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Join Maiysha Clairborne, an integrative family physician and co-author of Conscious Anti-Racism: Tools for Self-Discovery, Accountability and Meaningful Change. Maiysha shares her personal journey through compassion fatigue and functional depression within the medical field, shedding light on the importance of psychological safety in health care. Together, we delve into the intersectionality of psychological safety and marginalized identities in medicine, discussing barriers to seeking help, fostering genuine inclusion, and empowering diverse voices in leadership.

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

She discusses the KevinMD article, “Psychological safety: an overlooked factor in clinician burnout and moral injury in health care.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Maiysha Clairborne. She is an integrative family medicine physician, co-author of the book Conscious Anti-Racism: Tools for Self-Discovery, Accountability and Meaningful Change. Today’s KevinMD article is “Psychological safety: an overlooked factor in clinician burnout and moral injury in health care.” Maiysha, welcome back to the show.

Maiysha Clairborne: Kevin, it’s always a pleasure to be here with you. Thank you for having me again.

Kevin Pho: So Maiysha has been on the show multiple times. Go to KevinMD.com/podcast to hear her story and prior episodes. But today let’s jump right into your most recent one, about psychological safety. For those who didn’t get a chance to read it, tell us what it’s about.

Maiysha Clairborne: Well, I think that it’s important for us to have this conversation about psychological safety. And what I talk about is, I start with my own experience, and how we are not a culture that’s actually built for expression, built for safety. We’re a culture that actually has historically been very unsafe as health care professionals, as physicians particularly, to be in.

And so I start in the article just recounting my own experience in residency, even back before psychological safety was really a thing that’s being talked about. And what I talked about was how I now, looking back, realize that I suffered from functional depression as a resident. And we didn’t talk about that kind of thing. And even culturally speaking, in the Black community, it’s still stigmatized and we don’t talk a lot about it. So I was suffering in silence, and at the time I didn’t realize how many of my colleagues were also suffering in silence.

But what happened in residency is that there was a colleague of mine who was a year behind me, and he was filling out his application for licensure, and he disclosed his mental health challenges, his depression, and for that he was sidelined. And having watched that, it communicated, without them having to say anything, it communicated to me that what I was dealing with, I was not safe to disclose, or else, guess what, I would be sidelined too.

And so that led me down this path, which fortunately, I’m here today, but led me down this path to where I became suicidal.

And so I think that with what’s going on, especially post-COVID right now, it is imperative that we begin to address how our institutions, how our organizations, how our hospitals and health care systems create psychological safety for health care workers, in light of everything that we’re dealing with.

Kevin Pho: So when you said that your colleague was sidelined by the medical institution, what exactly does that mean?

Maiysha Clairborne: Well, what that means is, despite having had the depression back in medical school, despite having taken all the measures, doing therapy, despite having been cleared, he was taken off of the clinical schedule, his license was deferred for a period of time, he had to undergo intense reevaluation. And so for us it looked like he was sidelined because he disclosed. That’s what it looked like.

Kevin Pho: So whenever medical boards or hospitals ask for things like reappointments, and it gives you a bunch of forms, and they always ask you about behavioral health questions, how do you recommend filling those out if there’s a possibility of those not being confidential, and in fact being sidelined?

Maiysha Clairborne: Oh, that’s such a hard thing to answer, Kevin. I think that one has to decide for themselves. I’m not an advocate for lying on one’s application, that’s not necessarily what I’m saying. And you do have to think about how to frame it in a way that moves you along, how to disclose.

But more importantly, I think the systems need to take a different look at how they handle disclosure, because that’s the whole piece of what feels safe and what doesn’t feel safe.

Perhaps there’s a way for a physician to go to a person who’s safe in the organization and say, this is what’s going on, what do you recommend I do, what resources do you recommend, how do you recommend I frame this such that it doesn’t get scrutinized?

So I think that at this point it’s the institutional leaders’ opportunity and responsibility to begin to take a different look at how they deal with disclosures in that way.

Kevin Pho: In your piece you talk about that intersection between psychological safety and marginalized identities within the health care system. So talk more about that intersection.

Maiysha Clairborne: In terms of the health care system and inclusion and diversity, we do know that physicians and health care workers who occupy marginalized identities bear an additional burden of discrimination, of bias, of what some people call microaggression, which I like to call subtle acts of aggression, because microaggressions don’t feel micro to the people experiencing them.

And so it’s important to recognize that when we’re talking about psychological safety, people who occupy marginalized identities, who deal with that additional burden, are at risk for feeling unsafe emotionally, unsafe psychologically, and even sometimes unsafe physically.

In fact, there was a recent study done by the Commonwealth Fund in collaboration with the African American Research Society. And what they looked at is, they looked at how many health care workers across different identities were witnessing discrimination against patients based on race. And across the board, people who didn’t identify as white were higher in both witnessing, and also had a higher level of anxiety, and a lower level of willingness to report around these types of behaviors.

And so what that speaks to is the level of fear around repercussions. And that’s exactly what psychological safety is, is the ability to feel like one can express, one can speak up, one can feel included, and one can report concerns without fear of humiliation, without fear of repercussion, retaliation.

And so that’s one of the examples of where people who occupy marginalized identities carry that additional burden of witnessing, and of fear of repercussion for reporting.

Kevin Pho: So you gave a nice capsule of what psychological safety should be. Tell us what the situation is now. Are you saying that scenario of psychological safety is relatively uncommon in today’s institutions?

Maiysha Clairborne: I think that we are just now starting to broach the topic of psychological safety. From where I’m sitting, as a consultant and as an educator in that realm, we’re starting to see more conversation around that.

