Episode 11 - Psychological Safety, RN
January 10, 2025
About This Episode
In this episode of Better, RN, hosts Alyssa Saklak and Laurin Masnari welcome Katie Kennon and Kristy Murphy, two nurses on the Patient Safety team at Northwestern Medicine, to talk about the concept of psychological safety and how creating a safe and open culture improves both patient outcomes and healthcare team well-being.
"We're a learning organization. We want to continue to learn after safety events or continue to share the really great evidence-based practice that we're practicing."
Show Notes
Episode Guests
Kristy Murphy, MSN, RN, CPHQ
Katie Keenon, MSN, RN, CPPS, NEA-BC
Katie Kennon and Kristy Murphy are two nurses on the Patient Safety team at Northwestern Medicine.
In this episode of Better, RN, hosts Alyssa Saklak and Laurin Masnari welcome Katie Kennon and Kristy Murphy, two nurses on the Patient Safety team at Northwestern Medicine, to talk about the concept of psychological safety and how creating a safe and open culture improves both patient outcomes and healthcare team well-being.
"We're a learning organization. We want to continue to learn after safety events or continue to share the really great evidence-based practice that we're practicing."
- Kristy Murphy, MSN, RN, CPHQ
Patient Safety Program Manager, Northwestern Medicine
Show Notes
- Psychological safety is a shared belief held by members of a team that they are seen, heard and supported. The Patient Safety team that Kristy and Katie manage works to analyze processes, identify risks and implement systems that support both staff and patient safety. Their goal is to make it easier for healthcare professionals to succeed and minimize preventable harm.
- Northwestern Medicine has embraced a “fair and just culture” that balances accountability with a learning mindset. They say mistakes are opportunities for process improvement rather than a time for finger-pointing or blame. This mindset helps ensure a supportive and transparent environment.
- The Swiss Cheese analogy is one Kristy and Katie often use, which explains how small gaps or failures create holes like Swiss cheese in multiple layers of a process that can align, leading to harm. By addressing systemic vulnerabilities, the team strives to “turn Swiss cheese into American cheese.”
- It is important to note that nurses and clinicians can experience guilt and emotional distress after safety events. Northwestern Medicine offers peer support programs and open dialogue opportunities to help staff process and recover, preventing burnout and attrition.
- The Patient Safety Program has a low number of anonymous reporting, which shows that people feel comfortable disclosing who they are so that they can be a part of the solution. The team celebrates "good catches" and praises individuals who self-report issues, promoting a culture of transparency and shared responsibility.
Episode Guests
Kristy Murphy, MSN, RN, CPHQ
Katie Keenon, MSN, RN, CPPS, NEA-BC
Katie Kennon and Kristy Murphy are two nurses on the Patient Safety team at Northwestern Medicine.
transcript
[00:00:00] Alyssa Saklak: I'm Alyssa Saklak
[00:00:06] Laurin Masnari: and I'm Laurin Masnari
[00:00:08] Alyssa Saklak: on Better, RN, we get real about nursing,
[00:00:11] Laurin Masnari: the good and the gritty.
[00:00:12] Alyssa Saklak: We talk to real healthcare experts
[00:00:15] Laurin Masnari: with the goal of becoming better
[00:00:17] Alyssa Saklak: for our patients, our colleagues,
[00:00:18] Laurin Masnari: our family, our friends,
[00:00:20] Alyssa Saklak: our partners, and ourselves. Hi Lauren.
[00:00:30] Laurin Masnari: Hi, Alyssa. How are you?
[00:00:31] Alyssa Saklak: I'm feeling very psychologically safe and grounded right now.
[00:00:36] Laurin Masnari: I'm always feeling psychologically safe with you. I'm really excited to talk to two nurses on our Patient Safety team at Northwestern Medicine today about psychological safety. And what does that even mean? I feel like it's such a big deal buzzword or it could be such a buzzword, but to me, psychological safety really is feeling supported throughout my career, right? When I'm doing really well or after I've made a mistake, I feel like I will always have someone in my corner regardless of what has happened, whether that's congratulating me or maybe having a difficult conversation, but we have difficult conversations because they're necessary and they make us better. So that's sort of my thoughts on psychological safety. What do you think? What does psychological safety mean to you?
[00:01:23] Alyssa Saklak: I think that it is a culture where you feel safe and comfortable to bring up ideas and topics and conversations and not be judged for those things. I think that I tend to feel very safe here, like raising my hand or asking questions, but that's not always true in some places or some environments where you feel like the idea might be stupid or laughed at or, you know, maybe this isn't an issue. And so I'm curious to learn more from them, how that shows up here at Northwestern Medicine, how that shows up for nurses, patient care techs, our interdisciplinary respiratory therapy, physical therapy, occupational therapy, the list goes on, our physicians. That's a big team to create safety. How do we do it?
