In this episode of Healthcare Americana, host Christopher Habig explores the world of mental health and workplace dynamics with Tom Geraghty, Founder & CEO of PsychSafety.com. Exploring the vital concept of psychological safety, they discuss its profound impact on organizational culture and its potential to empower teams across diverse industries, drawing parallels from aviation, manufacturing, and healthcare. Tom’s journey from ecology to technology leadership shapes his deep understanding of creating environments where teams can thrive, providing unique insights and strategies applicable to any workplace setting. Discover how fostering psychological safety transforms workplaces and facilitates open communication, essential for preventing errors and fostering innovation.
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[INTRODUCTION]
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[EPISODE]
[00:00:38] Christopher Habig (CH): Welcome to Healthcare Americana, coming to you from the FreedomDoc Studios. I am your host Christopher Habig, CEO and Co-Founder of Freedom Healthworks. This is a podcast for the 99% of people who get care in America and a little extra global flavor today. We talk to innovative clinicians, policymakers, patients, caregivers, executives, and advocates who are fed up with the status quo and have a desire to change it. We take you behind the scenes with people across America and the world that are putting patients first and restoring trust in American and global healthcare.
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One of my favorite topics on this show and in my professional life, especially in the concierge and direct primary care space is talking about mental health and how we can really empower our primary care physicians to serve mental health needs for the vast majority of their patients. I always view mental health as being on a spectrum zero. You’re the happiest. You’re on cloud nine. There’s no worries in the world. 100, let’s say you’re a danger to society, and it’s a really sad case that you just cannot function out there on your own.
Primary care can do so much for so many people on that type of a spectrum. Yet we don’t even look at that as a solution to all the access problems which we have in America and really across the world. But then we say mental health and that it’s such a broad category of health needs, conditions, ideas, really. Then where do we access these type of resources? What actually helps? What can we do ourselves? Where do we need external health? It’s a massive, massive subject out there.
For today’s episode, we’re absolutely going to be hitting that one. Please welcome Tom Geraghty, Founder of PsychSafety.com. Tom, welcome to Healthcare Americana. It is a pleasure to have you.
[00:03:05] Tom Geraghty (TG): Thank you so much. It’s a pleasure to be here. I really appreciate it.
[00:03:08] CH: Now, many people would realize that during my introduction, I put a little international spin on this one. So you’re coming down to us from Nottingham, England, a beautiful area that is on my bucket list to visit. I haven’t been there. Stuck to mostly the London area, fortunately or unfortunately, depending on what you feel about that one.
But you’re coming to us here across the pond. What I love about it is that when we talk about mental health and, in your case, psychological safety, it’s something that citizens across the globe are impacted by. With that understanding, I want to talk about just a little bit of nomenclature, vocabulary definitions. PsychSafety.com, what does that mean to you about this topic of psychological safety?
[00:03:58] TG: Yes, great. Thanks. Yes, yes. Psychological safety has kind of been a term that’s, well, actually first emerged in the literature in the 1960s. But it only really came to prominence really in the sort of past 10, 20 years. It’s defined by a few people, but it’s defined by Amy Edmondson in her book, The Fearless Organization, as a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes. It’s essentially a belief that the group you’re in is safe for interpersonal risk-taking, that you can take interpersonal risks in that group, say things and ask things without fear of some sort of negative consequence. That’s what psychological safety is.
[00:04:44] CH: Now, somebody might be hearing that and saying, “Well, why the hell is Chris talking about mental health all the way up and down this episode here?” To me, a lot of those things are very much linked. You’re talking about stressors. You’re talking about anxieties. It’s this fear of screwing up and then just being completely chastised, canceled, if you will, for all the Zoomers out there. As a millennial, I can now call other people Zoomers, so there we go. That’s fair.
But so much we see toxic work environments where people are scared to death to speak up, to put new ideas out there, to make a mistake. In my mind, as a business owner, I’m like, “God, I can’t believe that. That’s such an antiquated school of thought but, obviously, a very real problem in organizations across the world.”
[00:05:29] TG: Yes, yes, yes. Exactly. This is the crucial point, particularly in healthcare. We have the – so people are always going to make mistakes. It’s human nature to make mistakes. We’re not going to perfectly execute the thing every time. Even the most expert people and the most – in the field that they’re most expert in are every now and then going to slip up and do something imperfectly.
