Creating safer spaces and stronger teams

JillNews

The VCH Medical Staff Equity, Diversity and Inclusion Committee has been presenting special events in recognition of International Women’s Day since 2019. This year’s theme was Safer Spaces, Stronger Teams with several guest speakers and panelists as well as opportunities to discuss specific scenarios in breakout groups. The evening was dedicated to the memory of Dr. Lynn Straatman, who was instrumental in establishing the committee and was fiercely dedicated to gender equity.

The evening was the brainchild of Dr. Jen Buck (NP), the regional department head for nurse practitioners and associate physicians director. She spoke of having identified as a feminist since she was a child and talked of how she aims to live the ideals of equity both personally and professionally. She noted that the goal of the session was to address a complicated issue in an engaging and positive manner.

Dr. Buck’s co-host for the evening was Dr. Kevin Shi, co-department head of Emergency Medicine at Richmond Hospital. The event was designed to provide techniques to use in difficult conversations, with the panelists providing insights on how they work to create safer spaces for their teams.

The impact of respectful behaviour on performance and patient safety

Interim Regional Medical Director, Wellness, Dr. Fahreen Dossa presented data that are a compelling invitation to action and change. She noted that workplace disrespect is undermining our health-care performance and patient safety:

  • 75 per cent of health-care staff experience disrespectful behaviour
  • 33 per cent of adverse events are associated with environments where disrespectful behaviour is prevalent
  • 35 per cent of medical errors correlate with the breakdown in communication tied to disrespectful behaviour
  • 25 per cent of patient safety compromises are linked to disrespectful workplace interactions
  • 12 per cent of patient mortality cases are connected to systemic issues driven by disrespectful behaviour

Dr. Dossa emphasized that even mild disrespectful behaviour causes significant declines in team performance, diagnostic accuracy, and intervention quality across all care settings. Disrespect also destroys cognitive performance and team collaboration.

Women health-care workers face a disproportionate impact:

  • 64 per cent of studies show higher workplace violence prevalence for women
  • Women experience significantly more verbal abuse, sexual harassment, and bullying
  • Female nurses are particularly vulnerable to workplace violence
  • Women report higher rates of burnout and altered career goals due to violence

Organizational level interventions significantly outperform individual resilience training in reducing burnout and improving safety outcomes. These include:

  • Reduce workload – decrease administrative burden, optimize scheduling, ensure adequate breaks and staffing ratios
  • Increase job control – provide worker autonomy, flexible arrangements, meaningful input into decisions affecting work
  • Balanced care models – balance worker well-being with patient needs, human-centred leadership, psychological safety

Dr. Dossa outlined actions to build safer spaces:

  • Step 1: implement monitoring – track absenteeism, turnover, satisfaction, and leadership accountability
  • Step 2: set KPIs – establish burnout-related performance indicators for senior leaders
  • Step 3: train leaders – build manager capacity to identify and mitigate disrespectful behaviour effectively
  • Step 4: foster safety – create peer support, open forums, adequate staffing, and flexible scheduling

Metaphors and mnemonics to support diverse, compassionate teams

UBC’s Faculty of Medicine Office of Respectful Environments, Equity, Diversity & Inclusion Associate Director Dr. Mai Yasue (PhD) provided tools to help medical staff feel more confident and emotionally grounded when navigating complex scenarios. She defined what feelings are and recommended Marc Brackett’s mood meter, a tool to build greater emotional awareness.

Dr. Yasue also reviewed the iceberg metaphor, where what we can see is based on information available to us rather than what’s below the waterline—or not visible or obvious. She noted that our lens also impacts what we see, particularly in difficult situations. Power dynamics, social context, current events, past traumas, different histories, cultural norms, family situations, and previous meetings can all influence how we react.

She then referenced Dan Siegel’s concept of the Window of Tolerance—the optimal range of emotional arousal within which people can function effectively, feel safe, and manage stress without becoming overwhelmed. When within this window, people are present, regulated, and able to process emotions. Outside this zone, individuals enter hyperarousal (anxiety, rage, panic) or hypoarousal (numbness, freezing, depression).

Dr. Yasue talked about basic psychological needs (agency, belonging, and competence) and how these impact autonomous motivation and lead to improved well-being, flourishing pro-social behaviour, and caring for others.

The O’DEAR framework for difficult conversations is another tool Dr. Yasue finds helpful. This is a communication device that can be used as a de-escalation strategy. The five steps are:

  1. Open (ask or state your desire to speak with the person and provide a general idea of the topic)
  2. Describe (describe the person’s behaviour (what they said or did) specifically, neutrally and objectively)
  3. Explain (explain the impact this had on you or your work)
  4. Ask (ask the other person to clarify their perspective on the situation or incident)
  5. Request (request that an alternative behaviour or approach be used in the future)

The 5 Ds upstander strategy was also mentioned: Directly intervene; Distract; Delegate; Document; and Delay.

Small group discussions

Participants attended breakout sessions to discuss assigned scenarios that described examples of sexism, racism, discrimination, misgendering, bullying, and harassment. A facilitator was provided for each group and tip sheets suggested for guiding responses. After these sessions, there was an opportunity for all participants to reflect on the discussions.

Panel discussion

Co-Department Head, Emergency Medicine, Richmond Hospital, Dr. Barinder (Bindi) Brar and Associate Head, Department of Medicine, VGH, Dr Iain McCormick were the evening’s panelists.

Dr. Brar’s colleague Dr. Shi began by recounting Dr. Brar’s attendance at an international conference session on how to have a successful career in emergency medicine. She asked the all-male panel if they believed being male helped their career. Dr. Shi asked her how she found the courage to ask the question. Dr. Brar responded that her question came from a place of curiosity, and she genuinely wondered if the panelists felt that it was their talent or the system that allowed for their success. The question generated a fulsome discussion and Dr. Brar noted that there were women on every panel at the following year’s conference.

Dr. Buck introduced Dr. McCormick, noting that his department has a great reputation and that people want to work there. She asked him what he brings to work and how he creates a safe space. Dr. MacCormick responded by saying he can’t take the credit and that the department’s culture has evolved over the years. He noted that complex cases benefit from multiple perspectives and that bringing everyone together can help determine what is happening with a patient. An atmosphere where you are afraid to speak up isn’t functional when deep communication is needed, he said. Dr. McCormick recognized that we all bring our gender and cultural backgrounds to our work and that these are essential contributions. Everyone has blind spots but the path to move forward is open.

Both panelists were asked if there was anything they would like to share with other leaders.

Dr. MacCormick responded that he finds when people use professional jargon their speech can be stiff and difficult to remember. He counsels people to use plainer language to reach a deeper understanding. Dr. Brar recommended encouraging physicians early in their careers to apply for leadership positions in order to have more well-rounded conversations. She suggested identifying who is coming up the pipeline who could help transform your department, hospital, or system.

Dr. Brar and Dr. McCormick were asked if they had any advice on how to convince hiring committees that diversity must be a priority. They agreed that by this stage it’s too late—we need to work on who is applying and why it’s so limited. We need to identify the up and comers and develop those with an affinity for leadership.

Session references and resources