LAUSR

Learning Objectives: Psychological safety, the phenomenon whereby team members feel empowered to speak up and actively engage in problem solving without fear of retribution, leads to higher quality decision-making and teamwork in organizational contexts. This study examines correlates of psychological safety in intensive care unit (ICU) teams and suggests team processes that may contribute to better performance. Methods: Electronic surveys were fielded in 12 adult non-specialty ICUs housed within a single health system. For each ICU we surveyed the attending physicians, trainees, bedside nurses, clinical pharmacists, and respiratory therapists, who worked one or more weekdays during a two-week observation window; in total, we collected 569 surveys from 352 clinicians. Analyses evaluated correlates of psychological safety, including teamwork (i.e., whether clinicians perceived effective collaboration among members), team efficacy (i.e., having confidence in other care providers’ skills), leader inclusiveness (i.e., whether attending physicians elicit and value others’ knowledge and opinions), and task clarity (i.e., whether clinicians understood what was expected of them that day). Missing data were imputed using the Kalman algorithm and the data were analyzed with longitudinal multilevel modeling. Results:Clinicians in this sample felt psychologically safe at T1 (M=4.08, SD=0.20 on a 5-point scale). The linear and non-linear effects of time were not significant and psychological safety did not vary significantly across ICUs. Both teamwork and leader inclusiveness were significantly associated with psychological safety, bs=0.44 and 0.08, ts=11.15 and 2.40, and ps=.01 and .02, respectively. Team efficacy also was associated with psychological safety, b=.13, t=4.10, p=.01. Task clarity was not significantly associated with psychological safety (b=-0.01, t=-0.26, p =.80). Conclusions: Findings from the current study indicate that the following factors are associated with psychological safety: perceiving effective collaboration among providers, feeling confident in other clinicians’ abilities, and having an attending that promotes team inclusiveness. Future work should evaluate whether and how psychological safety might improve patient care and if so, what the mechanism is, for example as a buffer for burnout.