Psychological safety: an overlooked factor in clinician burnout and moral injury in health care


I remember when I first decided to step away from medicine. While I wasn’t burned out like some of my colleagues whom I would later coach, I did have what I now understand to be compassion fatigue. It was a familiar feeling I had felt before, and I knew that if I continued down the path, it would take me right back to the night I almost ended my life.

Called by many names, burnout and moral injury among physicians and providers of health care continue to be a problem that is continuing to affect the health and well-being of our colleagues. It has led to masses of physicians leaving medicine or transitioning to non-clinical careers. While working with organizations and speaking with many of my colleagues over the years, one thing is clear. Safety is an issue, particularly psychological safety. Psychological safety, a term popularized by Harvard Business School professor Amy Edmondson, refers to an environment where individuals feel safe to voice their thoughts, concerns, and even mistakes without the fear of retribution or humiliation. In such a setting, people can express themselves authentically, fostering trust and open communication. While it’s not unique to health care, the experience of feeling psychologically unsafe contributes to burnout, disengagement, and compromised mental well-being, especially in historically marginalized physicians. However, the culture of medicine, in general, has not been great at making it a safe place to be human for any physician.

When I was in residency suffering from what I now know as functional depression, I was afraid that if I shared my struggle with attendings or even the residency psychologist, I might be penalized and labeled as “not being mentally fit” to practice. It was something I saw happen to a resident one year behind me that same year. Seeing that led to a sense of isolation, and that led me to almost end my life. Fortunately, I felt at least safe enough to reach out to two classmates. Some of my colleagues have not been so fortunate to feel they had that option and have since left this world. I didn’t have the language for what I was experiencing then, but now I know that even though I was not being overtly mistreated, I didn’t feel a sense of safety enough to reach out for assistance when I was struggling with my mental health.

Why we need to start talking about psychological safety in health care

For our mental health. While there are obviously many factors that play a part in mental well-being, being in an unsafe environment mentally, emotionally, or physically causes trauma over time. When we are repeatedly subjected to subtle acts of aggression, exclusion, or insults by our colleagues or patients, it can wear on us like the constant ache of a repeatedly stubbed toe.

To foster inclusion and belonging. Inclusion is not really inclusion if the people who are being “included” don’t feel they belong. Inclusion is not the same as tokenizing either. Inclusion is saying, “We want you here because you are a valuable part of our team … because your contributions are valued … because we value where you’ve been and your lived experience”. Furthermore, it is crucial to recognize the significance of psychological safety for historically marginalized physicians, as the lack of safety disproportionately impacts them. When physicians of all identities can bring their whole selves, it leads to a collaborative and healthy environment where physicians can contribute at their highest level.

To empower our voices in leadership. Physicians have the potential to bring diverse perspectives to areas that are beyond the exam room. I recently spoke with a female physician of color who shared that she stepped down from her leadership position because any contribution she made was either dismissed or completely ignored. When there is safety for doctors of all identities to bring their ingenuity to leadership spaces, without the experience of being dismissed or invalidated, doctors can and will contribute meaningfully and innovatively to the discussions that impact the future of health care.

To prevent harmful silence. Discrimination, harassment, and “not so micro” aggressions can take a severe toll on mental well-being, especially in historically marginalized populations. Because one of the aspects of a psychologically safe environment is making it safe to challenge (safe to name, report, call out injustice), it brings accountability to unacceptable behavior by encouraging doctors and other healthcare providers to report such incidents, preventing harmful silence that leads to burnout and mental health decline, ultimately fostering a more respectful workplace.

Psychological safety is not just a buzzword; it is an imperative. Centering psychological safety not only protects the mental well-being of physicians and health care providers (especially in historically marginalized communities), but also contributes significantly to our fulfillment, longevity, and leadership potential in medicine. By creating an environment where physicians can be their authentic selves, voice their concerns, challenge unacceptable behaviors, and thrive, organizations not only cultivate a more diverse and inclusive health care workforce but also provide better and more equitable and cost-effective care for patients.

Maiysha Clairborne is an integrative family physician and is the co-author of Conscious Anti-Racism: Tools for Self-Discovery, Accountability and Meaningful Change.






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