CPOM Module 8, Section 5: Diversity, Equity, Inclusion (DEI) and Psychological Safety
MODULE 8: CULTURE, ENGAGEMENT & WELL-BEING

Section 8.5: Diversity, Equity, Inclusion (DEI) and Psychological Safety

Building the foundational element of any high-performing team where every member feels safe to speak up, contribute fully, and challenge the status quo.

SECTION 8.5

DEI and Psychological Safety

The Non-Negotiable Prerequisite for Patient Safety and Operational Excellence.

8.5.1 The “Why”: Psychological Safety is a Patient Safety Imperative

Throughout this entire course, we have focused on building systems, workflows, and leadership skills to create a pharmacy that is efficient, effective, and, above all, safe. This final section addresses the single most important enabling condition for all the others: psychological safety. Coined by Harvard Business School professor Amy Edmondson, psychological safety is a shared belief held by members of a team that the team is safe for interpersonal risk-taking. It is the belief that you won’t be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.

In a typical workplace, this is a powerful driver of innovation and engagement. In a pharmacy, its importance is magnified a thousand-fold. Psychological safety is not a “nice-to-have” element of culture; it is a non-negotiable prerequisite for patient safety. Consider the operational reality of your pharmacy:

  • A new technician is unsure about a calculation but is afraid of looking stupid in front of the “expert” pharmacist, so they guess. The result: a ten-fold dosing error.
  • A staff pharmacist thinks a doctor’s opioid prescription seems unusually high, but the doctor is famously intimidating and has berated pharmacists before. The pharmacist is afraid of the conflict and dispenses the prescription against their better judgment. The result: a potential overdose.
  • A team member sees a flaw in the new automated dispensing cabinet workflow that could lead to cross-contamination but doesn’t say anything because the manager who designed the workflow is defensive about feedback. The result: a patient receives the wrong medication.

In each of these catastrophic failures, the root cause was not a lack of clinical knowledge or a technical error. The root cause was a lack of psychological safety. Someone had a crucial piece of information—a doubt, a question, a concern—but the interpersonal climate made them feel it was unsafe to voice it. As a pharmacy operations manager, your most profound responsibility is to intentionally architect a culture where the fear of speaking up is zero. The free flow of questions, concerns, and ideas is the lifeblood of a safe and high-performing pharmacy, and only a psychologically safe environment allows that blood to flow.

Analogy: The Sterile Cockpit vs. The Fearful Cockpit

Imagine the cockpit of a commercial airliner during takeoff and landing—the most critical phases of flight. The Federal Aviation Administration (FAA) has a strict regulation known as the “Sterile Cockpit Rule.” During these critical phases, the flight crew is prohibited from engaging in any conversation or activity that is not essential to the safe operation of the aircraft. No small talk, no distractions. The focus is absolute.

Now, consider two scenarios:

  • The Fearful Cockpit: The Captain is a decorated, highly experienced pilot with a reputation for being arrogant and short-tempered. The co-pilot is much younger. During the final approach, the co-pilot notices on his instruments that their airspeed is dangerously low. However, he is afraid of questioning the “great” Captain. He’s seen the Captain belittle other junior officers for speaking up. He stays silent, assuming the Captain must know what he’s doing. The plane stalls and crashes.
  • The Psychologically Safe Cockpit: The Captain has intentionally fostered a culture where any concern, from any crew member, is not just welcome but expected. The Captain has explicitly said in briefings, “I am human and I can make mistakes. Your job is to back me up. If you see something, say something, regardless of my rank.” Now, when the co-pilot sees the low airspeed, he doesn’t hesitate. He immediately says, “Captain, airspeed is low.” The Captain, without ego, corrects the issue, and the plane lands safely.

The pharmacy is a clinical cockpit. Every prescription verification, every sterile compound, every clinical intervention is a critical phase of flight. Your role as the manager is to be the Captain who creates the conditions where the most junior technician feels just as empowered as the most senior pharmacist to say, “Stop. I’m not sure about this.” A culture of fear might look efficient on the surface, but it is silently accumulating catastrophic risk. A culture of psychological safety is the only sustainable path to operational excellence and zero patient harm.

8.5.2 The Four Stages of Psychological Safety

Psychological safety is not a simple on/off switch. Dr. Timothy Clark, in his book “The 4 Stages of Psychological Safety,” provides a powerful model that shows how it develops in a clear, hierarchical progression. A team must master each stage before it can progress to the next. As a leader, your job is to assess where your team is on this spectrum and intentionally cultivate the behaviors that will move them to the next level.

