Episode 13: Building a Psychologically Safe Workplace, with Dr. Jeff Klassen

Episode 13 with Dr. Jeff Klassen, St. Boniface Hospital

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On April 29 in Toronto, Dr. Klassen engaged a packed house with his work around psychological safety, and his theories on what hockey and medical error have in common.

This special episode of Healthcare Change Makers was recorded at the 2019 HIROC Conference.

On this episode, host Michelle Holden, Communications and Marketing at HIROC, sits down with Dr. Jeff Klassen, Emergency Physician at St. Boniface Hospital.

Dr. Klassen speaks to effective teamwork and communication, sharing the work he is doing at St. Boniface with the TeamSTEPPS program, and his views on the importance of psychological safety in healthcare.


Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers. A podcast where we talk to those leaders about the joys and challenges of driving change in our complex and demanding healthcare organizations.

Michelle Holden: Hi. Good afternoon. We're here today with a special episode of Healthcare Change Makers at the HIROC Conference in Toronto. Today we're sitting down with Dr. Jeff Klassen, who's just finished his keynote presentation. We wanted to follow up and get a little bit more information on what he talked about. Dr. Klassen, welcome.

Dr. Klassen: Thank you.

Michelle Holden: I was wondering if you can tell us a little bit about yourself, and what you do at St. Boniface.

Dr. Klassen: Sure. Yeah. My name is Jeff Klassen. I live in Winnipeg, and I work as an emergency physician at St. Boniface Hospital. I have been there for probably six years. In that time, I've gotten two new jobs on the side. I am the director of a program called TeamSTEPPS Winnipeg, and I'm also a curriculum lead on quality improvement and patient safety at the University of Manitoba.

Michelle Holden: Can you explain a little bit what TeamSTEPPS is all about?

Dr. Klassen: Sure. TeamSTEPPS was not our idea. We didn't invent it. TeamSTEPPS came out of the United States between a health research company called AHRQ, and the Department of Defense, in response to a publication in 1997. It was called, To Err Is Human. It came out during the Clinton Administration, and under pressure, the Clinton Administration asked those two organizations to come up with a solution to the problem. It's just a set of didactic tools that go over basically a lot of the tools that aviation used to improve their outcomes. What we call, crisis resource management, or crew resource management some people call it. It's just a bundle of didactic information research.

They did a lot of research as they developed it, and then they offer it for free, so anybody can just use it, can get trained in it. You have master trainers that then can take it home and apply it to wherever they work in whatever way they feel it is suited.

That's how we did it initially. We ran these didactic sessions, and it worked okay. We ran some surveys, and we saw some benefit initially, but we lost it pretty quickly. Within about six months we had lost all the benefit that we initially had, and we didn't know why at first. In retrospect, we understand why now. Part of the problem is that people just weren't engaged, and it was more of a culture problem than it was an actual people willing to learn problem. So we had to really find ways to change the culture, and specifically psychological safety.

Michelle Holden: Yes. I wanted to ask you a little bit about that because you touched on your presentation a lot about how to change psychological safety, and how important it is. But could you give us some examples of some of the things you've done, or other organizations have done, that you are really impressed with, to really shift that focus?

Dr. Klassen: Sure. I will say first what we did very wrong. I didn't even understand what psychological safety was when we started this TeamSTEPPS stuff back in 2010ish, something like that. Now in retrospect, having a better understanding, I'm seeing so many missteps that we made. Imagine you're a nurse that's already working in a place where you don't feel particularly safe or supported. You're anxious about making a mistake and getting blamed for it. Then you receive an email from your administrator saying, "We're forcing you to go to this four-hour didactic session where you're going to have to sit and listen to lectures about patient safety because we've identified it as something that you need to do." I really can't think of anything that is a better combination of super boring and super terrifying. Right?

You're starting with people that are already anxious, and then you're just forcing this thing on them, and present it in a way that didn't really make them feel any safer. So what we did, and this is after lots of trial and error, but where we broke free is we decided, instead of forcing this on people, let's make it attractive, and have people attracted to it. The idea came up in a small working group of volunteers that I was fortunate enough to have. You know, everyone's on social media. Again, this was a couple years ago so, I mean social media's been around for a long time, but it wasn't quite as ubiquitous as it is now, but it was quickly identified that almost all of our staff is on social media. Why don't we just put a couple test things out there on social media, and see if that attracts people?

Then the question was, "What kind of stuff is going to help people feel safe?" So we focus on really humorous stuff. We made it catchy. We'd do a music video, or we'd do a little comedy sketch or something like that to disarm all the baggage that comes along with talking about patient safety, and really make it attractive that people would want to pursue it and watch it. Then before we knew it, we did a couple of those, before we knew it, people were asking how they could get involved in making some of these things. Now, it might've been because they just wanted to be in a funny video on the internet, but regardless, we got them on board. You're in a video about a communication tool called SBAR. People are going to start asking, "What is SBAR anyway," and now you've got to take some ownership of that.

So bit by bit this whole anxiety around talking about patient safety changed into something that was a bit more disarmed. I think through the process, because it was the team making all of this stuff, because we use people from our actual department to make all our content, we developed a sense of team where we could support each other, where we could learn from each other, where we could really talk about some of these things. That opened the door to talking about things safely in a different context. So talking about actual patient issues with more psychological safety because we've started from a place of support rather than from a place of anxiety. If that makes sense?

Michelle Holden: Yeah. Are you seeing, along with this culture shift, some improvements and actual results in terms of safety staff and patient safety?