[00:02:08] Laurin Masnari: We're constantly trying to improve the quality of the care that we provide, and really the only way that we can make things better is by making sure that there is this culture of openness and a safe dialogue that allows our teams to feel comfortable raising concerns. I have this Post-It on my computer, and it says, “We do the best we can with the info we have.” And that's sort of the mindset that I try to live by in everything that I do, but especially when I'm dealing with potential patient safety issues or opportunities for improvement on my unit specifically. I think there must be something that we can do to make this easier or more efficient or better safer or, you know, some way to improve on an issue, there has to be something that we could do better. So welcome Katie Keenan and Kristy Murphy today, who are two nurses on the Patient Safety team at Northwestern Medicine. We're going to discuss this concept of psychological safety and what does this mean for nursing, how do we prioritize it in our culture.
[00:03:06] Alyssa Saklak: We're excited to have you guys here and learn more about your nursing journey and where you're at right now. So, maybe we start with Kristy. Tell us a little bit about yourself.
[00:03:15] Kristy Murphy: I probably have a little different nursing journey than most of us. I started out in rehabilitation nursing. From there, did a lot of different roles in nursing and then moved actually into Infection Prevention, so over to the Quality side. And that's how I got into the patient safety role at Northwestern Medicine.
[00:03:36] Alyssa Saklak: And then we'll pass it off to Katie so that the listeners can get to know you a little bit better.
[00:03:40] Katie Keenon: So my name's Katie. I've been in health care for about 20 years. I've done everything from being a nurse's aide to being a nurse secretary, LPN. I've worked in nursing home settings and patient settings, and then very naturally went into leadership because I'm always wanting to do a little bit more and also help the patients and also the staff.
[00:04:02] Laurin Masnari: Could you just tell us very briefly for people who aren't familiar, what does the Patient Safety team at Northwestern Medicine do? What does that mean?
[00:04:10] Kristy Murphy: Day-to-day we work very closely with our risk managers, with the leadership, with the staff. We're looking for opportunities. We're always looking at how can we make it easier and safer for the employees, the physicians, to do the right thing and not have to live through a safety event. We're analyzing processes, we're walking alongside staff, asking a lot of questions, and really partnering with everyone to get it better. Katie, what would you add?
[00:04:41] Katie Keenon: Why it's so appealing for us is it's how do we make it easy for the staff, the leaders, and then obviously it's the outcomes for the patients are better, which really means that we're looking at all the things that we do wrong, right? Which is hard for me to explain to the community, but really in the end we know that nothing is perfect, and we're human, we make mistakes, so our job is helping to look at the processes and then put things into place to fix those, which again is awesome because our job has “patient” in it, but really a lot of our focus is the staff. How do we set them up for success? How do we set the leaders up for success? Which is really rewarding because then even though we're not bedside anymore, which is, you know, hard, I miss that part, but at least it's like a big picture, we can make those big improvements. I think that's really huge.
[00:05:25] Kristy Murphy: How do we be more proactive than reactive in health care? It's a mindset, it's a change, it's a challenge for healthcare systems, for all of us, but we, we want to do our best before a safety event.
[00:05:38] Alyssa Saklak: Is it required that every hospital has like a patient safety board or rep and, how does that differ across organizations and maybe what sets our Patient Safety team apart from others?
[00:05:50] Katie Keenon: We are very lucky with Northwestern Medicine that they have been on this journey actually for a very long time. Because there are some regulations, there's some things, but it's the right thing to do. That's why we have it in place, if that makes sense.
[00:06:02] Kristy Murphy: The Joint Commission, if they're an accredited hospital, which Northwestern Medicine is, all of our hospitals, we do follow those standards, and there are some leadership standards that support the safety culture, but our leadership has taken that to a whole different level to support.
[00:06:18] Laurin Masnari: I think the term Patient Safety team could be maybe a little bit misleading or confusing to people who aren't familiar, but we know that patient safety inherently means nurse safety. So this concept of physical safety and things like that, but psychological safety for our team members and for our nurses that work here, what is psychological safety and how does that play into the work that you guys are doing on a day to day?
[00:06:47] Kristy Murphy: Katie and I, when we were prepping for this, we first think we wanted to discuss what is the definition of psychological safety, and it's a shared belief held by members of a team that they are seen, that they're heard, they're supported. You have to have that trust and that appreciation for raising concerns or when there's mistakes that are made. But also we have to acknowledge in health care there are vulnerabilities, that the system is not perfect. And we may be seen like that, that we have this seamless system in health care, but we have to recognize all of those for there to be psychological safety within either our small little unit team, our bedside team, through the department, and then to the organization. And then even now, we see it throughout the system we have to have it. So there's different levels.
[00:07:37] Katie Keenon: Making sure the staff are OK to take care of the patients and, you know, preventing that burnout, having them there, making sure that if they need a break in the break room to collect themselves versus just take that next admit, do the next task.
[00:07:51] Kristy Murphy: Just keep going.
[00:07:53] Katie Keenon: Yes. I think that that has been amazing to see within the last maybe decade or so, and this isn't just nursing, it's also our docs too, like it affects everybody because we have to be able to take care of the patients.
