Measuring psychological safety in healthcare teams: developing an observational measure to complement survey methods

Fostering Psychological Safety and Supporting Mental Health Among Cardiovascular Health Care Workers: A Science Advisory From the American Heart Association

The psychological safety of health care workers is an important but often overlooked aspect of the rising rates of burnout and workforce shortages. In addition, mental health conditions are prevalent among health care workers, but the associated stigma is a significant barrier to accessing adequate care. More efforts are therefore needed to foster health care work environments that are safe and supportive of self-care. The purpose of this brief document is to promote a culture of psychological safety in health care organizations. We review ways in which organizations can create a psychologically safe workplace, the benefits of a psychologically safe workplace, and strategies to promote mental health and reduce suicide risk.

Psychological safety perception in community pharmacies: A randomized controlled trial of agile interventions

Background

Agile coaching, recognized as a more advanced methodology compared to education, is hypothesized to yield superior outcomes in enhancing psychological safety perception.

Objective

Investigating the effectiveness of agile interventions versus no intervention on psychological safety perception, this randomized controlled trial aimed to clarify outcomes.

Methods

The survey sample consisted of 54 licensed pharmacists, with each group comprising 18 participants: E1 underwent Agile Coaching, E2 underwent Agile Education, and C served as the control. After six weeks, psychological safety perception was measured using a validated scale, and statistical analyses, including the Kruskal-Wallis test and Mann-Whitney U test, were conducted.

Results

The group undergoing agile coaching showed the most substantial enhancements in psychological safety perception compared to others. Mann-Whitney U test revealed no significant difference in psychological safety perception between E1 and E2 groups before (Z = -0.938, p = 0.348) and after intervention (Z = -1.269, p = 0.204). Significant differences were observed between E1 and C both before (Z = -2.693, p = 0.007) and after intervention (Z = -1.414, p = 0.157). Significant differences were found between E2 and C before (p = 0.038) but not after intervention (p = 0.962).

Conclusions

The findings suggest that agile coaching could be an effective intervention for enhancing psychological safety in organizational settings, particularly in community pharmacies. Further research is warranted to explore long-term effects and generalize findings to broader contexts.

Validation of the Italian version of the Neuroception of Psychological Safety Scale (NPSS)

Research on the neuroscience of fear in both humans and non-humans has suggested that a lack of acquisition of safety cues might be a biological hallmark of posttraumatic stress disorder (PTSD). Danger perception, and in particular, feeling as one's own life is in danger, is thought to represent a major predictor of PTSD. Persistent danger perception is concurrently associated with a persistence of lack of safety. However, despite several research efforts, no validated psychometric tools exist regarding psychological safety as a unique core construct in the domain of a soothing-contentment system. By including social, compassionate, and bodily components, the Neuroception of Psychological Safety Scale (NPSS), neurophysiologically rooted in the polyvagal theory, aims to specifically assess psychological safety. Originally developed in English, we employed a rather large non clinical sample to validate our Italian translation of the NPSS (n = 338) and the scale was found to retain a three-factor structure. In light of its positive moderate correlations with the Unconditional Self-Kindness Scale (ρ = 0.376) and the Self-Compassion Scale-Short-Form (ρ = 0.481), good convergent validity and robust psychometric properties were shown by the NPSS. The Subjective Traumatic Outlook Questionnaire (ρ = -0.283) and the three subscales of the Body Perception Questionnaire-22-Body Awareness (ρ = -0.103), Supradiaphragmatic Reactivity (ρ = -0.234), and Body Awareness/Subdiaphragmatic Reactivity (ρ = -0.146)-were found to have weak negative correlations with the NPSS, which further demonstrated its good discriminant validity. Eventually, the NPSS was found to show good test-retest reliability (intraclass correlation coefficient = 0.922; three-week time interval), and its usage is fostered in clinical and research contexts where the evaluation of psychological safety is of relevance.

Psychological safety in the perioperative environment: a cost-consequence analysis

INTRODUCTION

Psychologically unsafe healthcare environments can lead to high levels of staff turnover, and unwanted financial burden. In this study, we investigate the hypothesis that lower levels of psychological safety are associated with higher levels of turnover, within an anaesthesiology department and we estimate the cost attributable to low psychological safety, driven by turnover costs.

