Collaborate – the future of service provision

A study on developing psychological safety in provider collaboratives.

Collab

PCC was commissioned by NHS England – Midlands specialised commissioning team to explore the evolution of the management of patient safety and quality in NHS led Mental Health, Learning Disabilities and Autism (MHLDA) Provider Collaboratives. The project was led by Peter Bullivant for PCC.

Working with NHS-led MHLDA Provider Collaboratives in the Midlands we explored the approaches the collaboratives took to developing arrangements for ensuring patient safety and quality across the services within the collaborative. The project team learned a lot from the work that had been done by the teams and it became clear that there was a lot of focus building relationships with examples, such as:

  • Transparent systems, structures and processes that nurture trust
  • Establishing the role of the commissioning hub as supportive critical friend
  • Collective review of data information to develop collective insight, problem solving and decision making
  • Co-production with all partners, clinicians users and experts by experience to develop collective vision, values and objectives
  • Embedding co-production in all aspects of change – reviewing design implementation and evaluation
  • Relationship development to build trust and open cultures
  • Systems and processes to promote learning cultures
  • Meeting cultures that promote empowerment
  • Building identity through messaging, marketing, logos
  • Knowledge management to create learning behaviours.

These findings led to further studies which explored the potential learning that could be obtained from understanding the causes of some of the most catastrophic failures in patient safety and quality across the NHS. This research showed some concerning but consistent factors:

  • People who experience fear of consequences can act in ways that are not in the best interest of patients
  • Structural pressures on leadership can result in them not being focused on ‘what really matters’ rather than patient safety and outcomes
  • Leaders who fear the consequences to themselves can nurture a culture of fear across an organisation
  • A culture of fear facilitates lack of openness and willingness to embrace error and subsequently act upon it
  • Cognitive bias can be applied when presented with information due to interpersonal risk
  • Apathy, acceptance of status quo as the norm can exist even when evidence indicates change is required
  • Negative cultures result in ‘not being at fault’ being more important than understanding what happened
  • Impression management is used to mask fundamental problems at organisation, team and individual level
  • People’s well-being and motivation can be affected by the ‘culture’ resulting in staff and skill mix shortages.

This showed that there were potential benefits from a paradigm shift away from a culture of fear to that of safety.

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Academic research; organisational psychology theories

The project took the findings of the qualitative research and explored relevant organisational psychology theories that could help create greater understanding of psychology affecting these environments, The research focused on the creation of a psychological safety climate and explored theories, such as:

  • Goal setting theory
  • Job demands and resources model
  • Four-factor theory of climate

As a result, the research produced a model demonstrating possible antecedents and outcomes of a psychological safety climate.

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This model was then used to conduct a further review of the qualitative research and approaches from other industries to develop a guide that can help provider collaboratives develop a climate that nurtures psychological safety and the benefits that can arise as a result.

The guide aims to help leadership teams within and across collaboratives understand the benefits of a psychological safe climate and some of the key components required to foster greater collaboration, effectiveness and better working environments. The guide was designed to help leadership teams develop plans based on the circumstances of their specific collaborative and levels of collaboration.

No collaborative or team is the same. The guide cannot prescribe the solution for your team or collaboration. It can give you the framework to build a plan that will work for you; a plan that can nurture a more open culture, more effective teams and a better place to work for those working hard every day to make a difference.

The guide describes six core elements to consider plus some underlying concepts that are important in creating the right climate.

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We will be producing a series of videos that explore our study in more detail.

Why psychological safety is important

If you would like to run a similar project or find out more contact enquiries@pcc-cic.org.uk. Find out more about our leadership programmes https://www.pcc-cic.org.uk/leadership/.

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