[00:08:07] Kristy Murphy: So one of the principles that Katie is starting to talk about is our fair and just culture that we try to create. There has been a shift in the culture in health care. And this is not just at Northwestern Medicine. It's, nationally, it's changing. And the fair and just really supports that psychological safety. So, it doesn't remove the accountability that you have as a professional licensed nurse or professional doctor. You're still held to those highest standards. But if I make a mistake or if Katie makes a safety event or mistake, we all want to be treated the same way, and we want to have that follow-up that's needed and necessary to do that improvement, which is overall what we say at Northwestern Medicine. We're a learning organization. We want to continue to learn after safety events or continue to share the really great evidence-based practice that we're practicing.
[00:09:01] Laurin Masnari: To me, that's almost, I think that's my personal definition of what psychological safety is. It's whether I am crushing it and I'm winning at everything that I'm doing or I've made a mistake, I'm still gonna have someone in my corner regardless. And I have felt that throughout my career here. I feel that now in my role as a manager with the director that I report report to.
[00:09:23] Alyssa Saklak: I think that there's a lot of stress and pressure being in health care. We know this, right? Like our mistakes and opportunities are a direct impact on patients and human beings. And so, I think that it's almost imperative for environments to move towards this type of culture because of how high stress that is, to ensure that we know, like, you studied, you put in all this work to be where you're at. It's not just you, right? And I think it's the we, and it's the organization, and it’s — to your point — the accountability that oftentimes doesn't always get talked about. The one part that I was talking to Lauren about is like you hear psychological safety, it's kind of a buzzword, but what does that mean for a bedside nurse? What does that mean for a manager? What does it mean for anyone at this organization? I'm curious kind of your perspectives on that.
[00:10:12] Katie Keenon: Again, I would just say it really has to start with that fair and just culture. And it can't just live in the leadership, and it can't just be something that we talk about. You have to truly have people that understand and back to like, what does safety do? What do we do? It's figuring out what happened, more importantly, why it happened, but what are we going to do to fix it? And when people can understand that and then also understand the fair and just culture. And then how do we work through that to look at it objectively? And then we get to, usually, that there's a part of the process that broke down that set Katie up for failure, and then we have to fix that and help Katie be successful, but we also need Katie to be a part of that. It's really about getting people to understand that so they know it's not punitive. Because right, it can feel like we're pointing the finger at people. And we have to get it down all the way to that bedside because to your point, every role has to understand that when things happen, even if they aren't what they should have been, or they don't go as planned, if we don't know about them, we can't fix them. We can't help you. And that's how we have our reporting structure, right? We call it NETS. And if things are not put in, we don't know about them; we can't fix them. But if people feel like they're going to get punished or it's not going to get fixed, they don't have that psychological safety, essentially, then they're not going to put them in, we're not going to fix them. So we even have some metrics in place to kind of monitor that right to know like, is our culture going in the right direction? Is it not? And essentially, that increased NETS is one of those metrics to show us that we have that increase in our psychological safety.
[00:11:46] Kristy Murphy: We see a very low number of anonymous reporting, which I think tags along with what Katie is saying on reporting. We want people to disclose who they are so that they can be a part of the solution.
[00:11:58] Katie Keenon: And then the pressure's on us to fix it, right? Then we need to fix it. We need to make it better. We need to hardwire it. We need to get it back to the front-line staff so they understand that because we also know that if they've identified something, we can't just ignore it, right? It can't be a black hole. We've got to make sure that they're aware of it. Sometimes these things do take time. So I have to say that part of that psychological safety is trust and respect and open communication with them because something might get identified, it might take a few weeks, maybe it takes a few months, because these are big things, but that's a big part where our roles come in too, where we need to make sure that we are good partners with them. We make sure that we're following up with our leaders, with our staff. We're communicating with them.
[00:12:39] Kristy Murphy: I would say one of the things when there's new employees and we do education, a part of our role is a lot of education, but how do we tie in the psychological safety and the culture that we're trying to instill here when you have a new employee or a new physician? So one of the things, and I know Katie does this, I know a lot of my colleagues do this, I know a lot of other leaders do this across Northwestern Medicine, I try to get them to focus instead who did the mistake, try to think about why and how and what. Even from peer to peer on the nursing unit, if a safety event happens, asking those questions, getting your colleague to talk about it. Because right there and then, they're going to start talking about it and learn… Well, the system, the barcode scanner was down, the med wasn't in the right bin. I'm just throwing out there some examples of looking at the system in the process of where those are things then they can connect to and their peers can connect to as they're talking through it and go, wow, it wasn't me, you know, it was the system.
