Diabes Matthew A, Ervin Jennifer N, Davis Billie S, Rak Kimberly J, Cohen Taya R, Weingart Laurie R, Kahn Jeremy M
Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania.
Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan; and.
Ann Am Thorac Soc. 2021 Jun;18(6):1027-1033. doi: 10.1513/AnnalsATS.202006-753OC.
Psychological safety is the condition by which members of an organization feel safe to voice concerns and take risks. Although psychological safety is an important determinant of team performance, little is known about its role in the intensive care unit (ICU). To identify the factors associated with psychological safety and the potential influence of psychological safety on team performance in critical care. We performed daily surveys of healthcare providers in 12 ICUs within an integrated health system over a 2-week period. Survey domains included psychological safety, leader familiarity, leader inclusiveness, role clarity, job strain, and teamwork. These data were linked to daily performance on lung-protective ventilation and spontaneous breathing trials. We used regression models to examine the antecedents of psychological safety as well as the influence of psychological safety on both perceived teamwork and actual performance. We received 553 responses from 270 unique providers. At the individual provider level, higher leader inclusiveness (adjusted β = 0.32; 95% confidence interval [CI], 0.24 to 0.41) and lower job strain (adjusted β = -0.07, 95% CI, -0.13 to -0.02) were independently associated with greater psychological safety. Higher psychological safety was independently associated with greater perception of teamwork (adjusted β = 0.30; 95% CI, 0.25 to 0.36). There was no association between team psychological safety and performance on either spontaneous breathing trials (incident rate ratio for each 1-unit change in team psychological safety, 0.85; 95% CI, 0.81 to 1.10) or lung-protective ventilation (incident rate ratio, 0.77; 95% CI, 0.57 to 1.04). Psychological safety is associated with several modifiable factors in the ICU but is not associated with actual use of evidence-based practices.
心理安全是指组织成员能够放心地表达担忧并承担风险的一种状态。虽然心理安全是团队绩效的一个重要决定因素，但对于其在重症监护病房（ICU）中的作用却知之甚少。为了确定与心理安全相关的因素以及心理安全对重症监护中团队绩效的潜在影响。我们在一个综合医疗系统内的12个ICU中，对医疗服务提供者进行了为期2周的每日调查。调查领域包括心理安全、领导者熟悉度、领导者包容性、角色清晰度、工作压力和团队合作。这些数据与肺保护性通气和自主呼吸试验的日常绩效相关联。我们使用回归模型来研究心理安全的前因以及心理安全对感知到的团队合作和实际绩效的影响。我们收到了来自270名不同提供者的553份回复。在个体提供者层面，更高的领导者包容性（调整后的β = 0.32；95%置信区间[CI]，0.24至0.41）和更低的工作压力（调整后的β = -0.07，95%CI，-0.13至-0.02）与更高的心理安全独立相关。更高的心理安全与更强的团队合作感知独立相关（调整后的β = 0.30；95%CI，0.25至0.36）。团队心理安全与自主呼吸试验（团队心理安全每增加1个单位变化的发生率比，0.85；95%CI，0.81至1.10）或肺保护性通气（发生率比，0.77；95%CI，0.57至1.04）的绩效之间均无关联。心理安全与ICU中的几个可改变因素相关，但与循证实践的实际应用无关。
