Becoming Cultures of Candor

April 12, 2023

Becoming Cultures of Candor

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BY Jenna Kellerman

There is a strong connection between staff well-being and organizational performance, and one of the key metrics for well-being is psychological safety. Last year, the U.S. Surgeon General released the Framework for Workplace Mental Health & Well-Being, which outlines steps and resources organizations can use to improve the well-being of staff and organizational culture.

The report notes, “When workers feel psychologically safe, they speak up without the risk of being punished, retaliated against or humiliated, and without fear of these risks.”

The field of aging services is full of incredibly caring, thoughtful, and relationship-minded people. Yet the systems and structures that surround this sector are often punitive, hierarchical, and often outdated. When these two things collide, it can make for a challenging environment of punishment and fear.

Let’s consider some potential scenarios:

A caregiver doesn’t report a resident’s change in condition because last time they did, the charge nurse rolled her eyes and said, “I’ll check on it later.”
A dietary aide has a new idea to improve dinner service but doesn’t communicate it to their supervisor because they are afraid of embarrassment if the idea fails.
A nurse doesn’t report an error or a near-miss because they’re afraid of losing their license.
An administrator doesn’t share an internal concern with an executive because they are afraid of retaliation.

In these types of situations, not only are staff working in stressful environments, but important growth in organizational quality and performance will not be realized. The field of aging services is certainly not the only sector to grapple with this challenge, but the power-and-control nature of licensed staff delegating tasks to caregivers and punitive regulatory oversight, layered with a historic workforce crisis, does create an environment where toxic behaviors can creep in unless leaders are invested in prioritizing psychological safety and candor.

Interestingly, the Surgeon General’s report listed “Five Essentials” that help organizations reimagine their culture, and each of the five categories are chock-full of behaviors that exhibit candor and transparency:

Prioritize workplace physical and psychological safety
Normalize and support mental health
Operationalize diversity, equity, inclusion, and accessibility (DEIA) norms, policies, and programs
Provide more autonomy over how work is done
Engage workers in workplace decisions
Build a culture of gratitude and recognition
Create cultures of inclusion and belonging
Cultivate trusted relationships
Foster collaboration and teamwork
Ensure relevant, reciprocal feedback

Trust itself is a key component of high-functioning and innovative teams. When there is trust, staff can work within their full scope of practice, they can explore, learn, share new and innovative ideas without embarrassment, are willing to admit near-misses to help prevent future accidents, and they can participate in root-cause analysis to improve and change systems.

One study, titled Relational Quality of Registered Nurses and Nursing Assistants: Influence on Patient Safety Culture, found that a highly relational group of nurses and nursing assistants had clear and transparent communication. The study noted, “Often the RN would stop and ask the NA their thoughts and perceptions. They encouraged each other to speak freely, and there was obvious psychological safety.” On the other end, a low-relational group of nurses and nursing assistants spoke over one another, used profanity, disagreed while others were talking, and felt like they worked in silos.

Communication has a direct tie to turnover. LeadingAge’s LTSS Center @Umass Boston published a study titled COVID-19: Stress, Challenges, and Job Resignation in Aging Services. It found that “Employees who felt more prepared due to high-quality communication were less likely to resign from their job.” Further, Great Place to Work found that staff who experience high levels of well-being at work are three times more likely to intend to stay, and three times more likely to recommend their employer to others. So transparency, communication, and well-being is imperative when it comes to both recruiting and retaining staff—on top of improving quality of care.

A candid, transparent, and healthy culture takes work and dedication to achieve. It takes commitment and buy-in from all staff, and it starts at the top. Leaders (at all levels) who hold information close to maintain power and control over others stand in the way of healthy and candid cultures, and thus, stand in the way of achieving higher quality outcomes. Leaders who openly communicate, foster psychological safety, and empower staff with autonomy and trust, will set the tone for a better place to work.

So where can you start? There are many excellent tools to help organizations learn about candor, build trust, and improve transparent communication. Check out:

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