METHODS

Psychological safety was measured in one academic department. The psychological safety score was correlated with 'intention to leave' using linear regression and Pearson correlation and a cost-consequence analysis was performed.

RESULTS

One hundred and thirty-eight physician anaesthesiologists (MDs) and 282 certified registered nurse anaesthetists (CRNAs) were surveyed. The response rate was 67.4% (93/138) for MDs and 60.6% (171/282) for CRNAs. There was an inverse relationship between psychological safety and turnover intent for both MDs (Pearson correlation -0.373, p value <0.0002) and CRNAs (Pearson correlation -0.486, p value <0.0002). The OR of intent to turn over in the presence of low psychological safety was 6.86 (95% CI 1.38 to 34.05) for MDs and 8.93 (95% CI 4.27 to 18.68) for CRNAs. The cost-consequence analysis demonstrated the cost of low psychological safety related to turnover per year was $337, 428 for MDs and $14, 024, 279 for CRNAs. Reducing low psychological safety in CRNAs from 31.6% to 20% reduces the potential cost of low psychological to $8 876 126.03.

CONCLUSION

There is a cost relationship between low psychological safety and turnover. Low psychological safety in an academic anaesthesiology department may result in staff turnover, and potentially high financial costs.

Multifaceted ORganizational InterventiONs (M-ORION) project for prevention of depression and anxiety among workers: study protocol for a five-arm cluster randomized controlled trial

BACKGROUND

Depression and anxiety are the most common mental health issues experienced by workers. Although organizational intervention has been extensively evaluated as a primary prevention of depression and anxiety, the corresponding scientific evidence remains limited because of the lack of cluster randomized controlled trials (cRCT) and failure to detect organizational-level effects. Therefore, the present study aims to assess the preventive effects of four types of interventions on depression and anxiety among workers in an open, five-arm, parallel-group cRCT.

METHODS

Overall, 140 worksites and 18,200 nested employees will be recruited from September 2023. The eligible worksites will be randomly assigned to each of the five arms, and programs will be offered for 6-12 months. The five arms are 1) psychoeducation for workers, 2) psychoeducation for supervisors, 3) work environment improvement, 4) physical activity promotion, and 5) active control. The primary outcomes of interest are depression and anxiety. We will also assess psychosocial factors at work, work engagement, health-related quality of life, well-being, economic outcomes, physiological outcomes of health checkups, cortisol levels extracted from fingernails, and indices representing the process and implementation outcomes, including program completion rates. Follow-up surveys will be conducted at 6, 12, and 18 months from baseline, and the primary endpoint is set at the 6-month follow-up. Repeated-measures multi-level mixed modeling will be used to evaluate the effect of each intervention compared with the control.

ETHICS AND DISSEMINATION

The study protocol was approved by the Research Ethics Committee of the Kitasato University Medical Ethics Organization (C22-082). The results and findings of this study will be published in a scientific journal and disseminated to companies that participate in the study.

TRIAL REGISTRATION NUMBER

UMIN000050949.

A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol

Background: International policy is increasingly committed to placing interdisciplinary team-working at the centre of health and social care integration across the lifespan. The National Clinical Programme for Older People in Ireland has a critical role in the design and implementation of the National Older Person's Service Model, which aims to shift the delivery of care away from acute hospitals towards community-based care. Interdisciplinary Community Specialist Teams for older persons (CST-OPs) play an important role in this service model. To support the development of competencies for interprofessional collaboration and an interdisciplinary team-based approach to care integration, a culture shift will be required within care delivery. Design:This study builds upon a collaborative partnership project which co-designed a framework describing core competencies for interprofessional collaboration in CST-OPs. A realist-informed process evaluation of the framework will be undertaken as the competencies described in the framework are being fostered in newly developed CST-OPs under the national scale-up of the service model. Realist evaluation approaches reveal what worked, why it worked (or did not), for whom and under what circumstances. Three iterative and integrated work packages are proposed which combine multiple methods of data collection, analysis and synthesis. Prospective data collection will be undertaken within four CST-OPs, including qualitative exploration of the care experiences of older people and family carers. Discussion: The realist explanatory theory will provide an understanding of how interprofessional collaboration can be fostered and sustained in various contexts of care integration for older people. It will underpin curriculum development for team-based education and training of health and social care professionals, a key priority area in the national Irish health strategy. It will provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and to realise the goals of integrated care for older people.

