Question
What are the most common barriers to psychological safety in respiratory therapy and healthcare team environments?
Answer
Several factors commonly work against psychological safety in healthcare settings.
Healthcare is structured around clear hierarchies: physicians, nurses, respiratory therapists, dietary staff, environmental services, and so on. These hierarchies affect who feels entitled to speak. In 2008, when I began my career, I did not have the confidence to challenge physicians. By 2021, after working in multiple states and building a reputation, I had more latitude. But that latitude came from privilege accumulated over time, not from a change in the hierarchy itself. Those structures exist whether we acknowledge them or not.
Fear of blame or punishment does not always involve formal disciplinary action. It can be as simple as fearing ridicule, embarrassment, or a tense interaction with a colleague. If someone forgot to document a call-off and is afraid to admit it, the solution is not to hide the mistake. Learning cannot happen in an environment of fear.
Time pressures and high workload are constant barriers. In a fast-moving clinical environment, emotional processing is frequently deprioritized in favor of the next task. That breathing treatment for a patient could have waited a few minutes so we could have done a brief debrief. Short staffing makes everything harder, including creating space for psychological safety. In my career, I have never worked at or consulted for a hospital that did not have open positions.
Bias and discrimination within teams are real barriers. So are cultural norms that discourage vulnerability. Early in my career, I was taught to keep my feelings outside of the patient's room. Over time, I noticed that when I showed authentic emotion, it actually brought me closer to patients and families. Vulnerability in appropriate measure is not a weakness. Saying "I do not know" when you genuinely do not know is a form of professional integrity.
According to the Joint Commission, approximately 70% of medical errors are communication errors. If we create safer spaces for communication, we create safer outcomes for patients.
This Ask the Expert is an edited excerpt from the course, Breathing Easy: Building Psychological Safety for Respiratory Therapists and Healthcare Teams, presented by Gabrielle Davis, MPH, MA, RRT, RRT-ACCS, RRT-NPS, TTS, LPC, NCC, FAARC.
