Psychological Safety and Team Performance in Primary Care

Ricardo Antunes, Catarina Viegas Dias

Keywords: Primary Care; Team; Psychological safety; Teamwork; Multidisciplinary; Autonomous; Interdependent.

Background:

Psychological safety is the degree to which individuals are able to take on personal risk and express divergence, without fear of embarrassment or criticism. Psychological safety is a team level phenomenon that is associated with patient safety and better learning environments in secondary care, but studies in teams providing primary care (TPPC) are lacking. In the past decades, there has been an increasing focus on the relevance of teamwork and interdependence among TPPC, which dynamics differ greatly from secondary care. However, the levels of psychological safety remain uncharacterized in primary care, and its impact on performance of TPPC remains understudied.

Research questions:

This study aims to describe the level of Psychological Safety in TPPC and explore its association with team performance.

Method:

We will conduct a cross-sectional study, following the STROBE guidelines. Psychologycal safety will be measured using a translated version of Edmonson’s Psychological Safety Tool Questionnaire. As a team performance proxy, we will use the global performance index, publicly available for all TPPC in Portugal. The study will include 8 primary care teams in the Lisbon area, which include doctors, nurses and clinical secretaries. Team selection will be random, and stratified 1:1 according to perfomance (lowest quartile/highest quartile). Sample size was calculated assuming a standard deviation of 5 (based on a study in secondary care) and an alfa error of 0.05 (two-sided), which will provide 80% power to detect a 10-point difference between psychological safety mean scores of low and high performing teams. Statistical analyses will include Pearson's correlation and multiple regression. The protocol will be submitted to the local Ethics Committee.

Results:

We antecipate that high perfoming teams will have higher psychological safety than low performing practices.

Conclusions:

Results will help increase awareness of the importance of psychological safety in primary care teams and might increase acceptability of future interventions to increase it.

Points for discussion:

Are other research teams exploring pyschological safety in primary care in Europe?

Representativeness versus feasibility of the study