Bias in the trauma bay: A multicenter qualitative study on team communication

BACKGROUND

Team communication and bias in and out of the operating room have been shown to impact patient outcomes. Limited data exist regarding the impact of communication bias during trauma resuscitation and multidisciplinary team performance on patient outcomes. We sought to characterize bias in communication among health care clinicians during trauma resuscitations.

METHODS

Participation from multidisciplinary trauma team members (emergency medicine and surgery faculty, residents, nurses, medical students, emergency medical services personnel) was solicited from verified level 1 trauma centers. Comprehensive semistructured interviews were conducted and recorded for analysis; sample size was determined by saturation. Interviews were led by a team of doctorate communications experts. Central themes regarding bias were identified using Leximancer analytic software (Leximancer Pty Ltd., Brisbane, Australia).

RESULTS

Interviews with 40 team members (54% female, 82% White) from 5 geographically diverse Level 1 trauma centers were conducted. More than 14,000 words were analyzed. Statements regarding bias were analyzed and revealed a consensus that multiple forms of communication bias are present in the trauma bay. The presence of bias is primarily related to sex but was also influenced by race, experience, and occasionally the leader's age, weight, and height. The most commonly described targets of bias were females and non-White providers unfamiliar to the rest of the trauma team. Most common sources of bias were White male surgeons, female nurses, and nonhospital staff. Participants perceived bias being unconscious but affecting patient care.

CONCLUSION

Bias in the trauma bay is a barrier to effective team communication. Identification of common targets and sources of biases may lead to more effective communication and workflow in the trauma bay.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

Investigating preceptor experiences with cultural intelligence in pharmacy education

BACKGROUND

A culturally intelligent pharmacy workforce is critical for addressing health disparities and ensuring that healthcare teams are equipped to support the medication needs of patients. Despite the critical role of preceptors in developing aspiring pharmacists, little is known about how they create or manage cross-cultural situations for students.

OBJECTIVE

The objective of this study was to explore preceptor experiences teaching cultural intelligence within experiential pharmacy settings.

METHODS

A convergent parallel mixed methods approach was used with a 10-item survey measuring preceptor teaching self-efficacy (measured from 0-cannot do at all to 10-highly certain can do) and interviews/focus groups to further understand cultural intelligence teaching experiences. Data were analyzed according to the 4 domains of the cultural intelligence framework (i.e., cultural awareness, cultural knowledge, cultural practice, and cultural desire). Survey data were analyzed descriptively and qualitative data were analyzed deductively.

RESULTS

Participants (n = 24) were most confident Discussing factors underlying health and healthcare disparities (e.g., access, socioeconomic status, environment, racial/ethnic) (7.54 ± 2.04) and least confident in Understanding the importance of cultural desire in teaching students to be culturally intelligent healthcare practitioners (5.21 ± 2.72). All four cultural intelligence domains were identified in the qualitative data (n = 315 codes), with preceptors providing evidence of cultural awareness (n = 38, 12.1%), cultural knowledge (n = 54, 17.1%), cultural practice (n = 183 codes, 58.1%), and cultural desire (n = 40, 12.7%). Preceptors described various pedagogical strategies, such as case discussions, reflection, and simulation.

CONCLUSIONS

Participants provided insight into pedagogical strategies for cultural intelligence that could promote student learning in experiential settings and help explicate curricular gaps. Further research regarding applicability of the cultural intelligence framework is needed, including application of these strategies and opportunities for preceptor development.

