Table 3 Facilitators of psychological safety identified in this study
Facilitator | Quote | Level | |
|---|---|---|---|
Leader and leader inclusiveness | Introducing individuals to the team | “The manager makes it a point that they will introduce everybody to the new person... so that you’re not sitting there feeling like nobody knows who you are and you’re not really allowed to say anything” | Team-based |
Leader actions and qualities, such as active encouragement of participation in MDT discussion, supportive nature and effective listening skills | “The senior clinician asks every single person if there are any issues, if there is something else to discuss, if they are having any problems” | ||
Open culture | Non-judgemental atmosphere | “Everybody can speak up (...)especially when the nurses and healthcare assistants, they’re all chipping in as well, you do feel very much like I can say whatever want and (...)it’s quite a safe environment as well because nobody judges you” | Team-based |
Receptiveness to contributions from all members | “Sometimes you might not get an idea, and a simple layman person may give you an idea that works. And people accept it, they appreciate it and that’s why it is easy for us to communicate” | ||
Support in silos | Identifying with a group of similar individuals (a silo) strengthened their voice and created unity within the subgroup. | “In the nursing team, we’ve all learnt how to stand our ground a bit more that also quite important otherwise it’s a challenge because if a doctor asks you to do something the kind of traditional idea is that they are in authority so it can be difficult to push back” | Team-based |
A silo leader reduced the power distance by acting as a spokesperson for the group. | “If something happened it’s easier for me personally to discuss and explain with my head of nurse than going to the manager or the partners which might be easy for my head of nursing team to explain it further and ask for a solution” | ||
Vocal personality | Having an inherent trait that enables an individual to voice opinions confidently. | Individual-level | |
Boundary spanner | The presence of a boundary spanner, an individual responsible for linking sub-groups within the wider MDT, often identified as the practice manager. | This individual was described as essential in ensuring “a link between admin and clinical teams”. | Team-based |
Chairing meetings | Chairing meetings facilitated individuals to speak up, and in turn, they acted as a facilitator to others speaking up | “I’m the chair of the meeting so I feel comfortable to express myself.” “I’ve also chaired lots of meetings as well so I am aware of the need to get everyone, to encourage everyone’s contribution” | Individual- level |
Interpersonal relationships | Longstanding members with stronger interpersonal relationships felt more comfortable speaking up compared to new individuals to the team. | “I’ve worked at the practice for five years so I know everybody very well and we’re all very comfortable in speaking our mind. I think when I first started at the practice, I was probably a little bit more hesitant to say my opinions.” | Team-based |
Small teams | Small teams help individuals to be more comfortable and confident, whilst preventing individuals feeling outnumbered | “I might say it later in a smaller group of um, of GPs and/or nurses but probably not in- in the bigger group.” | Team-based |