[00:13:39] Katie Keenon: I think it's powerful to share the stories. So that's why we call them “good catch” stories. During Safety Week, we share those stories and we elevate and recognize those people for two reasons. One, because the person that did a great job, they are encouraged to continue doing that. People read this story and they're like, yep, I do that. That's something I should continue doing too. But also maybe somebody reads the story and is like, well, maybe that's not what I do and I should do that. But again, it's back to that psychological safety, too, where people understand that it's free to speak up. I mean, we praise self-reporting all the time. You made a mistake and you were courageous enough to speak up and share it; that is amazing. Because if you didn't, there could have been more harm to that patient, right? It has to come down to your why, and the why always has to be the patient and the care the patient receives, right? That has to be the most important thing. That's why most of us got into health care, and we have to support each other with that. I think a lot of people on the units have their teams, their families, all those kinds of things who they talk to and that's really important so that we can encourage each other to speak up, but then our actions have to align. That's where the fair and just comes into place, right? We can't be punitive and not follow that algorithm and say, well, you know, Kristy, I'm going to punish you today, even though it was a process issue. Because otherwise then we know that we're going to have those problems go underground instead of those things being identified. So that transparency and open communication is really huge for them to feel safe enough to speak up.
[00:15:11] Alyssa Saklak: The one thing that keeps coming to mind is the Swiss cheese model. Is that, is that often, I know we like, giggle about it, but I feel like the first time it was presented to me — and maybe I'll have one of you explain it, ’cause I'm sure you'll do a better job. But when I first heard about it, it was kind of like groundbreaking. Like, oh yeah, there's so much that, like, has to be at play in order for things to go correctly, and we compared the aviation industry of their Swiss cheese model. Maybe talk about that a little bit for the listeners and someone who hasn't heard about, what is a Swiss cheese model?
[00:15:42] Katie Keenon: We use Swiss cheese because it has all the holes. So med pass is not a simple process. There is a ton of pieces to it. So say I get the order for the med; that's maybe the first Swiss cheese slice. Then you get to go get the med; that's the next slice. Then you go to give the med. Then you're, you know, barcode scanning. Like those are all the slices. However, because that's how many steps in the process, all those different holes in the Swiss cheese, there's opportunities for the holes to line up. And then that means that there's that opportunity for that preventable harm to get through to the patient. And that again is where we want to look at it because that's not just me making a mistake; that's partly the process. Like what part of the step in the process do we need to fix to make it easy to do the right thing versus sometimes we make it hard, and we want to make it as easy as possible, right? Because sometimes we make it easy to make those mistakes, um, and we want to essentially close all those holes in the Swiss cheese so it doesn't get through.
[00:16:45] Kristy Murphy: We as Patient Safety managers and leaders start to embrace this thinking about the holes in the Swiss cheese, you're also looking at what is contributing. So there could be the human factors. One of them being that I just worked, you know, three 12s in a row, I picked up another shift, I'm tired, now my phone has been ringing because Radiology needs me to take the patient down, all while I'm doing a med pass. And now I'm about to begin my med pass, and the system isn't supporting me. You know, the drawer in the Omnicell in the, to get the medication, isn't opening, is in the wrong box. Then I go to the bedside to administer it, and now I don't have a barcode scanner that's working. So, we look at it from the human factors, what's contributed, and then what part of the system or the process that’s contributed, and then that's how we put it through. And then with our operational leaders, we work to improve all those or plug the holes in the Swiss cheese and make it an American cheese.
[00:17:44] Laurin Masnari: That’s good, I like that. So, when we're talking about potentially these system failures or these opportunities that we identify for people to potentially easily make a mistake, how does the concept of “second victim syndrome” fit into all of this work that you're doing?
[00:18:05] Kristy Murphy: Second victim is the whole idea of, I'm going to take all the guilt on myself, I'm going to go home. It's going to kind of weigh on me. And then sometimes we see burnout. Sometimes we see people like walk away from the profession altogether. Sometimes we see them make more mistakes because they're distracted, and I don't want that. I know you're an amazing clinician. I know you're awesome. I know you did a great job. This is just something that happened, so I need you to help me, right? I need you to help me make it better. You can take five minutes: You can wallow in it, you can be upset about it, but after that, I need you to help me make it better. Right? So like, just even acknowledging that piece of it, and then we have a ton of great peer programs. So we have our EAP, which is, you know, wellness, that kind of stuff. We have peer to peer, which is great. Because the thing is, we have to have these support systems in place for our staff when these things happen, but then not everybody wants them, right? Or maybe it's a different venue, so they need to have these different ways to speak about it. They need to have different ways to get the support that they need. So even just having like the lunches with your peers, I think is really huge because again, a big part of healing is talking about things and being there for each other. But if you don't talk about it, if you don't acknowledge it, then it will eat away at you.
[00:19:22] Alyssa Saklak: One of the things that Lauren and I were talking about before the show was our transition to practice meetings that we have with new grad nurses with the education coordinator, the manager and the new nurse. And I always start by telling them like, “This is your space to talk about what you're struggling with, what's going well, with no punitive action and nothing but support to say, ‘What is it that you're struggling with? And this is not a reflection of your performance. You know, what, truly what can we support you with?’” Because giving someone the knowledge, skills, and the support system to excel in that has helped them transform and become some of the best caretakers I've seen. But it's not easy when your culture at an institution is one thing, and you're bringing in new people who maybe aren't as familiar with that.
