Communication can be difficult due to many internal and external barriers. Internal barriers are those which affect us as individuals, such as language differences, culture, motivation, expectations of the situation, past experiences and emotions. External barriers are those around us, such as background noise, distractions and lack of nonverbal cues.
Within healthcare, hierarchy often prevents people from speaking up. “Effective leaders flatten the hierarchy, create familiarity and make it feel safe to speak up and participate. Authoritarian leaders reinforce large authority gradients, creating unnecessary risk.” (Leonard et al, 2004). Teaching all members of the team to speak up to express patient safety concerns is key. All team members should be encouraged to use ‘critical language’ in times when they are concerned about patient safety – using language such as ‘I’m concerned’, ‘I’m uncomfortable’, ‘I’m scared’ or ‘this is unsafe’ is direct, clear and has the ability to stop a situation to allow for reassessment.
Psychological safety is a significant predictor of whether a team will perform highly. This is the extent to which team members feel safe to communicate honestly and openly with one another, to be vulnerable in front of one another and, crucially, to be able to respectfully and constructively disagree with one another. This is particularly important in ad hoc teams.