The 4 Stages of a Safe Team

4
Challenger Safety

“I feel safe to challenge the status quo, including the way things have always been done, and even to question the ideas of those in authority.”

3
Contributor Safety

“I feel safe to contribute my own ideas and suggestions, using my unique skills to make a difference, without fear of embarrassment or ridicule.”

2
Learner Safety

“I feel safe to ask questions, admit I don’t know something, give and receive feedback, and even make mistakes as part of the learning process.”

1
Inclusion Safety

“I feel safe to be my authentic self on this team. I am accepted and respected for who I am, including my unique attributes and background.”

The progression is crucial. You cannot expect a team member to challenge a doctor’s order (Challenger Safety) if they don’t even feel safe enough to ask a clarifying question about a new workflow (Learner Safety).

8.5.3 The Leader’s Playbook for Cultivating Safety

Psychological safety is not created by a mission statement or a poster on the wall. It is the direct result of the daily, consistent, and observable behaviors of the team’s leader. You, the manager, are the chief architect of your team’s level of safety. The following table outlines the specific leadership behaviors required to build each stage of safety.

Masterclass Table: Leadership Behaviors to Build Psychological Safety
Stage of Safety Leader’s Core Responsibility Key Leadership Behaviors & Pharmacy-Specific Examples
1. Inclusion Safety To model and demand mutual respect.
  • Pronounce Names Correctly: Take the time to learn how to pronounce everyone’s name correctly. It’s a fundamental sign of respect.
  • Engage in Non-Task Conversation: Show interest in your team members as people (as discussed in Q5).
  • Interrupt Microaggressions: If you overhear a comment that marginalizes a team member, you must intervene. A simple, “What did you mean by that?” can be a powerful interruption.
  • Pharmacy Example: You notice that during informal conversations, a few team members consistently interrupt a junior, female technician. In your next team meeting, you set a new ground rule: “We will have a ‘no interruptions’ policy to ensure everyone has a chance to speak.” You then model and enforce it.
2. Learner Safety To make it safe to be wrong.
  • Admit Your Own Fallibility: Be the first to say “I don’t know,” “I made a mistake,” or “I need your help.” This is the single most powerful way to make it safe for others to do the same.
  • Thank People for Questions: When someone asks a question, especially a basic one, respond with “That’s a great question.” This rewards the act of asking.
  • Decouple Mistakes from Punishment: Frame errors as learning opportunities. When a mistake is made, your first question should be “What can we learn from this to make our system safer?” not “Whose fault is this?” (This is the core of a Just Culture).
  • Pharmacy Example: A new pharmacist misses a clinical interaction. Instead of reprimanding them, you say privately, “This was a complex case, and it’s a good learning opportunity for all of us. Let’s deconstruct what happened. What was your thought process? What could we change in our workflow or our alerts to make this kind of error less likely in the future?”
3. Contributor Safety To make it safe to offer ideas.
  • Explicitly Ask for Input: Don’t wait for people to offer ideas. Actively solicit them. “Before we finalize this new workflow, I need to hear from each of you. What do you see as the potential problems?”
  • Reward Contributions (Even if You Don’t Use Them): When someone offers an idea, thank them for their contribution. If you use the idea, give them public credit. If you don’t, “close the loop” by explaining the rationale respectfully.
  • Provide Resources for Innovation: Give your team members small amounts of autonomy and time to work on process improvements (as discussed in the Burnout section).
  • Pharmacy Example: During a team meeting, a technician suggests a different way to organize the will-call bins to speed up retrieval. You say, “That’s an interesting idea, John. Tell us more about how you see that working… Okay, I like it. John, I’d like you to lead a small pilot test of your system at station one this week and report back on what you find.”
4. Challenger Safety To make it safe to challenge authority.
  • Explicitly Ask for Dissent: When presenting a plan, actively seek out opposing viewpoints. “I’ve laid out my proposal. Now, I need you to play devil’s advocate. What am I missing? What are the weaknesses in this plan? Please poke holes in it.”
  • Reward Courageous Challenges: When a team member respectfully challenges your idea or a long-standing process, you must thank them for their courage, even if it feels uncomfortable. Your reaction in that moment sets the tone for everyone else.
  • Implement a “Pre-mortem”: Before launching a new initiative, gather the team and ask, “Imagine it’s six months from now, and this project has completely failed. What went wrong?” This makes it safe to voice concerns and identify risks upfront.
  • Pharmacy Example: A senior pharmacist questions your decision to change the brand of syringes used for compounding. Instead of being defensive, you say, “Thank you for raising that, Mary. You have more hands-on experience with these than I do. What are your specific concerns about the new brand? Let’s get the two syringes and compare them side-by-side. I want to be sure we don’t make a mistake here.”

