Psychological Safety in Aged Care


Boards + Psychological Safety

Boards should be diligent in measuring, monitoring, and reporting on the psychological safety of their clinical teams due to its significant impact on patient outcomes, staff well-being, and overall organisational performance. Psychological safety refers to an environment in which individuals feel safe to speak up, share ideas, and express concerns without fear of retribution or negative consequences. When clinical teams feel psychologically safe, they are more likely to engage in open communication, collaborate effectively, and proactively identify and address potential errors or system failures.


Research has demonstrated the importance of psychological safety in healthcare settings. A study by Mira et al. (2019) found that higher levels of psychological safety were associated with lower rates of medication errors, reduced staff burnout, and increased patient satisfaction. Similarly, a systematic review by Chan et al. (2021) indicated that psychological safety positively influenced team performance, learning, and patient safety.

By measuring and monitoring the psychological safety of clinical teams, boards can identify potential areas for improvement and implement targeted interventions to foster a supportive culture. Regular reporting on psychological safety metrics enables boards to track progress, identify trends, and ensure that efforts to enhance psychological safety are effective and sustainable.

Aged Care in Crisis

In February 2023,  the Productivity Commission released findings into Aged Care and NDIS support which was quite alarming.

More than 37,800 “serious incident notifications” and more than 10,300 complaints, were received by the Aged Care Quality and Safety Commission during last financial year, according to data published in a report by the Productivity Commission assessing the efficiency and effectiveness of key government services.

In 2021-22 only 62 per cent of residential aged care sites nationally achieved the benchmark for personal and clinical care, 68 per cent for organisational governance, 70 per cent for human resources and 86 per cent for consumer dignity and choice.

Whilst these are reported numbers, these numbers likely reflect a “sanitised” and filtered reporting of actual events. Leaders may not report for reasons such as the overwhelm of paperwork, the response from governance boards, the threat of action from government, or they see it as a reflection of themselves and their team as opposed to a learning and improvement framework.

If our teams feel like they will be punished, penalised or humiliated then they will have a bias to under-report where and when they can.  It is a critical that we address cultures in aged care where reporting of incidents is a place of learning and improvement and not just compliance.

When staff feel unsafe and are acting continually in a way that is dissonant with how they wish to see themselves, they eventually leave. Some leave the organisation, but many will leave the industry as the cultures are barely surviving rather than thriving.


Staff in crisis

One of the biggest issues in the delivery of care is the lack and often stretched staff resources.  Whilst many industries were managing a 7.5% turnover of staff in 2021,  Aged Care was experiencing attrition of approximately 35%.

According to the latest Aged Care Census 2023, staff churn rates of up to 40% are being experienced in a workforce that is aging. 

Whilst many site burnout, poor pay, and overwhelming paper work, in many cases these factors are exacerbated by poor culture, poor staff support and poor leadership. 

When staff leave psychosocial hazards are increased for both teams and consumers – putting everyone at risk.

Measure Psychological Safety

Prioritising psychological safety aligns with the principles of high-reliability organisations (HROs) in healthcare. HROs place emphasis on fostering a culture of trust, open communication, and psychological safety to reduce errors and promote resilience. By focusing on psychological safety, boards can contribute to creating a culture of safety and continuous learning within their organisations.

Boards should be diligent in measuring, monitoring, and reporting on the psychological safety of clinical teams due to its profound impact on patient outcomes, staff well-being, and organisational performance. But also in terms of mitigating their own personal and organisational liability. 

 The establishment of psychological safety contributes to a culture of trust, open communication, and continuous improvement, leading to enhanced patient safety and overall healthcare quality.

“Psychological Safety is critical if we wish to deliver quality consumer care. My concern is that our boards are exposed to greater risk than ever before because tehy are not measuring, monitoring and reporting on psychological safety of our clincial teams. This means that when they review an incident reprot – they are only seeing a bite size of the incidences – that is very large gap”.  Carolyn Grant

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Psychological Safety Assessments