Article Text

Original research
Exploring the factors that promote or diminish a psychologically safe environment: a qualitative interview study with critical care staff
  1. Kate Grailey1,
  2. Clare Leon-Villapalos2,
  3. Eleanor Murray3,
  4. Stephen Brett1
  1. 1Department of Surgery and Cancer, Imperial College London, London, UK
  2. 2Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
  3. 3Said Business School, University of Oxford Said Business School, Oxford, UK
  1. Correspondence to Dr Kate Grailey; k.grailey18{at}imperial.ac.uk

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 National Health Service 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 Semistructured 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 and 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 these data to help foster a culture of openness, innovation and error prevention while minimising the risk of negative implications

  • human resource management
  • organisational development
  • quality in health care
  • adult intensive & critical care
  • qualitative research

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data in the form of qualitative interview transcripts and completed quantitative survey data are stored in a secure server within Imperial College NHS Healthcare Trust. They are available from the author (ORCID ID 0000-0002-4104-8444).

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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/.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data in the form of qualitative interview transcripts and completed quantitative survey data are stored in a secure server within Imperial College NHS Healthcare Trust. They are available from the author (ORCID ID 0000-0002-4104-8444).

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Footnotes

  • Twitter @cleonvillapalos

  • Contributors KG, EM and SB conceptualised and designed this study. KG and SB were involved in recruitment of participants. KG was responsible for data collection and overall data analysis. CL-V assisted with data analysis. All authors reviewed the data and coding discrepancies in line with qualitative research techniques. KG prepared the original draft manuscript. All authors reviewed and edited the manuscript. All four authors approved the final version of the manuscript. The corresponding author confirms that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. SB is the guarantor.

  • Funding KG received an unrestricted educational grant from BUPA Cromwell Hospital. Infrastructure support for this research was provided by the Imperial Comprehensive Biomedical Research Centre.

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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