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Remtulla R, Hagana A, Houbby N, et al. Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC Health Serv Res. 2021;21(1):269doi: 10.1186/s12913-021-06232-7.
Remtulla, R., Hagana, A., Houbby, N., Ruparell, K., Aojula, N., Menon, A., Thavarajasingam, S. G., & Meyer, E. (2021). Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC health services research, 21(1), 269. https://doi.org/10.1186/s12913-021-06232-7
Remtulla, Ridhaa, et al. "Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study." BMC health services research vol. 21,1 (2021): 269. doi: https://doi.org/10.1186/s12913-021-06232-7
Remtulla R, Hagana A, Houbby N, Ruparell K, Aojula N, Menon A, Thavarajasingam SG, Meyer E. Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC Health Serv Res. 2021 Mar 24;21(1):269. doi: 10.1186/s12913-021-06232-7. PMID: 33761958; PMCID: PMC7988250.
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BMC Health Serv Res. 2021 Mar 24;21(1):269. doi: 10.1186/s12913-021-06232-7.

Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study.

BMC health services research

Ridhaa Remtulla, Arwa Hagana, Nour Houbby, Kajal Ruparell, Nivaran Aojula, Anannya Menon, Santhosh G Thavarajasingam, Edgar Meyer

Affiliations

  1. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. [email protected].
  2. Imperial College London, School of Medicine, London, UK.
  3. Leeds University Business School, University of Leeds, Leeds, UK.

PMID: 33761958 PMCID: PMC7988250 DOI: 10.1186/s12913-021-06232-7

Abstract

BACKGROUND: Psychological safety is the concept by which individuals feel comfortable expressing themselves in a work environment, without fear of embarrassment or criticism from others. Psychological safety in healthcare is associated with improved patient safety outcomes, enhanced physician engagement and fostering a creative learning environment. Therefore, it is important to establish the key levers which can act as facilitators or barriers to establishing psychological safety. Existing literature on psychological safety in healthcare teams has focused on secondary care, primarily from an individual profession perspective. In light of the increased focus on multidisciplinary work in primary care and the need for team-based studies, given that psychological safety is a team-based construct, this study sought to investigate the facilitators and barriers to psychological safety in primary care multidisciplinary teams.

METHODS: A mono-method qualitative research design was chosen for this study. Healthcare professionals from four primary care teams (n = 20) were recruited using snowball sampling. Data collection was through semi-structured interviews. Thematic analysis was used to generate findings.

RESULTS: Three meta themes surfaced: shared beliefs, facilitators and barriers to psychological safety. The shared beliefs offered insights into the teams' background functioning, providing important context to the facilitators and barriers of psychological safety specific to each team. Four barriers to psychological safety were identified: hierarchy, perceived lack of knowledge, personality and authoritarian leadership. Eight facilitators surfaced: leader and leader inclusiveness, open culture, vocal personality, support in silos, boundary spanner, chairing meetings, strong interpersonal relationships and small groups.

CONCLUSION: This study emphasises that factors influencing psychological safety can be individualistic, team-based or organisational. Although previous literature has largely focused on the role of leaders in promoting psychological safety, safe environments can be created by all team members. Members can facilitate psychological safety in instances where positive leadership behaviours are lacking - for example, strengthening interpersonal relationships, finding support in silos or rotating the chairperson in team meetings. It is anticipated that these findings will encourage practices to reflect on their team dynamics and adopt strategies to ensure every member's voice is heard.

Keywords: Community; General practice; Primary care; Psychological safety; Teamwork

References

  1. Healthcare (Basel). 2017 Oct 14;5(4): - PubMed
  2. JCO Oncol Pract. 2020 Apr;16(4):e377-e383 - PubMed
  3. Can J Anaesth. 2015 Jun;62(6):576-86 - PubMed
  4. J Health Organ Manag. 2014;28(6):754-76 - PubMed
  5. Acad Med. 2009 Dec;84(12):1765-74 - PubMed
  6. Br J Hosp Med (Lond). 2013 Dec;74(12):687-90 - PubMed
  7. J Am Coll Surg. 2014 Nov;219(5):1001-7 - PubMed
  8. J Appl Psychol. 2012 Nov;97(6):1273-81 - PubMed
  9. BMJ Qual Saf. 2019 Jan;28(1):39-48 - PubMed
  10. J Basic Clin Pharm. 2014 Sep;5(4):87-8 - PubMed
  11. Iran J Nurs Midwifery Res. 2018 Jan-Feb;23(1):40-44 - PubMed
  12. Hosp Pediatr. 2016 May;6(5):275-81 - PubMed
  13. Health Care Manage Rev. 2020 Jul/Sep;45(3):245-254 - PubMed
  14. Nurse Educ Today. 2018 Aug;67:100-107 - PubMed
  15. Anaesthesia. 2016 Nov;71(11):1332-1340 - PubMed
  16. BMJ Open. 2016 Jul 29;6(7):e012467 - PubMed
  17. Health Care Manage Rev. 2014 Jul-Sep;39(3):186-97 - PubMed
  18. J Oncol Pract. 2016 Nov;12(11):1000-1011 - PubMed
  19. Med Educ. 2016 Mar;50(3):343-50 - PubMed
  20. J Adv Nurs. 2019 Jun;75(6):1229-1238 - PubMed
  21. Oncol Nurs Forum. 2014 Sep;41(5):545-7 - PubMed
  22. J Patient Saf. 2020 Dec;16(4):e230-e234 - PubMed
  23. Med Educ. 2014 Jun;48(6):583-92 - PubMed
  24. Clin Rheumatol. 2020 Mar;39(3):667-671 - PubMed
  25. Int J Qual Health Care. 2007 Dec;19(6):349-57 - PubMed
  26. Int J Environ Res Public Health. 2020 Jun 15;17(12): - PubMed
  27. BMC Health Serv Res. 2014 Jul 14;14:303 - PubMed
  28. Front Psychol. 2019 Sep 27;10:2137 - PubMed
  29. J Adv Nurs. 2016 Dec;72(12):2954-2965 - PubMed
  30. Milbank Q. 2012 Jun;90(2):347-74 - PubMed
  31. Nurs Manage. 2019 Aug;50(8):32-38 - PubMed

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