A survey approach to assess the work and learning environment and stimulate informed change within the individual departments of an academic health center

In the complex world of an academic health center, where doctors, researchers, students, and staff work side by side, the quality of daily life depends on something invisible but essential: the feeling of psychological safety. This concept describes an environment where people feel safe to speak up, share ideas, or admit mistakes without fear of punishment or humiliation. When this safety is present, teams perform better, people stay in their jobs longer, and the entire organization thrives. Conversely, when people feel unsupported or marginalized, the work suffers. Leaders often believe their institutions are more inclusive and supportive than the people actually working there realize, creating a gap between perception and reality. To bridge this gap, organizations need a way to listen directly to the people who experience the culture every day, not just the leaders who oversee it.

A team of researchers at the University of North Carolina at Chapel Hill decided to build a bridge across this gap by designing and deploying a large-scale survey. Their goal was to understand the work and learning environment within their own academic health center and to use that information to spark real change. They recognized that to improve a place where hundreds of different groups work, they could not simply ask broad questions and wait for a general answer. Instead, they needed to listen to specific departments, centers, and training programs, because that is where people actually live their professional lives. The researchers wanted to move beyond simple data collection; they aimed to create a process where the findings themselves would become a tool for departments to examine their own cultures and decide how to fix what was broken.

The project began with a careful design phase. The researchers, working with an external survey firm to ensure anonymity and trust, crafted a questionnaire that asked people to describe their experiences within their immediate work units. They asked participants to rate their agreement with statements about whether their department tried to be supportive, whether they felt appreciated and embraced, and whether they felt accepted for their beliefs. They also asked about specific negative experiences, such as bullying, harassment, or discrimination, and whether people felt comfortable reporting these issues. Before sending the survey out to the entire community, the team tested the questions with small groups of faculty, staff, and students to ensure the language was clear and the questions made sense to everyone.

In early 2022, the survey was opened to the entire community, which included thousands of students, residents, faculty, and staff. To encourage people to participate, the leadership sent personal messages, and each department appointed a "champion" to encourage their colleagues to take the time to answer. The response was strong, with more than four thousand people, or about 56 percent of the community, completing the survey. This high level of participation gave the researchers confidence that the results truly reflected the feelings of the people on the ground. The data was then analyzed to create a detailed picture of the environment, breaking the results down not just for the whole institution, but for each of the more than fifty individual departments and units.

The researchers realized that presenting raw data in a complex online dashboard was not enough. Leaders found the charts difficult to read and struggled to see what actions they should take. So, the team redesigned how they shared the information. They condensed the many survey questions into three clear themes: whether the unit strives to be supportive, whether people feel embraced and appreciated, and whether people feel accepted in their beliefs. For each department, they created a custom report that showed how that specific group scored on these themes compared to similar groups elsewhere in the health center. This approach allowed a department chair to see, for example, that their team felt less appreciated than their peers in other clinical departments, turning an abstract statistic into a clear signal for improvement.

The most critical part of the project was how these findings were delivered. The researchers did not just email the reports; they held in-person or virtual meetings with each department to walk through the data together. An executive leader from the health center presented the findings to the assembled staff, faculty, and students, ensuring that everyone heard the same message at the same time. These sessions were designed to be open and honest, acknowledging both the strengths of the department and the areas where the environment fell short. The presentations highlighted specific issues, such as whether certain groups within the department felt less safe or less supported than others, and offered concrete recommendations for next steps.

The reaction from the departments was immediate and active. The survey results acted as a catalyst, prompting many units to take action. Some departments held retreats to discuss why their staff felt a lower sense of belonging and to brainstorm ways to build a more inclusive culture. Others updated their websites to make it easier for people to report mistreatment or launched new training programs to help staff recognize and prevent microaggressions. Several departments formed new committees to address health disparities and to ensure that their decisions included input from a wider range of voices. The process did not just identify problems; it gave departments a shared language and a clear starting point to begin fixing them.

The researchers noted that the success of the project relied heavily on the combination of external expertise and internal knowledge. The external firm helped ensure the survey was conducted professionally and confidentially, while the internal team understood the nuances of the academic culture and knew how to present the findings in a way that resonated with the staff. They also learned that people were most interested in their immediate work environment—their specific department or team—rather than the health center as a whole. In the future, they plan to focus their surveys on these local units, as that is where people feel most connected and where change can happen most effectively.

Ultimately, this project demonstrated that when an organization takes the time to listen to its people and presents the findings in a clear, actionable way, it can drive meaningful improvement. By focusing on the three core dimensions of support, appreciation, and acceptance, and by sharing the data directly with the people who experience the environment, the academic health center turned a simple survey into a powerful engine for cultural change. The work showed that leaders do not need to guess what their employees feel; they only need to ask, listen, and then act on what they hear.