It particularly applies in healthcare where in different contexts, in different environments, there’s a lot of pressure. There’s a lot of noise going on. There’s other demands on your attention, on your time, other competing priorities. We need to recognize that everyone’s going to make mistakes. So creating an environment where we can admit those mistakes is really important, primarily so that we can address those mistakes.
We see in healthcare and in other domains such as nuclear power and aviation and technology, if someone makes a mistake and because they’re afraid of the consequences of even talking about it or suggesting that they made it, they – and we might hope that it’s not going to turn into anything big, right? We might – it was a small mistake. Hopefully, it won’t have a big impact. No one will notice. But then, of course, maybe it does. There’s a bad patient outcome as a result. We need to get in front of those mistakes that we make as early as possible. That means we’ve got to be able to talk about them.
That also means that we can put in practices and procedures and things to prevent them happening in the future. Otherwise, we’re going to make the same mistakes over and over again, right?
[00:07:00] CH: I love the reference to aviation industry. We hear this a lot because so many healthcare problems from a patient care standpoint, accidents, really caregiver error, are relatively preventable from bacterial infections to the worst-case scenario. You leave a tool or a sponge in someone’s body. The aviation industry in the US, we haven’t had a major airline fatality in like three decades.
I was trying to pull up the UK aviation industries and couldn’t exactly find the numbers I was looking for. But in Western developed countries, like every single accident is investigated. If you take a small airplane and you run it off the runway and there’s damage to the plane, the National Transportation Safety Board is going to come. The FAA is going to come and say, “All right, what happened here? Was this anything mechanical?” If it was mechanical, then guess what. Manufacturer’s on it. They’re issuing updates and notices to everybody owning that one, so they can fix it and be aware of it going forward.
It doesn’t exist in healthcare, and I’m just like, “Oh, my gosh. So many of these things are human error, as with everything; car wrecks, airplane wrecks, accidents.” But there is just – it’s like a level of accountability that just does not exist in my mind. Going back to your point, I think people across organizations are just – they’re afraid to say, “Ooh, yes. That was my bad. I screwed up,” especially in life and death circumstances.
[00:08:28] TG: Exactly that. Exactly that. You’re absolutely right. The aviation has proven itself to be so much safer through the implementation of something called cockpit resource management or crew resource management as it’s now called. This is – it’s the singularly most effective safety program that’s ever been implemented globally. That’s partly because it has been adopted globally by essentially every airline, every flight crew. There’s loads of elements to this, but a significant element to CRM is sort of flattening the hierarchy, flattening the paradynamics between members of the crew. This is to some degree being adopted in healthcare, in certain aspects of healthcare and in certain teams.
But you were talking about like leaving a tool in a patient on an operating table. You can imagine in some environments with some surgeons, there might be a nurse or an anesthetist sitting there. The surgeon’s in charge. The surgeon’s top of the pile. Maybe the surgeon’s got decades of experience, and they don’t want to speak up to the surgeon. They don’t want to challenge the surgeon’s power, but they’ve noticed that they’ve done something wrong. That takes a great deal of courage and psychological safety to speak up. They might not even be sure that the surgeon’s done something wrong, but they think they saw something. They think they saw a mistake. Do they speak up? Do they not? Do they own on the side of silence?
In CRM, in aviation, they’re very much trained to speak up, despite those paradynamics and encourage. Indeed, the people with the power are encouraged to make sure that people feel safe to speak up. When they do so, they’re praised and thanked for doing so.
[00:10:10] CH: I was going to say it really starts to the top. That’s a leadership quality of, “You go sit in the corner. Take directions.” Or, “Hey, I need your input because you’re very much a part of this team, just like everybody else is here.” I would say in a hospital, when you have a reporting incident, there’s probably more red tape and paper to fill out than there is during aviation accidents and most times like the minor stuff. I’m like this is nuts.
It’s only like this feedback loop is purposely so convoluted where even if I wanted to speak up and felt comfortable with it because there’s a patient life in the balance, I’m not even sure what to do, where to go. So how does your organization come in to reform that thinking?