Historically, though, this industry has not been a safe space for health care providers, and particularly for physicians, because, as you know, mental health is stigmatized, there’s sort of this hierarchical existence, and so that in and of itself makes it unsafe.

So I think that we are moving in a direction that is hopefully the right direction, and there is still a lot of work to be done there.

Kevin Pho: Tell us some of the work that needs to be done, both from a clinician standpoint but also from a health care leader standpoint. What would you like to see done?

Maiysha Clairborne: I think that there needs to be some policies in place. Well, first and foremost, there needs to be some education. Because I think that there’s not even an understanding of what psychological safety means, because historically these types of topics, these soft skill topics like emotional intelligence and psychological safety and communication, are considered unimportant.

So leaders need to lean into educating themselves. What constitutes psychological safety? What cultivates trust in our community?

And then the other thing that I think is very important, because we do a lot of learning about in our communities, but we don’t always bridge the gap between learning about what something is and actually learning the skills that are needed to be able to execute, to be able to apply on a day-to-day basis, like communication.

And as you know, Kevin, communication is my jam, that’s the thing that I love, love, love to talk about. But how do we cultivate psychological safety in real time, person to person interaction, and how we listen and how we speak to one another?

And that’s both education that is imperative from the leader to provider and to physician side, but also when we think about the physician and the provider to patient side, especially when dealing with identities that are not the same as ours. How do we connect with our patients in a way that has them feel included?

And I know a lot of us highly educated, highly trained people feel like, well, I can communicate well. And perhaps you can, but how is that landing with other people? And we have to educate ourselves and become aware of the skills, and what we’re already doing, so that we can bridge the gap to what we need to be doing.

Kevin Pho: Now, if a physician is unsure about the psychological safety scenario of their institution, what are some ways they can proceed forward to gauge whether it’s safe to disclose and safe from any repercussions? What are some ways they can gauge the environment before they step forward and potentially disclose or share sensitive information about themselves?

Maiysha Clairborne: I think that determining whether your organization is psychologically safe or not is really about how you experience the organization. So that’s the first place to look. Would you feel safe disclosing? How do you feel inside of the organization?

And then begin to investigate, well, what is it about the organization that feels unsafe specifically? When we begin to ask those questions, then we can start to get to the root of what’s missing, and potentially bring that to our leaders. And hopefully in the organization the leaders can take that conversation and say, you know what, maybe we need to do some education around this, maybe we need to do some CME around this.

Kevin Pho: Now, you’re a consultant, and I’m sure that you are in contact with a multitude of health care institutions. Tell us some of the barriers that you see that impede psychological safety in institutions.

Maiysha Clairborne: I think what impedes psychological safety in general is just the lack of awareness, the lack of awareness that it’s necessary.

And I think that, especially with leaders, and even with our physicians and providers, how we’re in such a productivity driven mindset, transactional mindset these days, that we forget to humanize and to be relational in our interactions with each other. So on a big picture level, I think that’s what impedes psychological safety, or creating a culture that is safe.

I think what impedes a lot of leaders from leaning into it is, number one, the uncertainty and unclarity about how it can make a difference. How can it help what we are really focusing on? And right now one of the big topics is workforce and engagement. And so I do a lot of talking about, well, if your culture is safe, then you’re going to keep your physicians, you’re going to keep your health care professionals, they’re going to be more willing to make your organization a career home.

But also I think that it’s hard to measure, and so that is often a barrier. Well, how are we going to even know that the culture is improving in its safety? And there are just multiple ways that you can look at how to indirectly measure psychological safety, because that in and of itself is a bit of an abstract term.

Kevin Pho: So give us a scenario, maybe to give that abstract term a little bit more of a concrete example. So tell us a story, in your ideal world, where a health care institution can provide that psychologically safe space to a clinician. What would be an example of that, what would be a story of that?

Maiysha Clairborne: Let’s just go back to residency. And maybe the ideal scenario would be, when I was suffering in silence, if I had seen my colleague who disclosed, if I had seen maybe the program director, maybe some of the attendings, sort of rally around and ask, well, how can we support you, how can we advocate for you? That would have communicated something a little bit different from, you know, the board says this, you’re just going to catch up on some charts, and you’re going to be out of clinical for six months, and that’s going to delay your graduation.

So I think that’s a very concrete example of what it would have looked like to me. Because psychological safety can be affected whether it’s experienced personally or whether it’s witnessed vicariously. So that would have communicated something different to me, and perhaps to my colleagues, that would have said, oh, you know what, these attendings are a lot more supportive than I would have thought, maybe I can disclose and get some help before I get to this point of feeling like I don’t want to move on.

Kevin Pho: We’re talking to Maiysha Clairborne. She is an integrative family medicine physician. Today’s KevinMD article is “Psychological safety: an overlooked factor in clinician burnout and moral injury in health care.” Maiysha, as always, we’ll end with your take-home messages to the KevinMD audience.

Maiysha Clairborne: I think if there’s anything to take away, it’s, for those who are in systems, you can sort of look at your surroundings, feel inside, like, do you feel safe in your community, do you feel safe in your organization? And if you’re not feeling safe, that’s definitely an opportunity to take this topic to your leaders, to look at, where can we do some more work in creating a culture of safety?

And to my leaders, this is the future. If you want to solve your workplace problems that you’re having right now, I think now is the time to begin having these conversations of, how do we create a culture of trust, how do we create a culture of safety and inclusion, so that we have people who want to be in our organizations and work with us for long periods of time? Because there is a shortage happening, and that shortage is only getting worse.

Kevin Pho: Maiysha, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Maiysha Clairborne: Thank you for having me, as always.