title: Psychological safety and error reporting within Veterans Health Administration hospitals.
abstract: OBJECTIVE
  In psychologically safe workplaces, employees feel comfortable taking interpersonal risks, such as pointing out errors. Previous research suggested that psychologically safe climate optimizes organizational outcomes. We evaluated psychological safety levels in Veterans Health Administration (VHA) hospitals and assessed their relationship to employee willingness of reporting medical errors.
  
  
  METHODS
  We conducted an ANOVA on psychological safety scores from a VHA employees census survey (n = 185,879), assessing variability of means across racial and supervisory levels. We examined organizational climate assessment interviews (n = 374) evaluating how many employees asserted willingness to report errors (or not) and their stated reasons. Finally, based on survey data, we identified 2 (psychologically safe versus unsafe) hospitals and compared their number of employees who would be willing/unwilling to report an error.
  
  
  RESULTS
  Psychological safety increased with supervisory level (P < 0.001, η = 0.03) and was not meaningfully related to race (P < 0.001, η = 0.003). Twelve percent of employees would not report an error; retaliation fear was the most commonly mentioned deterrent. Furthermore, employees at the psychologically unsafe hospital (71% would report, 13% would not) were less willing to report an error than at the psychologically safe hospital (91% would, 0% would not).
  
  
  CONCLUSIONS
  A substantial minority would not report an error and were willing to admit so in a private interview setting. Their stated reasons as well as higher psychological safety means for supervisory employees both suggest power as an important determinant. Intentions to report were associated with psychological safety, strongly suggesting this climate aspect as instrumental to improving patient safety and reducing costs.
authors.affiliation: From the Veterans Health Administration National Center for Organization Development Cincinnati, Ohio.
authors.forename: Ryan
authors.initials: R
authors.lastname: Derickson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fishman
authors.forename: Katerine
authors.initials: K
authors.lastname: Osatuke
authors.forename: Robert
authors.initials: R
authors.lastname: Teclaw
authors.forename: Dee
authors.initials: D
authors.lastname: Ramsel
mesh_terms: D003625:Data Collection; D006282:Health Personnel / Q000523:psychology*; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D019300:Medical Errors / Q000523:psychology / Q000706:statistics & numerical data*; D015279:Organizational Culture; D061214:Patient Safety; D012308:Risk Management / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D017132:Workplace / Q000458:organization & administration / Q000523:psychology