Abstract
BackgroundSimulation facilitators strive to ensure the psychological safety of participants during simulation events; however, we have limited understanding of how antecedent levels of psychological safety impact the simulation experience or how the simulation experience impacts real-world psychological safety.MethodsWe explored the experience of participants in an embedded, interprofessional simulation program at a large tertiary emergency department (ED) in Australia. We engaged in theoretical thematic analysis of sequential narrative surveys and semi-structured interviews using a previously derived framework of enablers of psychological safety in healthcare. We sought to understand (1) how real-world psychological safety impacts the simulation experience and (2) how the simulation experience influences real-world psychological safety.ResultsWe received 74 narrative responses and conducted 19 interviews. Simulation experience was both influenced by and impacted psychological safety experienced at the individual, team, and organizational levels of ED practice. Most strikingly, simulation seemed to be an incubator of team familiarity with direct impact on real-world practice. We present a model of the bidirectional impact of psychological safety and simulation within healthcare environments.ConclusionOur model represents both opportunity and risk for facilitators and organizations engaging in simulation. It should inform objectives, design, delivery, debriefing, and faculty development and firmly support the situation of simulation programs within the broader cultural ethos and goals of the departments and organizations.
Highlights
Discourse related to psychological safety within the simulation community has centred on how facilitators can create a “safe container” for participants, but this narrow emphasis limits the potential power of a critical teamwork concept [1]
Psychological safety is directly linked to real-world team performance through the impact of interpersonal risk taking on speaking up behaviors, teamwork behaviors, and team learning [2, 6]
This was part of a larger study related to psychological safety in the emergency department (ED), and it was approved by the Gold Coast Hospital and Health Service Research Ethics Committee (HREC/2020/QGC/60733)
Summary
Discourse related to psychological safety within the simulation community has centred on how facilitators can create a “safe container” for participants, but this narrow emphasis limits the potential power of a critical teamwork concept [1]. Simulation facilitators have diligently focused on fostering psychologically safe learning environments. (2022) 7:5 the concept of psychological safety originates and extends well beyond the walls of the simulation space. Psychological safety is directly linked to real-world team performance through the impact of interpersonal risk taking on speaking up behaviors, teamwork behaviors, and team learning [2, 6]. To have the most impact as a community of practice, it is time to link our understanding of psychological safety with real-world team performance rather than limit it to the simulation session in front of us. Simulation facilitators strive to ensure the psychological safety of participants during simulation events; we have limited understanding of how antecedent levels of psychological safety impact the simulation experience or how the simulation experience impacts real-world psychological safety
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