We Don’t Just Need a Safer Culture in Surgery. We Need a Braver One.

We talk a lot about safety in surgery.

Regulatory bodies build systems to reduce risk. Hospitals add layers of policy, reporting mechanisms, and checklists. All of this is done with good intention.

But there’s a critical truth we rarely name: the safer the people feel, the safer the surgery.

Psychological safety is not merely “nice-to-have.” It is foundational to patient safety.

Surgeons who feel psychologically safe perform safe surgery.
Team members who feel psychologically safe speak up when something seems off.
OR teams with psychological safety catch errors before they affect the patient.

And yet, our systems often attempt to manufacture safety while ignoring the human nervous systems inside the room.

What we actually need is not just a safer culture, but a braver one.

When Fear and Self-Censorship Drive the Room

Let’s look at a common OR scenario:

You’re in the middle of a case. You need an instrument now.

In your mind: Why doesn’t anyone understand the urgency?

Frustration rises. Your tone sharpens.

You ask, “What’s taking so long?”

The circulating nurse hears aggression.
Your intention (urgency) and your impact (perceived hostility) diverge.

In an unsafe culture, this moment gets stored away. Resentment builds.
The circulating nurse spins an internal story about you putting the patient at risk. They may gossip about you. Next time you work together, there’s obvious tension. Perhaps they file an “anonymous” incident report about your behavior.

This is the result of not knowing how to properly relate.

What a Safe and Brave Culture Looks Like

In a safe, brave OR culture, we don’t pretend these moments don’t happen.
We address them in real time, between the humans involved.

Instead of defending or doubling down, you name your lived experience:

“If my tone sounds snappy, it’s because I’m feeling frustrated.”
“My intention is to communicate urgency, not disrespect.”

This is turning the spotlight:
Shifting attention away from the story in your head and toward what is actually happening right then: internally and relationally.

Not blame or justification, but transparency.

Rather than making assumptions or documenting later, the circulator responds directly:

“Here’s what I heard…”
“Is that what you meant?”

This is looping for understanding:
Checking whether the meaning they assigned to your words matches your actual intention.

The new result: a conversation replaces an incident report.

Facing Micro-Aggressions Head-On

In a safe, brave culture, perceived micro-aggressions aren’t stored, stewed over, or escalated indirectly. They’re addressed directly and with curiosity.

Example: the patient

• A patient asks, “How old are you?”

  -Instead of swallowing irritation or performing confidence theater, you loop:

  “What I’m making that question mean is that you’re concerned I might be too young to do this. Is that right?”

Example: the colleague

• A colleague says (this actually happened to me): “If you want your own set, bring 16 cases a month. Like I do.”

  -You respond by turning the spotlight and looping:

  “You’re suggesting you’re more deserving of a dedicated set than me. Is that what you meant?”

Proper relating creates clarity, instead of defaulting to accusations and spinning false narratives.

Culture Changes One Surgeon at a Time

As the surgeon, you set the tone. You model what happens when tension arises. You show the team how to speak honestly and courageously. You demonstrate that accountability and compassion can coexist.

This doesn’t require perfection.
It requires presence.

You go first.
You go with humility.

How to Have Brave Conversations (Practically)

When tension arises, resist the urge to make up stories. Instead:

1. Turn the spotlight

Shift attention from assumptions to lived experience.

• “I’m noticing…”

• “I’m hearing…”

• “I’m feeling…”

This slows the nervous system and reveals what’s actually happening.

2. Loop for understanding

Check meaning before reacting.

• “Is that what you meant?”

• “Did I get that right?”

The internal goal is simple:
“Okay, now I follow.”

3. Delay your ego’s story

• Do not insert your interpretation until you verify the other person’s intention.

• Curiosity is key.

The Payoff

Proper relating saves enormous amounts of time, energy, and emotional bandwidth. It also reduces sham incident reporting and prevents escalation.

Most importantly, it creates safer surgery for patients.

We don’t just need safer systems.
We need braver humans inside them.

And that work starts, as always, with us.