Exploring the relationship between psychological safety in the workplace and in simulation based educational sessions for emergency department doctors and nurses

Grant ID: EMJS-364R34-2020-BRAZIL

Project Summary

Emergency department teams need to perform urgent and high stakes patient care. This requires individual expertise and effective teamwork underpinned by trust, respect and shared values.

Psychological safety is a “shared belief held by members of a team that the team is safe for interpersonal risk taking”. The factors affecting the development of psychological safety in emergency department teams are not well understood and we aim to explore this within the emergency departments at Gold Coast Health.

Learning more about how to develop psychological safety in teams will inform team training strategies, including but not limited to simulation-based training, and subsequently better care for patients presenting to emergency departments where high performing teams are critical.


The research team used quantitative and qualitative methods to explore the current state of psychological safety in their ED, examining what supports and threatens it in their local context. 72 nursing and medical staff first completed the “Team Learning and Psychological Safety Survey” and a narrative survey. Subsequently, semi-structured interviews were conducted with 19 participants.

Quantitative survey results showed moderate levels of overall psychological safety in the research team's ED, but there are important differences between groups. Nurses had lower psychological safety compared to registrars and consultants; and those working in ED for longer than 5 years felt more psychologically safe than those working in ED for 6-12 months.

Differences in perception of safety were even more stark in the qualitative data, with the importance of team and leader familiarity being the most striking. Simple things - like having worked together before, introductions at the beginning of the shift, and participating in education together - built a level of collegiality and belonging that contributed more obviously to safety than any other factors.

These findings were confirmed by research on simulation-based education sessions. The team found that antecedent psychological safety of teams participating in simulation has major influence on their simulation experience, which in turn impacts their experience of safety in the real working environment.

The findings have major implications for the practice of emergency medicine. Increasing familiarity of teams through shift huddles, pre-briefings, after-action reviews, simulation or through rostering can improve team and leader familiarity, which in turn increase the team’s psychological safety. In a challenging environment, psychological safety can impact patient safety, as the ability for team members to rely on each other to escalate, challenge, problem-solve, and provide feedback will become increasingly important.



- Purdy, E., Borchert, L., El-Bitar, A., Isaacson, W., Bills, L., Brazil, V., 2022. Taking simulation out of its “safe container”—exploring the bidirectional impacts of psychological safety and simulation in an emergency department. Advances in Simulation 7(5), p.1-9. https://doi.org/10.1186/s41077-022-00201-8


- Purdy, E., "The leaky container - managing risks and maximizing rewards of simulation for high performing teams". Invited Keynote, SESAM - European simulation conference. June 2022.

- Purdy, E., “Capably Navigating Acuity and Uncertainty Together”. Invited Canadian Association of Emergency Physicians National Grand Rounds. Online – Canada. January 2022.

- Purdy, E., “Psychological Safety is No Accident – Lessons from the Emergency Department and Simulation”. Invited Grand Rounds. The Women’s Hospital, Melbourne. December 2021.

- Brazil, V., Safe not soft. Psychological safety in healthcare simulation. eSIM virtual bi-monthly Grand Rounds Series, Alberta Canada. November 2021.

- Purdy, E., “Psychological safety is no accident – better team performance in emergency medicine.” Invited Keynote Address. Royal College of Emergency Physicians Conference. United Kingdom. October 2021. https://vimeo.com/609694802

- Purdy, E., “Psychological Safety is No Accident –Better Team Performance in Emergency Medicine", GCHHS research day. https://vimeo.com/649167980


- Brazil, V., Purdy, E., Advances in Simulation: Lifting the lid on the ‘safe container’ of healthcare simulation . Simulcast podcast. https://simulationpodcast.com/150-advances-in-simulation-lifting-the-lid-on-the-safe-container-of-healthcare-simulation/

- Brazil, V., Purdy, E., ‘SAFE, NOT SOFT’ – HITTING THE SWEET SPOT FOR SIMULATION-BASED EDUCATION. International Clinical Educators Network Blog. https://icenetblog.royalcollege.ca/2020/11/03/safe-not-soft-hitting-the-sweet-spot-for-simulation-based-education/


Amount Awarded


Grant Scheme


Principal Investigator:
Dr Victoria Brazil

Co Investigators:
Dr Eve Purdy
Dr Warwick Isaacson
Ms Lucy Bills

Associate Investigators:
Ms Laura Borchet
Mr Anthony El-Bitar


Collaborating Institutions


  • Advances in Simulation: Lifting the lid on the ‘safe container’ of healthcare simulation . Simulcast podcast. Brazil V and Purdy E
  • Psychological safety is no accident - better team performance in emergency medicine

  • CONTACT US +61 7 3112 8668 info@emfoundation.org.au Suite 1A 34 Sherwood Road Toowong, Qld 4066