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Table 2 Practical tips for managing the bidirectional flow of psychological safety into and out of simulation

From: Taking simulation out of its “safe container”—exploring the bidirectional impacts of psychological safety and simulation in an emergency department

Minding the leaks in Shaping the leaks out
Diagnose and manage the team dynamics before even entering the room. Prior experience with simulation, team familiarity, hierarchy, pre-existing relationships, and power dynamics are relevant to the simulation experience. Stop saying, “what happens in simulation, stays in simulation” [25]. It just isn’t true. We show that simulation impacts ideas, relationships, and judgements participants have about colleagues, their organizations, and themselves.
Reflect on your own positioning as a facilitator. Your credibility and pre-existing relationships with participants matter. If you don’t foster psychological safety outside of the simulation room, you shouldn’t be a facilitator in it. Continue employing traditional ways of building, maintaining, and repairing psychological safety in the simulated environment [1, 3, 18, 21, 24]. This likely results in a significant leak of familiarity, confidence, leadership behaviours, and trust back into the working environment.
Commit at an organizational level to the process. To be most effective, simulation will be a manifestation of an improvement ethos not an isolated event. Start overtly debriefing around concepts related to psychological safety. Name and explore ideas like familiarity, role understanding, supportive leadership, trust, inclusiveness, belonging, speaking up, and confidence—or what gets in the way of them.