8.5.4 The Foundation of Safety: Diversity, Equity, and Inclusion (DEI)

It is impossible to achieve true psychological safety without a deep and authentic commitment to the principles of diversity, equity, and inclusion. These are not separate initiatives; they are the bedrock upon which psychological safety is built. Without DEI, any attempt to foster safety will be superficial and ultimately fail.

How DEI and Psychological Safety Interlock
  • Diversity without inclusion and psychological safety is just a numbers game. You can hire a diverse team, but if the members of that team don’t feel safe to voice their unique perspectives, the value of their diversity is lost. They will assimilate to the dominant culture rather than enrich it.
  • Inclusion is the set of behaviors that creates psychological safety. It is the active process of welcoming, valuing, and soliciting the contributions of every single person, especially those from underrepresented backgrounds.
  • Equity is the procedural foundation of psychological safety. If team members perceive that the processes for hiring, promotion, scheduling, and task assignment are unfair or biased, trust is destroyed, and it becomes unsafe to engage. An inequitable system is an inherently unsafe system.
The Manager’s Role in Building an Inclusive Pharmacy Team

As a leader, you have a direct and powerful role in translating broad corporate DEI goals into the daily lived reality of your team. This requires conscious, deliberate action to identify and mitigate unconscious bias in your processes and interactions.

Mitigating Bias in Hiring and Promotions

  • Standardize Interview Questions: Ask every candidate for a given role the exact same set of behavioral questions. This allows for a more objective, apples-to-apples comparison and reduces the risk of “affinity bias” (favoring candidates who are like you).
  • Use a Diverse Interview Panel: Ensure that interview panels include individuals from different backgrounds, roles, and demographics. This brings multiple perspectives to the evaluation process.
  • Focus on Skills, Not “Culture Fit”: Be wary of the vague term “culture fit,” which is often a smokescreen for unconscious bias. Instead, define the specific skills, competencies, and values required for success and evaluate all candidates against that objective rubric.

Ensuring Equity in Daily Operations

  • Audit “Glamour Work” vs. “Office Housework”: Be conscious of who gets assigned high-visibility “stretch” projects versus who gets stuck with the “office housework” (e.g., ordering supplies, cleaning, organizing). Studies show this often breaks down along gender lines. Create a fair, rotational system for both types of tasks.
  • Amplify Marginalized Voices: Pay attention to who gets interrupted and whose ideas get ignored in meetings. Use your authority to redirect the conversation. “Hang on, I’d like to hear the rest of what Priya was saying.” Or, if an idea from a junior member is ignored and then repeated by a senior member, give credit where it’s due: “Thank you, David, for building on Priya’s excellent point.”
  • Equitable Scheduling: Ensure that the processes for approving time off and creating schedules are transparent and applied consistently to everyone, regardless of their status or relationship with you.

Using Inclusive Language and Communication

  • Adopt Gender-Neutral Language: Use inclusive terms like “team,” “everyone,” or “folks” instead of “guys.”
  • Respect Pronouns: If your organization encourages it, model the behavior of sharing your own pronouns and respectfully using the correct pronouns for your team members.
  • Be Mindful of Idioms and Cultural References: Be aware that common idioms (e.g., “knock it out of the park”) may not translate for team members from different cultural backgrounds. Strive for clear, direct language.

8.5.5 Final Thought: The Ultimate ROI

The work of building a diverse, equitable, and psychologically safe environment is not easy. It requires courage, humility, and a constant willingness to examine your own behaviors and biases. It requires you to have uncomfortable conversations and to challenge long-standing norms. But the return on that investment is immeasurable. It is a pharmacy where every single team member, from the newest technician to the most experienced pharmacist, feels empowered to act as a guardian of patient safety. It is a workplace where problems are solved faster, innovation flourishes, and the best people want to stay and build their careers. It is, quite simply, the essential foundation for creating a pharmacy that is not only operationally excellent but also profoundly human.

Your Leadership Legacy

At the end of your career as a pharmacy leader, you will not be remembered for the percentage you reduced inventory costs by or how many prescriptions you dispensed per hour. You will be remembered for the culture you built. You will be remembered by the technicians you mentored, the pharmacists you developed, and the team you inspired. You will be remembered for whether you created an environment where people felt seen, respected, and safe. That is the ultimate measure of success, and it is a legacy worth building every single day.