P92 Power dynamics in healthcare teams – a barrier to team effectiveness and patient safety: A systematic review

INTRODUCTION: Hierarchies in healthcare teams are pervasive and widely acknowledged as impacting on working cultures. This review explores the impact of power dynamics in multidisciplinary healthcare teams on patient safety and team effectiveness. METHODS: A systematic review was conducted using five academic databases (PubMed, CINAHL, PsycInfo, Cochrane Library, Embase) between January 2010-2020. Potentially relevant articles were selected based on title and abstract review, followed by full text review, data extraction and data appraisal. Consistent with PRISMA guidelines, two researchers independently carried out all stages, from data screening to quality appraisal. A narrative synthesis was conducted. RESULTS: The databases searches yielded a total of 869 studies. 28 studies met the eligibility criteria and were included in the synthesis. Of these, 20 articles associated power dynamics with team effectiveness and 19 linked power dynamics to patient safety outcomes. Hierarchical power dynamics inhibit team communication and speaking up behaviours, which impacts team effectiveness and patient safety. Barriers to speaking up include workplace policies; respect for seniors’ experience; time pressures; feelings of intimidation and powerlessness; fears of reprisal and repercussions; perceived poor self-efficacy; lack of confidence and role clarity. CONCLUSION: Hierarchies and power dynamics have a profoundly negative effect on patient safety and team effectiveness through their negative impact on communication and speaking up behaviours. Whilst hierarchies cannot be abolished, to improve team communication and collaboration, healthcare organisations and training programmes should consider initiatives that break down silos and promote an inclusive approach to patient care. Initiatives that target the practice of collective leadership and an open and supportive work environment have been shown to improve communication and team effectiveness. Theme: Cross-disciplinary research