[00:20:06] Kristy Murphy: Taking time to build the relationships with whatever department you're in, they do help, because they help create that safety net psychologically so that if I do make a mistake, I'm comfortable now to share it with my peers, or go and maybe do a cross-check. “Hey, I haven't put in a Foley catheter in a while. Could you come help me?” That doesn't mean that I'm not a good nurse, that I…It just means I haven't done that skill, and I want to keep the patient safe. So, I'm going to pull in my peer. We call them our safety tools, and utilizing those safety tools, allows the nurse to practice at that highest standard.
[00:20:42] Alyssa Saklak: This was such an enlightening conversation, Kristy and Katie. Thank you both so much for shedding some light on the importance of patient safety and really how does that translate to provider and nurse safety and the focus that Northwestern Medicine has on your well-being at work, outside of work, making sure that you feel safe in all aspects.
[00:21:02] Laurin Masnari: So thank you both so much for your time.
[00:21:04] Kristy Murphy: Yeah, thank you.
[00:21:05] Katie Keenon: Thank you.
[00:21:06] Laurin Masnari: Thank you for listening. Please follow us wherever you get your podcasts, and rate and review the show.
[00:21:15] Alyssa Saklak: We'd love to hear your comments and any topics you might want us to explore.
[00:00:06] Laurin Masnari: and I'm Laurin Masnari
[00:00:08] Alyssa Saklak: on Better, RN, we get real about nursing,
[00:00:11] Laurin Masnari: the good and the gritty.
[00:00:12] Alyssa Saklak: We talk to real healthcare experts
[00:00:15] Laurin Masnari: with the goal of becoming better
[00:00:17] Alyssa Saklak: for our patients, our colleagues,
[00:00:18] Laurin Masnari: our family, our friends,
[00:00:20] Alyssa Saklak: our partners, and ourselves. Hi Lauren.
[00:00:30] Laurin Masnari: Hi, Alyssa. How are you?
[00:00:31] Alyssa Saklak: I'm feeling very psychologically safe and grounded right now.
[00:00:36] Laurin Masnari: I'm always feeling psychologically safe with you. I'm really excited to talk to two nurses on our Patient Safety team at Northwestern Medicine today about psychological safety. And what does that even mean? I feel like it's such a big deal buzzword or it could be such a buzzword, but to me, psychological safety really is feeling supported throughout my career, right? When I'm doing really well or after I've made a mistake, I feel like I will always have someone in my corner regardless of what has happened, whether that's congratulating me or maybe having a difficult conversation, but we have difficult conversations because they're necessary and they make us better. So that's sort of my thoughts on psychological safety. What do you think? What does psychological safety mean to you?
[00:01:23] Alyssa Saklak: I think that it is a culture where you feel safe and comfortable to bring up ideas and topics and conversations and not be judged for those things. I think that I tend to feel very safe here, like raising my hand or asking questions, but that's not always true in some places or some environments where you feel like the idea might be stupid or laughed at or, you know, maybe this isn't an issue. And so I'm curious to learn more from them, how that shows up here at Northwestern Medicine, how that shows up for nurses, patient care techs, our interdisciplinary respiratory therapy, physical therapy, occupational therapy, the list goes on, our physicians. That's a big team to create safety. How do we do it?
[00:02:08] Laurin Masnari: We're constantly trying to improve the quality of the care that we provide, and really the only way that we can make things better is by making sure that there is this culture of openness and a safe dialogue that allows our teams to feel comfortable raising concerns. I have this Post-It on my computer, and it says, “We do the best we can with the info we have.” And that's sort of the mindset that I try to live by in everything that I do, but especially when I'm dealing with potential patient safety issues or opportunities for improvement on my unit specifically. I think there must be something that we can do to make this easier or more efficient or better safer or, you know, some way to improve on an issue, there has to be something that we could do better. So welcome Katie Keenan and Kristy Murphy today, who are two nurses on the Patient Safety team at Northwestern Medicine. We're going to discuss this concept of psychological safety and what does this mean for nursing, how do we prioritize it in our culture.
[00:03:06] Alyssa Saklak: We're excited to have you guys here and learn more about your nursing journey and where you're at right now. So, maybe we start with Kristy. Tell us a little bit about yourself.
[00:03:15] Kristy Murphy: I probably have a little different nursing journey than most of us. I started out in rehabilitation nursing. From there, did a lot of different roles in nursing and then moved actually into Infection Prevention, so over to the Quality side. And that's how I got into the patient safety role at Northwestern Medicine.
[00:03:36] Alyssa Saklak: And then we'll pass it off to Katie so that the listeners can get to know you a little bit better.
[00:03:40] Katie Keenon: So my name's Katie. I've been in health care for about 20 years. I've done everything from being a nurse's aide to being a nurse secretary, LPN. I've worked in nursing home settings and patient settings, and then very naturally went into leadership because I'm always wanting to do a little bit more and also help the patients and also the staff.
