Carnegie Mellon University

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June 04, 2021

New Research Reveals Significance of Psychological Safety Influences Among ICU Staff

In the high-stakes environment of the Intensive Care Unit (ICU), the difference between speaking up and shutting down can significantly impact team effectiveness when working with patients.

A team of researchers from Carnegie Mellon University, the University of Pittsburgh, and the University of Michigan suspected that psychological safety—defined as the conditions by which team members feel safe to take risks, explore new ideas, and challenge the status quo—may be a hidden ingredient in the formula of success for health care providers in ICUs.

For the study “Psychological Safety in Intensive Care Unit Rounding Teams,” published in the Annals of the American Thoracic Society, the research team surveyed healthcare providers in 12 ICUs across the UPMC Health System to examine the role of psychological safety in their everyday work. “The concept of psychological safety has arisen as a potentially important determinant of health care team performance, but very little data exists surrounding its influence in the ICU,” explained Laurie Weingart, Richard M. and Margaret S. Cyert Professor of Organizational Behavior and Theory at Carnegie Mellon’s Tepper School of Business.

The Key Role of Leader Inclusiveness

Over the span of 10 consecutive days in each ICU, the research team surveyed physician trainees, registered nurses, respiratory therapists, clinical pharmacists, and advanced practice providers to gauge their perception of five key psychosocial factors: leader familiarity, leader inclusiveness, role clarity, job strain, and teamwork. In addition to analyzing the survey results at the individual and team levels, the researchers examined the link between psychological safety and daily performance on lung-protective ventilation and spontaneous breathing trials.

Their data indicates that at the level of individual providers, higher leader inclusiveness was associated with greater feelings of psychological safety, while higher levels of job strain were associated with lower feelings of psychological safety.

“One of the greatest takeaways from our data is the key role of leader inclusiveness as a strategy for improving psychological safety,” said Taya Cohen, Associate Professor of Organizational Behavior and Theory at the Tepper School. When leaders emphasize inclusive behaviors, like actively soliciting input from team members, explaining the rationale for key decisions, or admitting uncertainty to make room for disagreement, team members with a lower position in the hierarchy are more likely to feel safe enough to offer a dissenting opinion.

Research Affirms the Value of Psychological Safety in ICU teams

Surprisingly, team members’ beliefs about psychological safety were positively associated with greater perceived teamwork but not with actual team performance. “It may be that the medical treatments we chose were more dependent on individual than team performance,” Cohen reflected.

“This research makes important headway into understanding the influence of team leaders on the processes of fluid and dynamic teams with particularly high-stakes outcomes,” Matthew Diabes, Tepper School Ph.D. candidate and lead author, said.

While the study raises questions for future exploration, it provides valuable preliminary evidence to affirm the value of psychological safety in ICU teams. “We’re looking forward to continuing our effort to identify strategies to improve team functioning in critical healthcare roles,” concluded Weingart.


Summarized from an article in Annals of the American Thoracic Society, Psychological Safety in Intensive Care Unit Rounding Teams, by Diabes, Matthew A. (Carnegie Mellon University), Ervin, Jennifer N. (University of Michigan), Davis, Billie S. (University of Pittsburgh), Rak, Kimberly J. (University of Pittsburgh), Cohen, Taya R. (Carnegie Mellon University), Weingart, Laurie R. (Carnegie Mellon University) and Kahn, Jeremy M. (University of Pittsburgh). Copyright 2020. All rights reserved.