Harassment in Medicine: Cultural barriers to psychological safety

Abstract Psychologically safe organizational cultures are inherently inclusive and promote healthy sharing of power and knowledge. These conditions allow innovation to thrive and optimize member performance. Unfortunately, despite its evidence-based nature, medicine continues to struggle with providing safe environments for its members. There are several cultural barriers to psychological safety that permit endemic harassment. These include having large power gradients, a weak ethical climate and a number of enabling structural factors that maintain a toxic culture. Moving toward psychological safety will be challenging work as it requires a difficult and complex analysis of the shared value system that enables the status quo. Programs and policies that promote equity, diversity and inclusion are an important start but likely insufficient on their own to achieve psychological safety. Leadership that models difficult reflection and supports inclusive transformation is the key to a safe culture shift.