgeon availability. He ultimately underwent surgery and was discharged a few days later but was readmitted several weeks later with chest pain and shortness of breath.
Meyer AND, Singh H. JAMA. 2019;321:737-738.
Safe diagnosis is a complex challenge that requires multidisciplinary approaches to achieve lasting improvement. Effective feedback is a primary component of individual, team, and organizational learning. This commentary describes how creating pathways within an organization that enable physicians to provide and receive feedback about diagnostic performance can limit overdiagnosis and overuse.
Barr D, Epps QJ. J Thromb Thrombolysis. 2019;47:146-154.
Anticoagulants are commonly prescribed medications that have high potential for harm if administered incorrectly. This review summarizes common errors at the prescribing, dispensing, and administration phases of direct oral anticoagulant therapy. The authors suggest team-based strategies—such as process assessment, policy development, and medication reconciliation—to prevent adverse drug events associated with direct oral anticoagulants.
Duffy JR, Culp S, Padrutt T. J Nurs Adm. 2018;48:361-367.
Prior research has shown that missed nursing care may in part result from reduced nurse staffing and is associated with adverse outcomes for patients. Using survey data from a sample of nurses at a single community hospital, researchers found that reduced nurse staffing, lower job satisfaction, and decreased satisfaction with teamwork were important factors related to missed nursing care.
Scott IA, Campbell DA. Med J Aust. 2018;208:196-197.
Leaders in the effort to improve diagnosis have heralded diagnosis as a team activity. This commentary suggests that specialists are more vulnerable to anchoring bias and more siloed approaches to problem solving than their generalist colleagues when faced with complex diagnostic problems. The authors recommend that specialists hone their generalist skills, seek multidisciplinary consultation, and focus on patient-centered rather than disease-centered care to ensure a wide range of considerations are explored to avoid diagnostic error.
Taylor JR, Thompson PJ, Genzen JR, et al. Lab Med. 2017;48:97-103.
Diagnostic error represents a significant source of patient harm. In this study, researchers surveyed physicians to understand how to improve the involvement of laboratory professionals in assisting with diagnostic challenges. They conclude that there may be a greater role for laboratory professionals in the diagnostic process beyond providing test results.
Admitted to the intensive care unit (ICU) with acute respiratory distress syndrome due to severe pancreatitis, an older woman had a central line placed. Despite maximal treatment, the patient experienced a cardiac arrest and was resuscitated. The intensivist was also actively managing numerous other ICU patients and lacked time to consider why the patient's condition had worsened.
McCulloch P, Morgan L, New S, et al. Ann Surg. 2015;265.
Safety culture and work systems influence safety, but it is unclear whether safety improvement efforts should focus on one or both factors. This study sought to improve adherence to the WHO surgical safety checklist and to enhance technical and nontechnical team performance using several safety interventions. One intervention focused on improving safety culture, while another was directed at the work system. Investigators also tested a combined approach. Although both team training and system redesign individually demonstrated improvement, the combined approach was more successful than either individual approach. This finding suggests that in order to truly enhance surgical safety, organizations must invest in both systems and culture interventions.
Hautz WE, Kämmer JE, Schauber SK, et al. JAMA. 2015;313:303-4.
This simulation study found that diagnostic performance by fourth-year medical students improved when they worked in pairs compared to when they worked individually. The authors suggest that working collaboratively allowed students to avoid cognitive biases that can impede timely and correct diagnosis. These results emphasize the importance of real-time feedback in the diagnostic process.