[00:04:02] Laurin Masnari: Could you just tell us very briefly for people who aren't familiar, what does the Patient Safety team at Northwestern Medicine do? What does that mean?
[00:04:10] Kristy Murphy: Day-to-day we work very closely with our risk managers, with the leadership, with the staff. We're looking for opportunities. We're always looking at how can we make it easier and safer for the employees, the physicians, to do the right thing and not have to live through a safety event. We're analyzing processes, we're walking alongside staff, asking a lot of questions, and really partnering with everyone to get it better. Katie, what would you add?
[00:04:41] Katie Keenon: Why it's so appealing for us is it's how do we make it easy for the staff, the leaders, and then obviously it's the outcomes for the patients are better, which really means that we're looking at all the things that we do wrong, right? Which is hard for me to explain to the community, but really in the end we know that nothing is perfect, and we're human, we make mistakes, so our job is helping to look at the processes and then put things into place to fix those, which again is awesome because our job has “patient” in it, but really a lot of our focus is the staff. How do we set them up for success? How do we set the leaders up for success? Which is really rewarding because then even though we're not bedside anymore, which is, you know, hard, I miss that part, but at least it's like a big picture, we can make those big improvements. I think that's really huge.
[00:05:25] Kristy Murphy: How do we be more proactive than reactive in health care? It's a mindset, it's a change, it's a challenge for healthcare systems, for all of us, but we, we want to do our best before a safety event.
[00:05:38] Alyssa Saklak: Is it required that every hospital has like a patient safety board or rep and, how does that differ across organizations and maybe what sets our Patient Safety team apart from others?
[00:05:50] Katie Keenon: We are very lucky with Northwestern Medicine that they have been on this journey actually for a very long time. Because there are some regulations, there's some things, but it's the right thing to do. That's why we have it in place, if that makes sense.
[00:06:02] Kristy Murphy: The Joint Commission, if they're an accredited hospital, which Northwestern Medicine is, all of our hospitals, we do follow those standards, and there are some leadership standards that support the safety culture, but our leadership has taken that to a whole different level to support.
[00:06:18] Laurin Masnari: I think the term Patient Safety team could be maybe a little bit misleading or confusing to people who aren't familiar, but we know that patient safety inherently means nurse safety. So this concept of physical safety and things like that, but psychological safety for our team members and for our nurses that work here, what is psychological safety and how does that play into the work that you guys are doing on a day to day?
[00:06:47] Kristy Murphy: Katie and I, when we were prepping for this, we first think we wanted to discuss what is the definition of psychological safety, and it's a shared belief held by members of a team that they are seen, that they're heard, they're supported. You have to have that trust and that appreciation for raising concerns or when there's mistakes that are made. But also we have to acknowledge in health care there are vulnerabilities, that the system is not perfect. And we may be seen like that, that we have this seamless system in health care, but we have to recognize all of those for there to be psychological safety within either our small little unit team, our bedside team, through the department, and then to the organization. And then even now, we see it throughout the system we have to have it. So there's different levels.
[00:07:37] Katie Keenon: Making sure the staff are OK to take care of the patients and, you know, preventing that burnout, having them there, making sure that if they need a break in the break room to collect themselves versus just take that next admit, do the next task.
[00:07:51] Kristy Murphy: Just keep going.
[00:07:53] Katie Keenon: Yes. I think that that has been amazing to see within the last maybe decade or so, and this isn't just nursing, it's also our docs too, like it affects everybody because we have to be able to take care of the patients.
[00:08:07] Kristy Murphy: So one of the principles that Katie is starting to talk about is our fair and just culture that we try to create. There has been a shift in the culture in health care. And this is not just at Northwestern Medicine. It's, nationally, it's changing. And the fair and just really supports that psychological safety. So, it doesn't remove the accountability that you have as a professional licensed nurse or professional doctor. You're still held to those highest standards. But if I make a mistake or if Katie makes a safety event or mistake, we all want to be treated the same way, and we want to have that follow-up that's needed and necessary to do that improvement, which is overall what we say at Northwestern Medicine. We're a learning organization. We want to continue to learn after safety events or continue to share the really great evidence-based practice that we're practicing.
[00:09:01] Laurin Masnari: To me, that's almost, I think that's my personal definition of what psychological safety is. It's whether I am crushing it and I'm winning at everything that I'm doing or I've made a mistake, I'm still gonna have someone in my corner regardless. And I have felt that throughout my career here. I feel that now in my role as a manager with the director that I report report to.
[00:09:23] Alyssa Saklak: I think that there's a lot of stress and pressure being in health care. We know this, right? Like our mistakes and opportunities are a direct impact on patients and human beings. And so, I think that it's almost imperative for environments to move towards this type of culture because of how high stress that is, to ensure that we know, like, you studied, you put in all this work to be where you're at. It's not just you, right? And I think it's the we, and it's the organization, and it’s — to your point — the accountability that oftentimes doesn't always get talked about. The one part that I was talking to Lauren about is like you hear psychological safety, it's kind of a buzzword, but what does that mean for a bedside nurse? What does that mean for a manager? What does it mean for anyone at this organization? I'm curious kind of your perspectives on that.
