Jennifer Weller¹
Tanisha Jowsey² and Carlos Campos¹
1 University of Auckland
2 Bond University

Critical reflection is an essential skill in health professionals education and is routinely taught and assessed. How are critical reflection skills supported in clinical practice, and in particular, critical reflection on leadership and team building skills in acute care teams. 

Teams make better decisions if all team members contribute to decision-making, ask questions and voice concerns. Psychological safety is required for this active engagement in patient care.(1) However, patient harm, avoidable only if someone had spoken up, and been listened to continue to be reported. Staff won't speak up if it's feels unsafe to do so. Clinical leaders need to take responsibility for ensuring psychologically safety where all staff feel safe to express their views. We aimed to develop a tool for clinicians to critically reflect on their own attitudes and behaviours impacting psychological safety in their clinical teams. 

Methods 

In a grounded theory interview study of multi-professional senior surgical staff we explored reactions to being spoken up to and created a theoretical model from which we develop a 9- item critical reflection tool for senior staff on their attitudes and behaviours around team members speaking up to them. We piloted this with 47 multi-disciplinary healthcare practitioners attending simulation based team-training instructors courses. We analysed the written responses to test the tool’s ability to provoke reflection, and to further refine the tool. 

We developed an 8-item, tool comprising Likert scale ratings and written rationale for each rating. Analysis of written responses from pilot data confirms our tool promotes personal in- depth critical reflection on attitudes and behaviours relevant to promoting psychological safety in healthcare teams. 

Future research will address the ability of the tool to promote critical reflection in a wider healthcare audience, and its value as an intervention to promote change in attitudes and behavours. 

References (maximum three) 

1. Edmondson AC, Roloff KS. Overcoming barriers to collaboration: Psychological safety and learning in diverse teams. InTeam effectiveness in complex organizations 2008 Nov 20 (pp. 217-242). Routledge. 

2. Long J, Jowsey T, Garden A, Henderson K, Weller J. The flip side of speaking up: a new model to facilitate positive responses to speaking up in the operating theatre. British Journal of Anaesthesia. 2020 Dec 1;125(6):1099-106.