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Table 2 Barriers to psychological safety identified in this study

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

Barrier Quote Level
Hierarchy MDT members such as doctors valued more “Sometimes we can feel the kind of separation like you feel like your input is slightly valued less than a doctor’s would be” Organisational
“We have had a few incidences where doctors can talk down to us as if it’s as though we aren’t as knowledged as them(…)so it can be a bit soul-destroying sometimes”
Lack of Knowledge Lack of awareness of the cases being discussed “because of working (part-time) (...) I probably don’t know enough about that particular subject so I won’t speak but it frustrates me sometimes because I’d like to but I probably wouldn’t in case I’m saying the wrong thing” Team based
Increased anxiety related to saying something incorrect or appearing as the lone member lacking in knowledge “I realised it was very clear for the rest of the team but me as for what action has to be taken clinically. So I kind of wrapped up the discussion because I realised there were a few things I didn’t think of that were obvious for the rest”
Authoritarian Leadership Discussion’s being ‘imposed’ rather than being discussed
Member’s feeling powerless in clinical decision making
When the leadership “is not really nice or [is] authoritative or rude, then you know, there’s not much [they] can do because eventually it’s their practice” Team based
Leaders devaluing ideas by team members “You need an essential body of leadership to listen, identify and act and we don’t have that. There’s loads of people with good ideas on the ground for the practice but it doesn’t relate to sensible decisions higher up because it’s kind of a vacuum of leadership in the centre of the organization.”
Personality Dominant personalities overpowering conversations
Other members unable to contribute
“There’s quite a mix of personalities and dynamics within the group(...)sometimes just trying to get your point across, so you might have to bring it up several times and you might have to repeat yourself a few times”
“Sometimes one of the partners might have been a bit more dominant in their opinion and not everybody liked it
Individual level
Intrinsic barriers: shy personality, lack of confidence, fear of public speaking & personal worries about self-image “I think I’ve got that- the problem with me is feeling embarrassed, that’s my problem. I don’t think it’s anything to do with the team … they’ve never made me feel stupid”