Transcendental and Material Silence: A Multimodal Study on Silence in Team Meetings

Silence in management and organization studies has been predominantly understood as something negative. However, recent examples have highlighted silence as a positive element in learning and organizing. We contribute to prior literature on positive silence and multimodality by arguing silence can operate as a semiotic mode that mobilizes resources for meaning-making. Ten team meetings in a financial organization in Europe were investigated. Visual ethnography was mobilized to gather data through interviews, observations, and photographs. Our analysis identified two types of silence—transcendental and material—that both function through three mechanisms to resemiotize meaning. A framework is presented to situate silence in relation to verbal and visual modes. Three contributions are made to studies on silence and multimodality: extended conceptualizations of silence, silence as a semiotic mode in itself, and methodological pathways for studying silence. In addition, practical implications for team meetings and silence in the workplace are discussed.

Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings

BACKGROUND

Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program.

METHODS

Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model.

RESULTS

Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change.

CONCLUSION

To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.

The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings

OBJECTIVES

The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) exploring whether PS differs by healthcare worker demographic factors, and (4) exploring whether PS differs by participation in 2 institutional programs, which encourage PS and speaking-up with patient safety concerns (i.e., Safety WalkRounds and Positive Leadership WalkRounds).

METHODS

Of 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate, 81%) completed the 6-item PS scale, demographics, safety culture scales, and questions on exposure to institutional initiatives. Psychometric analyses, correlations, analyses of variance, and t tests were used to test the properties of the PS scale and how it differs by demographic factors and exposure to PS-enhancing initiatives.

RESULTS

The PS scale exhibited strong psychometric properties, and a 1-factor model fit the data well (Cronbach α = 0.80; root mean square error approximation = 0.08; Confirmatory Fit Index = 0.97; Tucker-Lewis Fit Index = 0.95). Psychological Safety scores differed significantly by role, shift, shift length, and years in specialty. The PS scale correlated significantly and in expected directions with safety culture scales. The PS score was significantly higher in work settings with higher rates of exposure to Safety WalkRounds or Positive Leadership WalkRounds.

CONCLUSIONS

The PS scale is brief, diagnostic, and actionable. It exhibits strong psychometric properties; is associated with better safety, teamwork climate, and well-being; differs by demographic factors; and is significantly higher for those who have been exposed to PS-enhancing initiatives.

The Survey Measure of Psychological Safety and Its Association with Mental Health and Job Performance: A Validation Study and Cross-Sectional Analysis

OBJECTIVES

This study validated the Japanese version of O'Donovan et al.'s (2020) composite measure of the psychological safety scale and examined the associations of psychological safety with mental health and job-related outcomes.

METHODS

Online surveys were administered twice to Japanese employees in teams of more than three members. Internal consistency and test-retest reliability were tested using Cronbach's α and intra-class correlation coefficient (ICC), respectively. Structural validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Convergent validity was tested using Pearson's correlation coefficients. Multiple linear regression analyses were conducted to examine the relationship between psychological safety and psychological distress, work engagement, job performance, and job satisfaction.

RESULTS

Two hundred healthcare workers and 200 non-healthcare workers were analyzed. Internal consistency, test-retest reliability, and convergent validity were acceptable. CFA demonstrated poor fit, and EFA yielded a two-factor structure, with team leader as one factor and peers and team forming the second factor. The total score showed significant and expected associations with all outcomes in the adjusted model for all workers.

CONCLUSIONS

The Japanese version of the measure of the psychological safety scale presented good reliability and validity. Psychological safety is important for employees' mental health and performance.

Measuring Employees’ Communication for Innovation: The Employee Innovation Potential Scale

Abstract. This research aimed to introduce and validate a new self-report measure of organizational communication related to early stages of employee-driven innovation – the Employee Innovation Potential Scale (EIPS). Exploratory factor analysis and confirmatory factor analysis were performed consecutively on two samples of employees from Serbian companies ( N = 723). The final form of the EIPS comprises 25 items and measures four factors: insight into company problems and their causes, company values employees' ideas, idea communication, and interest in company improvements. Employees who shared more ideas had higher scores on all four factors compared to employees who did not share any ideas or just a few, which confirmed factors’ criterion validity. Moreover, employees who shared more global and radical ideas had higher scores on the first two factors. The results supported the four-factor solution of EIPS and its criterion validity.

Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study

AIMS

This study aimed to assess predictors of patient safety competency among emergency nurses.

