Psykologisk tryghed er afgørende for effektiviteten af forbedringsteam

FAGLIG ORIENTERING

Psykologisk tryghed og en lærende tilgang er afgørende for effektiviteten af forbedringsteam. Det viser en analyse i forbindelse med Project Fives Alive!, et forbedringsprojekt, der har til formål at reducere børnedødeligheden i Ghana. Projektet støttes af Institute for Healthcare Improvement, IHI.

Af Simon Tulloch, chefkonsulent, Dansk Selskab for Patientsikkerhed

I read with great interest an article recently published in BMC Health Service Research based on the ‘Project Fives Alive!’ (PFA). PFA is a national, multi-year quality improvement (QI) project aimed at reducing mortality in children under 5 years of age by improving “the processes of care during pregnancy through the most vulnerable period of labor, delivery, and post-natal care”. The project is based on Ghana and supported by the Institute for Healthcare Improvement (IHI).

Mere om psykologisk tryghed

The aspect of the project under investigation was team effectiveness, i.e. the degree to which the teams meet the expectations set out in the project aim. The authors highlight that in QI, team effectiveness is synonymous with the consistency and fidelity with which teams implement QI methods to deliver local improvements in care quality. Stating that “highly effective teams rarely manifest by accident. Rather, success is determined by numerous internal and external factors”.

One determinant of team effectiveness is ‘team learning’, which is mediated by team psychological safety. The authors define team learning as ‘a process of detecting and correcting error’, and psychological safety as ‘the shared belief that the team is a safe place for interpersonal risk taking’.

Three hypotheses are tested as a means of understanding the mediating effects of different factors, such as leadership, perceived support, psychological safety, and learning behaviour on team effectiveness (QI implementation). The results indicated clear (and strong) effects of a) leadership (style) on team psychological safety, b) psychological safety on learning behaviour, and c) learning behaviour on QI implementation.

As such, the authors state “These findings suggest potential leverage points … In addition to training teams in QI methods, leaders should be trained in concepts like psychological safety, conflict management and motivation”. They conclude by stating “We find convincing evidence that psychological safety and learning behaviour are key determinants of QI implementation … this study also demonstrates that leaders play a critical role in establishing a climate of psychological safety that supports effective teamwork and learning behaviour”.

These findings echo our experiences in Denmark. As such, we have developed specific training and educational programs on the subject of psychological safety for healthcare teams, elements of which have also been integrated into our ‘Improvement Science for Leaders’ educational programs.

You can access the full article here:

Albritton, J.A., Fried, B., Singh, K. et al. The role of psychological safety and learning behavior in the development of effective quality improvement teams in Ghana: an observational study. BMC Health Serv Res 19, 385 (2019)