Exploring the factors that promote or diminish a psychologically safe environment: a qualitative interview study with critical care staff

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