[00:10:49] TG: That’s the big question, really. I think it comes down to many, many things. It might be easier to think about it, in one sense, you’ve got systemic challenges to speaking up. That might be incentives, structures, frameworks, laws even. On the other side, you’ve got individual behaviors or group behaviors and interactions and practices.
For example, if we’re in an operating theater and we might not even be involved. We might just be observers. If we see someone else speak up but then get punished for doing so or embarrassed for doing so or humiliated for doing so, next time the opportunity comes or the need comes for me to speak up, I’m going to be thinking, “Oh, that’s not a safe thing for me to do.” There’s that modeling and the demonstration of interpersonal safety.
But there’s also the systemic and wider frameworky stuff, where there’s a good example of this back in the UK health system. There was a case a little while back. A doctor was treating a patient, and loads of other stuff went wrong in the ward. People have turned up late. Someone else didn’t turn up. There were unplanned things going on. It was all chaotic. Unfortunately, this resulted in someone missing what they should have spotted and a child dying of sepsis.
Now, what happened after that was that the doctor in a sort of reflective session, trying to work in a session designed to learn lessons from that where doctors would encourage to be as open as possible, in that session later on, it turned out those notes that were made in that session were used against this doctor to prosecute her, which of course, then has the net effect, the outcome effect of dissuading other people in the organization when they see that sort of thing happening, dissuading people from talking about and admitting and being candid about the mistakes and things that they did when something goes wrong.
[00:12:50] CH: Their words of being helpful are used against them. This is where you just point the fingers to the lawyers.
[00:12:58] TG: Yes, you could. You could, yes.
[00:13:00] CH: Here you go, guys. Here, we’re trying to figure out. Go through here and suffer. There’s a terrible tragedy that goes on. Instead of helping fix things, so this thing never happens again, it’s almost like an old Soviet Union mentality of you’re going to shoot the messenger.
[00:13:18] TG: This is a very good point because if you look at some of the contributing factors to the Chernobyl disaster, which was in the Soviet Union at the time, many of the contributing factors to that disaster were the fact that people didn’t feel safe to speak up, challenge authority, ask questions, suggest a different way of doing things. Everyone had to wait for the boss to give the say-so or to give a command before they were ready to act. That resulted in the disaster itself and far more people dying than needed to. So, yes, those sort of cultures not only create more mistakes and more incidents, but they worsen the impact of them as well.
[00:13:58] CH: Brilliant HBO documentary. Or I don’t even know if it’s a documentary, but brilliant HBO series about that that understands it. I was left. I’m like, “Okay. So all these people are supposed to be Russian and Soviets, yet everybody has British accents. What is going on here?” Once you get past that, it is an absolutely brilliant, brilliant show with amazing actors telling a fascinating story. I remember one of the last episodes. They boiled or they broke nuclear fusion down into just very simplistic terms. I was like, “Wow, that was the best explanation of anything I’ve ever seen, let alone like actual nuclear science, absolutely brilliant.”
Tom, I want to kind of pick your brain on this a little bit. Let’s approach it from a listener standpoint who’s listening and saying, “Hey, this applies to me. I am that. I want to help. I can help more, but I’m afraid to speak up. I’m afraid to do it.” How do I impact change in my company as somebody who is not necessarily in a leadership standpoint?
[00:15:01] TG: Yes. For people actually in practice at the front line, at the sharp end of work, we do have to recognize that some people have more power than others. That power might be actual power like hierarchy and having control over other people’s roles, responsibilities, salaries, and things like that. Or it might be simply tenure. You might have been – someone might have been with the organization a long time. Or there might be other aspects of power involved.
We can only use the power that we’ve got, but we can use whatever power we’ve got. That can be – we can make use of that through modeling psychologically safe behaviors, asking questions, suggesting ideas, challenging ways of working in your team if necessary, where it’s constructive and useful to do so. But I would say step one is talk about psychological safety. Make psychological safety a safe thing to talk about. That will start the ball rolling.
Other people then might get on board and understand what you’re trying to do here. You might be able to form a bit of a community around the idea, bringing some extra practices. Of course, you can try and influence up. If you are at the top, then the things that you do will have so much broader and wider impact. But everyone’s got a role to play, for sure.
