Speaking up, psychological safety and power distance in a paediatric department : a mixed methodology study

Abstract

Schein and Bennis (1965) postulate that psychological safety has a major impact on one’s interactions within his workplace. Edmonson (1999) sheds light on the importance of psychological safety at team level. Baer and Frese (2003) identified psychological safety’s unifying value within an organisation. From power distance, feelings of superiority or inferiority arise. This strengthens the need for a psychological safe environment avoiding fears within individuals for speaking up. Therefore, the following hypotheses were devised: i) lower power distance has a positive effect on speaking up; ii) lower power distance has a positive effect on psychological safety; iii) staff perception of psychological safety mediates the relationship between power distance and speaking up. This research takes a mixed methodology approach, to triangulate psychological safety, speaking up and power distance within a paediatric department. An explanatory approach, where in the quantitative part the perceptions within the paediatric department about these phenomena are acquired, via the ‘The Speaking Up About Patient Safety’ from Schwappach et al. (2018) and the six item power distance scale from Dorfmann and Howell (1988) questionnaires (see Appendix A for questionnaires). In the qualitative part, semi-structured interviews provide an insight into barriers and facilitators at an individual level, while the focus group sheds light on the managerial perspective. Despite not achieving statistical significance in the hypothesised relationships tested, due to the poor uptake (13.3%), this research found a negative correlation between power distance, speaking up and psychological safety. This low uptake itself hints at poor psychological safety ‘for speaking up.’ Highlighted during the qualitative part of this study, themes of oppression, turmoil, stagnation and internal politics were quoted as barriers to psychological safety, whilst collegiality, transparency and progress emerged as facilitators. Managerial barriers were identified on two levels – individual and organisational. Individual barriers include fear, anamnesis, demoralisation, whilst organisational barriers include hierarchy, understaffing and poor feedback. Recommendations for improvement emerging from this study include closing the gap, support and anonymity. This research demonstrated that these dynamic phenomena are interlinked, and a complex relationship exists. The healthcare organisation should implement the above, to act as catalysts in the transitioning to a non-blame culture and promoting speaking up.