The National Health Service faces many challenges including the preservation of a healthy workforce and prevention of medical error. Psychological Safety, defined as an environment “safe for interpersonal risk taking” can help mitigate these challenges. This environment, where individuals feel safe to “speak up” can promote organisational safety and individual wellbeing. “Stress” is also implicated in the aetiology of error and low job satisfaction, justifying strategies to minimise its occurrence. This Thesis aims to describe key and previously undescribed features regarding the manifestation of psychological safety and stress in healthcare workers.
Existing data regarding psychological safety were explored through a comprehensive evidence synthesis. Three mixed methods studies encompassing qualitative interviews and quantitative surveys were subsequently conducted. These explored the aetiology, presence, impact and sequelae of psychological safety and stress in critical care workers, emergency department staff and hospital managers.
Data provided a detailed understanding of the complexity of the workplace environment from an individual worker’s perspective. A reassuring climate of psychological safety was demonstrated in clinical participants. This was lower for managers, highlighting how this environment can differ within the same organisation. Data analyses yielded novel information regarding the influence of situational context and personality on psychological safety and demonstrated the potential for negative consequences of such an environment. Both ‘typical’ stressors and the COVID-19 pandemic were evaluated, highlighting that whilst generally detrimental, challenging events could create positive sequelae including enhanced camaraderie. Models were developed highlighting key factors within the workplace that can be improved to enhance psychological safety and mitigate stress.
It is important for staff wellbeing and organisational safety that a climate of psychological safety is cultivated, and that stresses are mitigated and supported. Healthcare leaders can use the models presented in this Thesis to identify modifiable areas for change and implement solutions within their own workplace environments.