Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams

TLDR

Professional hierarchies in medicine and the need for quality improvement are well established in the health care literature. This study introduces leader inclusiveness and examines how it, together with profession‑derived status, affects psychological safety and engagement in quality improvement within cross‑disciplinary health care teams. The authors hypothesize that status predicts psychological safety, that leader inclusiveness predicts and moderates this relationship, and that psychological safety predicts engagement in quality improvement, mediating the link between leader inclusiveness and engagement. Survey data from 23 neonatal intensive care units confirm the hypothesized relationships and provide insights into antecedents and strategies for fostering improvement efforts in cross‑disciplinary teams. © 2006 John Wiley & Sons, Ltd.

Abstract

Abstract This paper introduces the construct of leader inclusiveness —words and deeds exhibited by leaders that invite and appreciate others' contributions. We propose that leader inclusiveness helps cross‐disciplinary teams overcome the inhibiting effects of status differences, allowing members to collaborate in process improvement. The existence of a professional hierarchy in medicine and the differential status accorded to those in different disciplines is well established in the health care literature, as is the need for quality improvement. We build on this foundation to suggest that profession‐derived status is positively associated with psychological safety (H1)—a key antecedent of speaking up and learning behavior—in health care teams. We hypothesize that this effect varies across teams (H2), and furthermore, that leader inclusiveness predicts psychological safety (H3) and moderates the relationship between status and psychological safety (H4). Finally, we suggest psychological safety predicts engagement in quality improvement work (H5) and mediates the relationship between leader inclusiveness and engagement (H6). Survey data collected in 23 neonatal intensive care units involved in quality improvement projects support our hypotheses. These results provide insight into antecedents of and strategies for fostering improvement efforts in health care and other sectors in which cross‐disciplinary teams engage in collaborative learning to improve products or services. Copyright © 2006 John Wiley & Sons, Ltd.