BACKGROUND

The role of emergency nurses is to provide high-quality health care to patients and ensure their safety. The patient safety competency includes the absence of unnecessary or potential harm when providing health care to patients. In providing health care, effective teamwork can affect patient safety and outcomes. Psychological safety is essential to effective teamwork. Psychological safety allows health care workers to accept the interpersonal risks needed to perform effective teamwork and maintain patient safety.

METHODS

This study was cross-sectional correlational research. Using convenience sampling methods, 254 emergency department nurses from five educational hospitals were enrolled in the study. Patient Safety in Nursing Education Questionnaire was used to measure the patient safety competency, the teamwork questionnaire to examine the teamwork, and Edmondson psychological safety questionnaire was used to measure psychological safety. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multivariate stepwise linear regression analysis were applied using SPSS 14.0.

RESULTS

Participants' mean patient safety competency score was 2.97 (1-4). Between 18 independent variables evaluated in the multiple regression analysis, seven had a significant effect on the patient safety competency of emergency nurses (R²: 0.39, p < .001).

CONCLUSIONS

The patient safety competency of emergency department nurses was primarily related to the structure and leadership of the team and secondary to psychological safety and experience in patient safety activity. The results demonstrated that policymakers and hospital managers should improve and enhance team structure and leadership via supervision and cooperation with the nursing staff. The development of training programs in patient safety activities, improvement, and increase of psychological safety at the levels of the nursing units is essential to increase patient safety competencies in the emergency nursing program.

The community of inquiry framework for virtual team-to-team debriefings during interprofessional trauma simulations

Purpose

Psychological safety is key to effective debriefing and learning. The COVID-19 pandemic necessitated rapid adaption of simulation events to virtual/hybrid platforms. We sought to determine the effect of utilizing the Community of Inquiry framework (CoI) for debriefing virtually connecting interprofessional learner teams on the psychological safety experienced during trauma simulations.

Methods

General surgery (GSR), emergency medicine (EMR) residents, trauma nurses/nurse practitioners and medical students participated in multiple simulation events designed to improve teamwork and leadership skills. Pre-course materials were provided before the event for learners to prepare. Briefings delineating expectations emphasized importance of and strategies employed to achieve psychological safety. Four unique clinical scenarios were run for each simulation event, with a debrief after each scenario. Virtual team-to-team debriefings were structured using the Community of Inquiry (CoI) conceptual framework. All learners completed pre-/post-assessments utilizing Inter-professional Collaborative Competencies Attainment Survey (ICCAS).

Results

Twenty-five learners participated (13 GSR, 5 EMR, 3 medical students, 2 trauma APRNs and 2 trauma RNs). Learner assessment found 88% (22) "agreed"/"strongly agreed" that virtual team-to-team debriefing had social, cognitive and educator presence per the CoI domains. However, one GSR and two nurse learners "strongly disagreed" with these statements. Most learners felt the debriefing was effective and safe. All participants "strongly agreed"/"agreed" the simulation achieved ICCAS competencies.

Conclusions

Debriefings utilizing a virtual platform are challenging with multiple barriers to ensuring psychological safety and efficacy. By structuring debriefings using the CoI framework we demonstrate they can be effective for most learners. However, educators should recognize the implications of social identity theory, particularly the effects of hierarchy, on comfort level of learners. Developing strategies to optimize virtual simulation learning environments is essential as this valuable pedagogy persists during and beyond the COVID-19 pandemic.

Psychological safety during the test of new work processes in an emergency department

Background

Emergency medicine is a complex setting for healthcare delivery which relies on communication, negotiation, teamwork, trust, and shared dialog. The nature of the work comprises dealing with emotionally challenging situations and acting under uncertainty. For healthcare staff this poses the need to be adaptive and open to change. Psychological safety is an important component of productive teamwork and learning in such contexts. Edmondson’s model of team psychological safety highlights factors which contribute to the development of psychological safety for staff groups and the mediating role this has for team performance.

Aim

The aim of the study was explore the link between psychological safety and improvement work. The research question was: Do the aspects covered in the Edmondson model fully describe healthcare workers’ perceptions of psychological safety and are all aspects in the model needed to describe these perceptions during testing of new work procedures in an emergency department?”