Dr. Klassen: Well, I'm going to be the first to admit that I'm horrible at research, and I've done a horrible job researching this, and that's on me. We have seen some things. We've seen decreased patient complaints. I wish I knew about things like Amy Edmondson's psychological surveys before we started, so I could have done them right at the beginning, and done them again now to see if things have changed. It's been more qualitative stuff. When I first started I would hear things from paramedics and from other staff that was coming from other places that had to come to our department that it felt uncomfortable.

That was a pretty common theme, and even from people that worked in our department we would see some staff being completely overwhelmed with the work on one half of the department while staff on the other side was checking their Facebook status. There was none of this cross monitoring or this mutual support that you'd expect from a team. That's come 180 over the course of us doing this TeamSTEPPS stuff, and it's been identified by multiple physicians that work at different hospitals across our city. Our city's going through a huge, stressful shift right now.

We're closing down emergencies, we're expanding other emergencies, and it's been a huge burden for front care workers. I've had multiple comments from different physicians how resilient our staff seems to be across the board. We're having less turnover. We're having better attitudes. You ask our staff now, if it comes up in conversation, our staff consistently say, "I feel supported where I am. I like my job even though it's really stressful right now." We always love to complain about some of the stressful things that are going on. But overall the theme is, when it comes to our team, we're there for each other, and we're looking out for one another. I wish I had actual numbers I could throw down on the table.

Michelle Holden: No, but as you said, the qualitative is important to look at as well. Sometimes it is valuable in what you hear just on the fly.

Dr. Klassen: It's been super fun to watch too.

Michelle Holden: We wanted to know, Jeff, what was your aha moment in terms of this movement toward the culture shift, and making staff feel safe, and making decisions, and bringing things forward?

Dr. Klassen: It wasn't really one moment. Throughout my med school career, I was always terrified of making mistakes and hurting people. That was a big obsession of mine. So when I got into emergency medicine as a resident, and I was expected to have a niche, I very comfortably, very naturally, progressed towards patient safety. We are all expected to have a niche through our residency, some kind of extra thing on top of just emergency medicine. Patient safety always fit for me. Then there was already this TeamSTEPPS initiative started. The process had started before I was on board, but because I was already interested in patient safety, I got invited late in the game to go ahead and get master trained, and help with this implementation.

So when I got the master training in Minneapolis on TeamSTEPPS, that was a big shifter for me because I had worked at both Health Sciences Centre, and the Grace, and the Victoria, and all these different emergencies across our city. I could see that some of these crisis resource management problems were big problems where I had worked, and to different degrees and different aspects. I could see that if we could implement this, if we could make some of these concepts really across the board accepted, we would have a huge culture change.

So it was a process over several years, and even though I didn't know really how to implement it right off the hop, the concepts were always there, and I could always see the importance of them basically from that training that I took, that master training going forward. Yeah, and luckily for me, even though we didn't see results right off the hop, administrators and other people have seen how important it is as well. They just supported me to try these different aspects, and coming at it from different angles, and allowing me to fail, keeping me very psychologically safe.

Philip De Souza: You learned this from the U.S.? Was there not a program happening here in Canada that you could learn from?

Dr. Klassen: There are master trainer sessions happening everywhere now. We started implementing right at the get-go of TeamSTEPPS. TeamSTEPPS was only about a year and a half old in terms of the Department of Defense version of TeamSTEPPS. At the time, there was only about four or five centers across the states that were offering master trainer courses. So yeah, I went to Minneapolis. But now there are master trainer sessions happening all over the place, and actually the Canadian Patient Safety Institute has a whole database. If you're interested in TeamSTEPPS, you talk to them. They get you hooked up with the resources in your area. They'll help you arrange stuff. TeamSTEPPS is gaining traction in Canada for sure. But at the time, no, you had to go to the states.

Michelle Holden: Dr. Klassen's presentation today was so engaging, and I just felt like I wanted to know from you Jeff, where you get the inspiration for these presentations, and also how do you connect the audience to these simple everyday examples?

Dr. Klassen: People often ask me about my Connor McDavid analogy. For those of you who are listening, for those who don't know, Connor McDavid is the captain of the Edmonton Oilers. You can tell this is a Canadian podcast because we're going to tie everything back to hockey. But he's only been in the NHL for four years. He's quite clearly the most technically skilled and talented hockey player on the planet. Yet he consistently fails to make the playoffs. His team consistently loses. I just feel it's such a beautiful analogy because we have all these healthcare workers that are also very technically skilled and very well meaning. Yet medical error continues to be a huge problem across the world.

It's such a great analogy to help people reconcile this issue that this isn't a bad apple problem. This isn't an individual problem. Just like Connor McDavid's issues getting into the playoffs, this is a team effort that we have to come across. I always have appreciated storytelling and analogies. I just feel they help get points across in a way more impactful way. I could go on and on about complexity theory, and someone would come home the next day, and they wouldn't remember the words "complexity theory". But if I say, "Connor McDavid syndrome", that's something that somebody can really hold onto, and take home with them.

Even if they don't remember all the nuts and bolts of it, it's a concept that I think that translates really well on multiple different levels. I try and do the best I can with all the concepts. Again, it breaks down a lot of the stigma and baggage that comes along with talking about medical error and patient safety. It's for a lot of people I think a very guarded topic because nobody wants to make these mistakes. Nobody wants to be the cause of any sort of harm, and even though it's not an individual cause, there's still that anxiety walking around within the medical care system. So when you can use analogies like that as much as possible, I think it just makes it so much easier for people to listen.

Michelle Holden: Great. Well, thank you so much Dr. Klassen for sitting down with us, and talking a little bit about your presentation, and also what this means to you at St. Boniface and the work you're doing.

Dr. Klassen: It was my pleasure. Thanks for having me.