A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour

Abstract

Background: Having psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions. Methods: A key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers. Results: Fourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions' ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours. Conclusion: To improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams. Prospero registration number: CRD42018100659.

Exploring psychological safety in healthcare teams to inform the development of interventions: combining observational, survey and interview data

“…This study provides an in-depth understanding of psychological safety within four healthcare teams working in the same case study hospital. It addresses recent calls for the use of multiple methods to capture a more accurate and nuanced understanding of psychological safety in healthcare teams [8,10]. While survey results from each team reflected high psychological safety, observations and interviews captured exceptional cases and more subtle dynamics within teams.…”

“…This highlights the need for teams whose roles are more separate from one another to make deliberate efforts to cultivate familiarity. This corresponds with the need to develop interventions which are suited for use across and between multiple disciplines [8]. This is particularly important in a healthcare context, where psychological safety is needed for "teaming", an active process which allows multidisciplinary healthcare teams to work together to deliver increasingly complex patient care [10,42].…”

“…In addition to gaining an understanding of psychological safety within healthcare teams, this study aimed to inform the development of interventions to improve it. A recent systematic review of such interventions has highlighted that in order to improve their effectiveness, interventions targeting psychological safety need to be grounded in the experiences of the target audience [8]. This study contributes to a more in-depth understanding of psychological safety within healthcare teams which is needed to develop future interventions.…”

“…However, a culture of fear and low psychological safety still exists within healthcare organisations [3][4][5][6][7]. There is a need to develop and implement interventions to improve psychological safety within these teams [8]. The ongoing Covid-19 pandemic has highlighted the importance of psychological safety within healthcare teams.…”

“…Cultivating psychological safety is necessary in order to enable healthcare teams to collectively redesign processes and services to cope with new challenges, learn from mistakes and implement changes accordingly [9]. In order to improve psychological safety, we must first understand the complexity and nuance of psychological safety within healthcare teams [8,10].…”