Methods

Using a mixed-method approach we investigated a change programme with interviews, a questionnaire and a workshop in an emergency department of a hospital in the Capital Region of Denmark. Thematic analysis of qualitative data and descriptive statistics of questionnaire data were undertaken.

Results

Data indicate the Edmondson model is useful to help understand and identify important antecedent and outcome factors during a period of testing new work-flow processes. The model could not capture all aspects in this study’s data material, and was updated as a result. The main modifications were explicitly integrating the physical aspects of the work setting into the considerations of psychological safety, the inclusion of an additional antecedent factor relating to perceptions of care quality and adopting bi-directional links between the antecedent and consequence elements in the model.

Conclusions

Although limited in scale, the study supports Edmondson’s model of psychological safety as appropriate in describing many of the dynamics experienced by staff engaged in testing new work process. However, additional factors, not included in Edmondson’s model and potential adaptations to the model are proposed.

A concept analysis of psychological safety: Further understanding for application to health care

AIM

To clarify the concept of psychological safety in a healthcare context and to provide the first theoretical framework for improving interpersonal relationships in the workplace to better patient care.

DESIGN

A Rodgers' concept analysis.

METHODS

The concept analysis was conducted using a systematic search strategy on PubMed, CINAHL, PsycINFO and Ichushi-Web.

RESULTS

An analysis of 88 articles studying psychological safety in health care identified five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, group-level phenomenon, safe work environment for taking interpersonal risks and non-punitive culture. The antecedents included structure/system factors, interpersonal factors and individual factors. The four consequences included performance outcomes, organizational culture outcomes, and psychological and behavioural outcomes.

Teamworking in Healthcare during the COVID-19 Pandemic: A Mixed-Method Study

The widespread impact of COVID-19 on healthcare has demanded new ways of working across many organisation types and many forms of healthcare delivery while at the same time endeavouring to place minimal, or no, additional burden on already strained healthcare teams. This is a cross-sectional mixed-method study which captured the experiences of teamwork during the COVID-19 pandemic contributing to successful collaboration. We hypothesised that work engagement and psychological safety separately contribute to collective leadership and organisational citizenship behaviours. Participants were healthcare staff on active duty during the COVID-19 pandemic in Ireland (n = 152) who responded to our social media (Twitter) invitation to participate in this study. Survey and free-text responses were collected through an online platform. Structural equation modelling examined the relationships between work engagement and psychological safety, and collective leadership and OCBs. Open text responses relating to experiences of teamworking during the pandemic were analysed for latent themes. From the survey data, the structural model demonstrated excellent statistical fit indicating that psychological safety, but not work engagement, was predictive of collective leadership and OCBs. From the qualitative data, two key themes were generated: (1) Contrasting experiences of working in a team during the pandemic; and (2) The pandemic response: a tipping point for burnout. This study offers a valuable starting point to explore the factors driving change and the shift to more collective ways of working observed in response to COVID-19. Future studies should use longitudinal data to capture the temporal relationship of these variables which could be moderated by prolonged pressure to healthcare staff during the pandemic.

The model of psychological safety of a soldier's personality

BACKGROUND

From 2014 to the present, Ukrainian military personnel have been fighting in Eastern Ukraine against illegal armed formations of separatists. The resulting combat stress negatively affects servicemen's mental health status. This study aimed to examine the factor structure of a scale to assess the psychological safety of a soldier's personality (PSSP), taking into account changes in the conditions of military service to improve the professional and psychological training of military personnel.

PARTICIPANTS AND PROCEDURE

The study involved 118 officers of the National Guard of Ukraine. The semantic differential method, expert judgment, and exploratory factor analysis were used to determine the factor structure of the PSSP.

RESULTS

The PSSP model to maintain combat readiness in daily activities includes four components: "Moral and communicative", "Motivational and volitional", "Value and meaning of life" and "Inner comfort". For activities in extreme conditions (during combat deployment), the personality potential of four structural components is used: "Moral and volitional regulation", "Coping strategies", "Value and meaning of life" and "Post-traumatic growth/regression".

