When Dare Meeks, MSN, RN, became chief nursing officer at SCA Health in 2019, she set out to build a culture wherein every nurse, technician and administrator feels not just allowed to speak up, but expected to.
Six years later, she joined Becker’s to discuss how that investment in psychological safety is paying off in engagement scores and nurse retention.
Editor’s note: This interview was lightly edited for clarity and length.
Question: Beyond compensation, what types of cultural or structural changes have you seen make the biggest difference in keeping nurses engaged and committed, especially over the long term?
Dare Meeks: Several things we’ve been working on, really, since 2019, when I stepped into this role: a real focus on psychological safety — in our culture of patient safety, and the ability and empowerment of our frontline nurses and nursing leaders to speak up.
We have a program that every teammate — whether they be a nurse, tech, or work in the business office — completes within their first week. It focuses on a common language we use to speak up, which is evidence-based. It’s called CUS. The C stands for “I’m concerned,” the U stands for “I’m uncomfortable,” and the S stands for “this is a safety issue.” When anyone hears those words in that environment, it means we need to take a beat and listen. Really hard-wiring that psychological safety and the expectation to speak up — not just “we want you to,” but “we expect you to as part of our culture” — has been a strong contributor. We’ve gotten great feedback in our EXI teammate engagement surveys, which we do twice a year, with high scores around psychological safety. That’s a direct contributor to reduced turnover and increased engagement.
Q: Could you talk a little about why these safety measures are so critical in a healthcare setting?
DM: Twenty-six years ago, there was a published white paper called “To Err Is Human,” which showed thousands and thousands of patients harmed as a result of healthcare in our country.
Twenty-six years later, we are still seeing similar numbers. Where we work is a high-risk, high-complexity environment, similar to aviation or nuclear power. There’s risk at every step along the way, from something as simple as getting a patient’s history wrong to administering medications or performing procedures.
It is so critical, because we are human beings taking care of other human beings, that we have the ability to speak up clearly, that we’re empowered to do so, and that it happens in a non-punitive environment where we don’t get retaliated against for speaking up.
When we’ve done 100,000 surgeries in our career, it doesn’t feel as risky to us as it does to the patient who’s only had one surgery in their life. A real-world analogy: in our daily lives, when we’re in a hurry, we have a tendency to drive faster than the speed limit or roll through a four-way stop. Most of the time, nothing bad happens. And when nothing bad happens, it affirms in our brain that it’s okay to keep doing that. But what’s really happening is we’re taking a step, every single time, closer to the day something bad will happen. The same applies in a high-risk surgical care environment. If we skip a step because we’re in a hurry or someone’s pressuring us, and nothing bad happens, we believe we can skip that step again. So it’s critically important that we educate our teams to that awareness — because it is very easy to become less aware when we do something over and over again.
That type of culture also circles back to retention. When people believe in what’s happening and how they’re caring for patients, they stay.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.