[00:10:12] Katie Keenon: Again, I would just say it really has to start with that fair and just culture. And it can't just live in the leadership, and it can't just be something that we talk about. You have to truly have people that understand and back to like, what does safety do? What do we do? It's figuring out what happened, more importantly, why it happened, but what are we going to do to fix it? And when people can understand that and then also understand the fair and just culture. And then how do we work through that to look at it objectively? And then we get to, usually, that there's a part of the process that broke down that set Katie up for failure, and then we have to fix that and help Katie be successful, but we also need Katie to be a part of that. It's really about getting people to understand that so they know it's not punitive. Because right, it can feel like we're pointing the finger at people. And we have to get it down all the way to that bedside because to your point, every role has to understand that when things happen, even if they aren't what they should have been, or they don't go as planned, if we don't know about them, we can't fix them. We can't help you. And that's how we have our reporting structure, right? We call it NETS. And if things are not put in, we don't know about them; we can't fix them. But if people feel like they're going to get punished or it's not going to get fixed, they don't have that psychological safety, essentially, then they're not going to put them in, we're not going to fix them. So we even have some metrics in place to kind of monitor that right to know like, is our culture going in the right direction? Is it not? And essentially, that increased NETS is one of those metrics to show us that we have that increase in our psychological safety.
[00:11:46] Kristy Murphy: We see a very low number of anonymous reporting, which I think tags along with what Katie is saying on reporting. We want people to disclose who they are so that they can be a part of the solution.
[00:11:58] Katie Keenon: And then the pressure's on us to fix it, right? Then we need to fix it. We need to make it better. We need to hardwire it. We need to get it back to the front-line staff so they understand that because we also know that if they've identified something, we can't just ignore it, right? It can't be a black hole. We've got to make sure that they're aware of it. Sometimes these things do take time. So I have to say that part of that psychological safety is trust and respect and open communication with them because something might get identified, it might take a few weeks, maybe it takes a few months, because these are big things, but that's a big part where our roles come in too, where we need to make sure that we are good partners with them. We make sure that we're following up with our leaders, with our staff. We're communicating with them.
[00:12:39] Kristy Murphy: I would say one of the things when there's new employees and we do education, a part of our role is a lot of education, but how do we tie in the psychological safety and the culture that we're trying to instill here when you have a new employee or a new physician? So one of the things, and I know Katie does this, I know a lot of my colleagues do this, I know a lot of other leaders do this across Northwestern Medicine, I try to get them to focus instead who did the mistake, try to think about why and how and what. Even from peer to peer on the nursing unit, if a safety event happens, asking those questions, getting your colleague to talk about it. Because right there and then, they're going to start talking about it and learn… Well, the system, the barcode scanner was down, the med wasn't in the right bin. I'm just throwing out there some examples of looking at the system in the process of where those are things then they can connect to and their peers can connect to as they're talking through it and go, wow, it wasn't me, you know, it was the system.
[00:13:39] Katie Keenon: I think it's powerful to share the stories. So that's why we call them “good catch” stories. During Safety Week, we share those stories and we elevate and recognize those people for two reasons. One, because the person that did a great job, they are encouraged to continue doing that. People read this story and they're like, yep, I do that. That's something I should continue doing too. But also maybe somebody reads the story and is like, well, maybe that's not what I do and I should do that. But again, it's back to that psychological safety, too, where people understand that it's free to speak up. I mean, we praise self-reporting all the time. You made a mistake and you were courageous enough to speak up and share it; that is amazing. Because if you didn't, there could have been more harm to that patient, right? It has to come down to your why, and the why always has to be the patient and the care the patient receives, right? That has to be the most important thing. That's why most of us got into health care, and we have to support each other with that. I think a lot of people on the units have their teams, their families, all those kinds of things who they talk to and that's really important so that we can encourage each other to speak up, but then our actions have to align. That's where the fair and just comes into place, right? We can't be punitive and not follow that algorithm and say, well, you know, Kristy, I'm going to punish you today, even though it was a process issue. Because otherwise then we know that we're going to have those problems go underground instead of those things being identified. So that transparency and open communication is really huge for them to feel safe enough to speak up.
[00:15:11] Alyssa Saklak: The one thing that keeps coming to mind is the Swiss cheese model. Is that, is that often, I know we like, giggle about it, but I feel like the first time it was presented to me — and maybe I'll have one of you explain it, ’cause I'm sure you'll do a better job. But when I first heard about it, it was kind of like groundbreaking. Like, oh yeah, there's so much that, like, has to be at play in order for things to go correctly, and we compared the aviation industry of their Swiss cheese model. Maybe talk about that a little bit for the listeners and someone who hasn't heard about, what is a Swiss cheese model?