CONCLUSIONS

The PSSP model consists of four components that have different content depending on the conditions for performance of professional tasks by military personnel. It is advisable to use the obtained results of the content of the PSSP model in the development of professional and psychological training programs for the purposeful formation of the resilience of military personnel, taking into account the conditions of their activities.

Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

Poor well-being among health care workers, often observed as professional burnout, is a well-documented phenomenon. The coronavirus disease 2019 (COVID-19) pandemic has further stressed the health care workforce, but its specific effects on this workforce remain unknown. This study examined well-being and resilience among health care workers during the COVID-19 pandemic.

METHODS

The study used a cross-sectional survey design. Data collection took place through anonymous surveys of nurses (LPNs and RNs), advanced practice providers (NPs, physician assistants, and certified nurse midwives), certified registered nurse anesthetists, respiratory therapists, health care technicians, and therapy service professionals (physical, occupational, and speech therapists). Of the 6,120 health care workers recruited to participate in the study, data from 2,459 participants were analyzed using logistic regression and linear regression.

RESULTS

The study found that several factors significantly increased the likelihood of at-risk well-being. These included having a lower level of resilience, using support resources, feeling the organization lacked understanding of the emotional support needs of health care workers during the pandemic, believing the workload had increased, believing there was insufficient personal protective equipment, believing there was inadequate staffing to safely care for patients, and having a lower degree of psychological safety. After controlling for health care workers' role and employment location, several factors were found to be significantly associated with higher levels of resilience. These included having positive perceptions about the organization's understanding of the emotional support needs of health care workers during the pandemic, believing sufficient educational resources were available regarding the care of COVID-19 patients, having positive perceptions of leadership support from direct managers, having positive perceptions of the redeployment policy, and having a higher degree of psychological safety.

CONCLUSIONS

This study identified several work environment factors that have significantly affected health care workers' well-being and resilience during the COVID-19 pandemic. This knowledge has practical relevance for health care leaders who aim to better understand and address the well-being and resilience of the health care workforce during this pandemic and beyond.

E-perceptions and Business 'Mating': The Communication Effects of the Relative Width of Males' Faces in Business Portraits

This study investigates the relative impacts of the facial width-to-height ratio (fWHR) on the first impressions business professionals form of business consultants when seeing their photographs on a corporate website or LinkedIn page. By applying conjoint analysis on field experiment data (n = 381), we find that in a zero-acquaintance situation business professionals prefer low-fWHR business consultants. This implies that they prefer a face that communicates trustworthiness to one that communicates success. Further, we have investigated the words that business professionals use to describe their preferred consultant. These approach motivations help practitioners to improve the picture-text alignment. The results underline the necessity to critically assess the pictures and text used on websites and media platforms such as LinkedIn for business purposes, and to see them as a key element of business and self-communication that can be altered in order to improve business 'mating.'

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

BACKGROUND

Psychological safety allows healthcare professionals to take the interpersonal risks needed to engage in effective teamwork and to maintain patient safety. In order to improve psychological safety in healthcare teams, an in-depth understanding of the complex and nuanced nature of psychological safety is needed. Psychological safety concepts, including voice, silence, learning behaviour, support and familiarity, informed the current study's investigation of psychological safety. This study aims to use a mixed-methods approach to develop an in-depth understanding of psychological safety within healthcare teams and to build on this understanding to inform the development of future interventions to improve it.

METHODS

Survey, observational and interview data are triangulated in order to develop an in- depth understanding of psychological safety within four healthcare teams, working within one case study hospital. The teams taking part included one multidisciplinary and three unidisciplinary teams. Observational and survey data were collected during and immediately following team meetings. Individual interviews were conducted with 31 individuals across the four teams. Thematic analysis was used to analyse these interviews.

RESULTS

Survey results indicated a high level of psychological safety. However, observations and interviews captured examples of silence and situations where participants felt less psychologically safe. Findings from across all three data sources are discussed in relation to voice and silence, learning, familiarity and support.

CONCLUSION

The results of this study provide a detailed description and in-depth understanding of psychological safety within four healthcare teams. Based on this, recommendations are made for future research and the development of interventions to improve psychological safety.