[00:16:22] CH: It seemed to be like it’d be an overall positive for any organization. Tom, we’re going to take a quick commercial break. We hear back from our fantastic sponsors. Then afterwards, we’re going to dive into a little bit more about the man behind the microphone here and figure out your journey into getting into this point right now.
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Now, back to our regularly scheduled programming. Here we go. It’s always fun when I start to get tongue-tied. We’re talking with Tom Geraghty, the Founder of PsychSafety.com. Tom, with the first half of this episode, we talked a lot about how mental health plays in workplaces and how people feel empowered about the workplaces and ultimately got to the point where it’s like how do you recreate change in your workplace if you’re saying, “Wow, I can do so much more.”? Or if you’re a leader that says, “I think my people are terrified of me, and I don’t like that feeling going to work every single day because it’s hard to get answers and questions. How do we innovate, and how do we move forward together as a team when everybody’s terrified to even speak up?”
A lot of different things they could do from a cultural standpoint. But I’m curious from your stand point, your journey getting here. Tell us a little bit about your background and your credentials and really what makes it when you walk into a boardroom to say, “Here’s what we need to do, guys.” Why people are listening to you.
[00:18:43] TG: Well, good question. Good question. My background is somewhat varied. My first degree was in ecology. My first job was in ecological research. Then I moved from that into technology and became sort of through – moved up through the hierarchies and ended up managing teams, managing engineering teams, software development teams, became CIO and CTO of various different firms, including small hyperscaling startups to big global financial enterprises and things.
Through that journey, I became really passionate about creating high-performing teams, and more specifically, creating the conditions in which teams can thrive. What are the foundations? What are the principles underlying high-performing teams? Through that work, I find it really fascinating. At some point through that journey, I think around 2015, I came across the term psychological safety when I watched a TED Talk by Amy Edmondson. That was the moment where it really felt like the light bulb lit up above my head. I thought this is what I’ve been trying to do. This is the stuff I’ve been trying to create. I just didn’t have a name for it yet. I just didn’t know. I didn’t have a hook to hanger on.
That was when I began to really espouse the idea of like psychological safety, what it was, and how we could do it. I started up a blog. I started doing talks. Now, I’m a full-time psychological safety geek. I also have an MBA, and I’m working towards a master’s degree in public health, in fact. When I’m working with management teams, board rooms, and execs, and people on the ground, operations teams and people at the front line, what makes my job interesting and what means we can help people improve is that I work and we work with loads of different domains. We work with teams in healthcare. We work with teams in manufacturing. We work with teams in aviation and technology and everywhere else.
Because we can take the best practices and what people are doing in aviation and transfer that to healthcare, we can learn lessons from manufacturing and look at the Toyota production system and the Andon Cord and implement that in healthcare teams. That’s super, super powerful, and it’s super interesting, just from my perspective.
[00:21:08] CH: I think it’s important to make that distinction that when I say, “Hey, what do you tell boardrooms when you walk into,” this is not a topic that is just meant for the largest of corporations out there, largest of hospitals out there. This is something that every single step along the chain of command or even the chain of communication, which in my mind, the chain of communication is completely different from the chain of command.
But every single step along the journey there, this is important for them. How are you empowering the people around you to communicate freely, positively, respectfully, I think, a lot of times with one another and with you so that you can all move forward? So at the entry level, this is a topic that is insanely valuable. At the very top and every single step along the way is very, very relevant to them. We work with physicians a lot of time in solo or small group offices. We see this where the front office person is the first and last person that a patient will interact with, and that’s usually the person that they’ll key in on their experience.
But a lot of time, physicians are just not necessarily discarding that person, but they’re not spending enough time managing that front office person who’s probably lower paid. It’s an entry-level job in most places, but that chain of communication is just almost non-existent in the patient setting and really the patient feedback setting because you have to have trust. In my mind, without that, without a physician saying this is the way that this office runs and empowering that front office person to be able to identify problems and process improvements, the whole thing just craters. My point is it doesn’t matter how big or small the organization is. Without these principles in place, they don’t have a shot.
[00:22:52] TG: Yes. Yes, yes, exactly. Once of the things I like to say about psychological safety and, in fact, this isn’t just me. This is Amy Edmondson and many other people. Psychological safety, particularly for people in charge, for people in leadership roles or management roles, is so much about getting comfortable being uncomfortable, getting comfortable being challenged, empowering people and encouraging people to challenge you, to raise concerns, to challenge the way you’ve done things, to suggest different ways of doing things. Raise ideas and admit mistakes as well.
