By: Brittany Prevost (@BrittP_27)
Like most people in the early spring, I busied myself refreshing newsfeeds and following the active developments of the COVID-19 pandemic as it infiltrated Canadian communities, and subsequently Canadian hospitals. Well into my third year of anesthesiology residency training, I was nearly finished a stretch of “off-service” rotations and looked forward to my return to the operating room. However, near the end of March my inbox lit up with a message I had been anticipating – direction from my program that, rather than assigned anesthesiology curriculum, I would be redeployed to intensive care for the foreseeable future.
Redeployment of anesthesiology residents to ICU is a logical arrangement. First, we have applicable skills and knowledge, well versed in much of the medicine related to critical care including respiratory failure, sedation management, and resuscitation. Second, we were suddenly an available resource, given operating rooms were limiting bookings to emergent and urgent cases. And, full disclosure, I enjoy working in the ICU, so I was ready to lend my hands.
My next inbox notification was a welcome note from the physician coordinating ICU residents at that site. Their email was concise and included the following:
- An acknowledgement of the unprecedented situation we were all facing.
- Clear description of how daytime physician staffing would be altered to help us physically distance, and to give us each an additional day or two off for rest and self-care.
- Encouragement to contact him personally about anything, including questions or concerns.
- Appreciation for our help in the weeks ahead.
For two months I was a member of an incredible multidisciplinary intensive care team caring for critically ill patients, some of whom had COVID-19. Redeployed residents joined redeployed nurses and other patient care staff moved to share the coming load. The gears of the hospital rearranged in an effort to acclimate to a new normal. Despite the daily reality of possible exposure to a novel pathogen, I felt safe among this team. Physically safe, as I was fortunate to have sufficient personal protective equipment and guidance to use it properly. But more than that, I felt a sense of belonging – immediately welcomed, and supported by other team members. Perhaps most notable is that I sensed this camaraderie from my first shift. Until the first wave of the COVID-19 pandemic reached Toronto, I never actively considered how we should orient residents at the start of a rotation, particularly “off-service” residents joining from other disciplines.
Think about the last time you joined a new team, new rotation, new project. What happened? How soon did you get a vibe from the group? How did you decide if it was safe to voice opinions or ask questions? Have orientations been different in COVID-19 Era? Should we do them differently moving forward?
Business management scholars have studied onboarding and how new employees become integrated into workplaces. They refer this process as organizational socialization and have identified that these initial interactions can affect future employee productivity, job satisfaction, and turnover rates (1). During the process of onboarding and introductions, employees seek to develop the attitudes, behaviours, and knowledge they require to become active team members. New employees also establish early whether they perceive psychological safety in their work environment (2). The psychologically safe workplace allows employees to take risks – learning, providing feedback, or voicing questions – without fear of judgement or retribution (3). It is part of the secret sauce of high functioning teams and essential for successful teamwork in volatile, uncertain, complex, or ambiguous conditions. Leaders set the tone when they demonstrate values in line with psychological safety. Today’s leaders should model vulnerability, be clear about limitations, and actively welcome feedback from all group members.
Reflecting on my spring redeployment, the educational coordinator eased my apprehension and fostered a sense of belonging in their initial email. I greatly appreciated candid acknowledgement of the fear and uncertainty we were all feeling, clarity that personal safety and wellness were being prioritized, simply outlined expectations, and encouragement to contact them at any time. I found myself following their lead, trying to model these behaviours as I reached out to residents joining our team in my second month working in the unit. It turns out, psychological safety – like COVID – is contagious. (5)
As a medical community we are left pondering some hard questions…why does a moment when psychological safety was deliberately fostered stand out so vivdly in my training? Why is this not always the norm? What are the barriers to psychological safety in our learning and working environments? How instead might we enhance, celebrate, and foster nodes of psychological safety in our community? How do we spread the contagion?
Urgent answers to these questions are more relevant than ever, as growing COVID-19 hospitalizations will necessitate further staff redeployments in the weeks and months ahead. So, my challenge to clinical leaders and senior trainees is to be very deliberate in how you reach out to the “off-service” staff tapped to join your ranks. Like the first wave, these times are full of uncertainty, and your new members deserve to be joining a team ready to support them, available to listen, and motivated to work together.
About the author: Brittany Prevost is a fourth-year anesthesiology resident at the University of Toronto. She is currently completing a Master’s in Medical Education. She was redeployed to work in the ICU during the spring wave of COVID in Toronto ON, Canada.
References:
- Bauer TN, Bodner T, Erdogan B, Truxillo DM, Tucker JS. Newcomer Adjustment During Organizational Socialization: A Meta-Analytic Review of Antecedents, Outcomes, and Methods. J Appl Psychol. 2007; 92(3):707–21.
- Mornata C, Cassar I. The role of insiders and organizational support in the learning process of newcomers during organizational socialization. J Work Learn. 2018; 30(7):562–75.
- Edmondson AC, Lei Z. Psychological Safety: The History, Renaissance, and Future of an Interpersonal Construct. Annu Rev Organ Psych. 2014; 1(1):23–43.
- Edmondson, A. C. and Chamorro-Premuzic, T. Today’s Leaders Need Vulnerability, not Bravado. HBR. Oct 2020. Available from: https://hbr.org/2020/10/todays-leaders-need-vulnerability-not-bravado
- Soares, A. E., & Lopes, M. P. (2014). Social networks and psychological safety: A model of contagion. Journal of Industrial Engineering and Management (JIEM), 7(5), 995-1012.
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