[00:15:42] Katie Keenon: We use Swiss cheese because it has all the holes. So med pass is not a simple process. There is a ton of pieces to it. So say I get the order for the med; that's maybe the first Swiss cheese slice. Then you get to go get the med; that's the next slice. Then you go to give the med. Then you're, you know, barcode scanning. Like those are all the slices. However, because that's how many steps in the process, all those different holes in the Swiss cheese, there's opportunities for the holes to line up. And then that means that there's that opportunity for that preventable harm to get through to the patient. And that again is where we want to look at it because that's not just me making a mistake; that's partly the process. Like what part of the step in the process do we need to fix to make it easy to do the right thing versus sometimes we make it hard, and we want to make it as easy as possible, right? Because sometimes we make it easy to make those mistakes, um, and we want to essentially close all those holes in the Swiss cheese so it doesn't get through.
[00:16:45] Kristy Murphy: We as Patient Safety managers and leaders start to embrace this thinking about the holes in the Swiss cheese, you're also looking at what is contributing. So there could be the human factors. One of them being that I just worked, you know, three 12s in a row, I picked up another shift, I'm tired, now my phone has been ringing because Radiology needs me to take the patient down, all while I'm doing a med pass. And now I'm about to begin my med pass, and the system isn't supporting me. You know, the drawer in the Omnicell in the, to get the medication, isn't opening, is in the wrong box. Then I go to the bedside to administer it, and now I don't have a barcode scanner that's working. So, we look at it from the human factors, what's contributed, and then what part of the system or the process that’s contributed, and then that's how we put it through. And then with our operational leaders, we work to improve all those or plug the holes in the Swiss cheese and make it an American cheese.
[00:17:44] Laurin Masnari: That’s good, I like that. So, when we're talking about potentially these system failures or these opportunities that we identify for people to potentially easily make a mistake, how does the concept of “second victim syndrome” fit into all of this work that you're doing?
[00:18:05] Kristy Murphy: Second victim is the whole idea of, I'm going to take all the guilt on myself, I'm going to go home. It's going to kind of weigh on me. And then sometimes we see burnout. Sometimes we see people like walk away from the profession altogether. Sometimes we see them make more mistakes because they're distracted, and I don't want that. I know you're an amazing clinician. I know you're awesome. I know you did a great job. This is just something that happened, so I need you to help me, right? I need you to help me make it better. You can take five minutes: You can wallow in it, you can be upset about it, but after that, I need you to help me make it better. Right? So like, just even acknowledging that piece of it, and then we have a ton of great peer programs. So we have our EAP, which is, you know, wellness, that kind of stuff. We have peer to peer, which is great. Because the thing is, we have to have these support systems in place for our staff when these things happen, but then not everybody wants them, right? Or maybe it's a different venue, so they need to have these different ways to speak about it. They need to have different ways to get the support that they need. So even just having like the lunches with your peers, I think is really huge because again, a big part of healing is talking about things and being there for each other. But if you don't talk about it, if you don't acknowledge it, then it will eat away at you.
[00:19:22] Alyssa Saklak: One of the things that Lauren and I were talking about before the show was our transition to practice meetings that we have with new grad nurses with the education coordinator, the manager and the new nurse. And I always start by telling them like, “This is your space to talk about what you're struggling with, what's going well, with no punitive action and nothing but support to say, ‘What is it that you're struggling with? And this is not a reflection of your performance. You know, what, truly what can we support you with?’” Because giving someone the knowledge, skills, and the support system to excel in that has helped them transform and become some of the best caretakers I've seen. But it's not easy when your culture at an institution is one thing, and you're bringing in new people who maybe aren't as familiar with that.
[00:20:06] Kristy Murphy: Taking time to build the relationships with whatever department you're in, they do help, because they help create that safety net psychologically so that if I do make a mistake, I'm comfortable now to share it with my peers, or go and maybe do a cross-check. “Hey, I haven't put in a Foley catheter in a while. Could you come help me?” That doesn't mean that I'm not a good nurse, that I…It just means I haven't done that skill, and I want to keep the patient safe. So, I'm going to pull in my peer. We call them our safety tools, and utilizing those safety tools, allows the nurse to practice at that highest standard.
[00:20:42] Alyssa Saklak: This was such an enlightening conversation, Kristy and Katie. Thank you both so much for shedding some light on the importance of patient safety and really how does that translate to provider and nurse safety and the focus that Northwestern Medicine has on your well-being at work, outside of work, making sure that you feel safe in all aspects.
[00:21:02] Laurin Masnari: So thank you both so much for your time.
[00:21:04] Kristy Murphy: Yeah, thank you.
[00:21:05] Katie Keenon: Thank you.
[00:21:06] Laurin Masnari: Thank you for listening. Please follow us wherever you get your podcasts, and rate and review the show.
[00:21:15] Alyssa Saklak: We'd love to hear your comments and any topics you might want us to explore.