Through the 20th century, through any different industries to different degrees, the whole – a lot of the management paradigm is the bus is in charge. Don’t challenge the boss. The boss has all the answers and don’t raise the concerns and don’t challenge them. But if you can create an environment where you welcome challenge, you welcome feedback, you welcome bad news even. The bad news already exists, so you want to find out about it. It’s better to hear it than not hear it.
But so often, when people give us bad news, we – it’s very infective, very, very difficult to not give sort of unconscious signals that we don’t want to hear it to roll our eyes, slump our shoulders, sigh or something like that. Instead if we can respond productively, positively to hearing that and saying, “Okay, right. We’re going to do something about this. Thank you for telling me.” My point is it’s hard. It’s hard for everyone, and it’s probably even harder for managers who are used to not being challenged.
[00:24:23] CH: They just don’t know how to cope. They don’t know what to do, right? There’s personalities that go into it, too. So there are so many modern-day tools where I can take. I’m like, “Hey, Tom. Give me two minutes of your time. I can get a personality profile on you that just spells it out.” In a management situation, if Chris is managing Tom or Tom is managing Chris, here’s how you need to communicate with one another.
Those tools are so widely available. We use them all the time. It makes life just so much easier because in this day of digital communication, someone’s going to look at an email. I could send the same email to 10 different people and have 10 different emotional reactions to it. There’s no human – you can’t look at my face and how I’m reacting to this kind of stuff. Am I smiling? Am I crying? Am I pissed off when I’m writing it? I just don’t know.
You look at some of these tools that are available out there from personality standpoint, and they’re like, “Oh. Well, this is how Chris communicates. This is a normal run-of-the-mill thing. He’s not mad or whatever all the way through.” But people just kind of default to their entry setting, and it’s just like, “Oh, okay. I’m going to throw my hands up and get pissed or whatever it is without taking a step.” Take a pause. Take a beat. Look at this and say, “Great. How does somebody communicate within this, and then how do I make sure that I am eliciting the best possible feedback for him as I possibly can?”
Tom, I’m going to give you one last question here, my friend. Say that you are the Billboard King of the UK. You’ve got all the billboards under your control. You got time to put a message up there for somebody going by at 120 km an hour. What do you say on there so that they can understand it and digest it and not crash?
[00:25:59] TG: One of my favorite sayings, in fact, we have stickers that say this as well, is everything is an experiment. Absolutely everything we do is an experiment. The point of that is that we should learn. We do learn from everything we do, whether it’s a mistake, whether it’s a failure, or whether it’s a success. The outcome of work should be learning how to do it better next time, not just succeeding in the thing we’re doing. It’s only by learning how to do it better next time that we’ll improve, and then we’ll get, and we’ll continuously improve.
Change the framing of work into experiments, into opportunities to learn. It doesn’t mean we’re going to tolerate failure any more than we did before. We still want to aim high and strive for the best outcome possible. But we accept that we’re not going to get it right every time. Sometimes, things do go wrong. But if we learn from that, whether it succeeded or whether it failed, then we’re setting ourselves up to maximize the learning, maximize the opportunity for improvement for next time we do it.
[00:27:04] CH: Tom Geraghty, Founder of PsychSafety.com. Tom, I wish you all the best, and thanks for taking time with us with the time zone change and joining us here on Healthcare Americana.
[00:27:15] TG: Thank you. Thank you very much. I loved it.
[00:27:17] CH: That’s going to do it for this episode of Healthcare Americana. If you haven’t yet, be sure to subscribe to the show on your favorite podcast platform. Check us out online, healthcareamericana.com to catch previous episodes. Subscribe to our mailing list and visit our online store. Once again, I am your host, Christopher Habig. Thanks for listening.
[OUTRO]
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[00:28:37] Christopher Habig: Hi, again, everyone. This is Chris. On Healthcare Americana, we’re always on the lookout for great stories to tell in the healthcare industry. We’d like to hear yours. Check out healthcareamericana.com, and send us your ideas for episodes or if you’d like to be a guest. Thanks again for listening. Hope you enjoy it.
[END]