Exploring the factors which promote or diminish a psychologically safe environment: a qualitative interview study with critical care staff.
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Published version
Author(s)
Grailey, Katherine
Leon-Villapolos, Claire
Murray, Eleanor
Brett, Stephen
Type
Journal Article
Abstract
Objectives
This study aimed to quantify the presence of psychological safety (defined as an environment “safe for interpersonal risk taking”) in critical care staff, exploring the ways in which this manifested
Design
Qualitative interview study incorporating a short quantitative survey.
Setting
Three Intensive Care Units within one NHS Trust in London
Participants
Thirty participants were recruited from all levels of seniority and roles within the multidisciplinary team. A purposive sampling technique was used, with recruitment ceasing at the point of thematic saturation. Interventions
Semi-structured interviews explored attitudes towards psychological safety and contained a quantitative assessment measuring the climate of psychological safety present.
Results
Twenty-eight participants agreed that it was easy to ask for help, with 20 agreeing it is safe to take a risk on the team, demonstrating a strong perception of psychological safety in this group.
Our thematic analysis highlighted areas where the context influenced an individual’s psychological safety including personality, culture & leadership. Possible negative consequences of psychological safety included distraction and fatigue for the team leader. We demonstrated that speaking up can be influenced by motivations other than patient safety – such as undermining or self-promotion.
Conclusions
Our data demonstrate reassuring levels of psychological safety within the participants studied. This allowed us to explore in depth the participant experience of working within a psychologically safe environment. We add to the current literature by uniquely demonstrating there can be negative consequences to a psychologically safe environment in the healthcare setting. We expand on the influence of context on psychological safety by developing a model – allowing leaders to identify which elements of context can be modified in order to promote speaking up. Team leaders can use this data to help foster a culture of openness, innovation and error prevention; whilst minimising the risk of negative implications
This study aimed to quantify the presence of psychological safety (defined as an environment “safe for interpersonal risk taking”) in critical care staff, exploring the ways in which this manifested
Design
Qualitative interview study incorporating a short quantitative survey.
Setting
Three Intensive Care Units within one NHS Trust in London
Participants
Thirty participants were recruited from all levels of seniority and roles within the multidisciplinary team. A purposive sampling technique was used, with recruitment ceasing at the point of thematic saturation. Interventions
Semi-structured interviews explored attitudes towards psychological safety and contained a quantitative assessment measuring the climate of psychological safety present.
Results
Twenty-eight participants agreed that it was easy to ask for help, with 20 agreeing it is safe to take a risk on the team, demonstrating a strong perception of psychological safety in this group.
Our thematic analysis highlighted areas where the context influenced an individual’s psychological safety including personality, culture & leadership. Possible negative consequences of psychological safety included distraction and fatigue for the team leader. We demonstrated that speaking up can be influenced by motivations other than patient safety – such as undermining or self-promotion.
Conclusions
Our data demonstrate reassuring levels of psychological safety within the participants studied. This allowed us to explore in depth the participant experience of working within a psychologically safe environment. We add to the current literature by uniquely demonstrating there can be negative consequences to a psychologically safe environment in the healthcare setting. We expand on the influence of context on psychological safety by developing a model – allowing leaders to identify which elements of context can be modified in order to promote speaking up. Team leaders can use this data to help foster a culture of openness, innovation and error prevention; whilst minimising the risk of negative implications
Date Issued
2021-08-04
Date Acceptance
2021-07-20
Citation
BMJ Open, 2021, 11 (8), pp.1-8
ISSN
2044-6055
Publisher
BMJ Journals
Start Page
1
End Page
8
Journal / Book Title
BMJ Open
Volume
11
Issue
8
Copyright Statement
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
License URL
Identifier
https://bmjopen.bmj.com/content/11/8/e046699
Subjects
adult intensive & critical care
human resource management
organisational development
qualitative research
quality in health care
Critical Care
Humans
Leadership
Patient Safety
Qualitative Research
State Medicine
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Publication Status
Published
Date Publish Online
2021-08-04