Examining the Influence of Power Distance on Psychological Safety Within Healthcare Teams
TimeThursday, April 152:00pm - 3:00pm EDT
Patient care is increasingly reliant on healthcare teams, which requires the collaboration of individuals from varying professional backgrounds, including physicians, nurses, therapists, to name a few. Teamwork plays an important role in the prevention of adverse outcomes in patient care, with poor team dynamics directly impacting the rate of medical errors. To achieve safe and effective care, the individuals who comprise healthcare teams must be able to work well together, interacting with one another in a manner which allows for the successful integration of individual expertise and efficient communication.
The inherent hierarchical nature of healthcare ascribes a certain status to individuals on the basis of their profession. For example, historically, physicians have had more status than nurses, who have more status than physical therapists, and so on. These internalized power differences can originate from the primarily hierarchical nature of how medicine is both taught and practiced, resulting in a climate where individuals with less power are marginalized. In interdisciplinary contexts, teamwork can be hindered by this hierarchy as team members with less authority feel less comfortable sharing their expertise with others. The resulting breakdown in communication between team members impacts the overall functioning of the team as well as its success.
The power differential established within healthcare teams can also be a contributing factor in the level of psychological safety felt by team members. Psychological safety is a quality which is instrumental in the development of effective teamwork. It refers to the amount of comfort that members of the team have with speaking up, asking questions, and voicing their concerns, without fearing negative consequences. With increased levels of psychological safety, individuals are more likely to admit errors or challenge their superiors in the event that a mistake can either be prevented or has already occurred.
In any group of people where such power disparity is present, the cultural dimension of power distance becomes a factor influencing team performance. Power distance is defined as the extent to which unequal power distributions within a group are accepted by individuals with less power. This component can be influenced by an individual’s cultural background, as cultures can be characterized on the basis of how much power distance is considered acceptable.
Power distance is one of six cultural dimensions initially established by Hofstede as a method of defining the culture on a national level. Cultures with higher power distances are more accepting of inequality between leaders and their subordinates, often expecting that subordinates follow orders without question. In contrast, cultures with lower power distances are more uncomfortable with inequality and prefer equality among all the members of a group. When the cultural diversity present within a team is taken into consideration, it can be seen that teamwork processes are impacted by varying conceptualizations of what a team is, with distinctions arising from cultural differences . The implications of this with respect to medical teams relate to how power distances can influence team dynamics and thus impact the quality of patient care.
The objective of our research is to determine to what extent an individual’s level of power distance influences how psychologically safe they feel as part of their healthcare team. We also examine what impact the expected power distance of the leader of a team has on the psychological safety of the entire team and examine how differing levels of expected power distance within a team influence the team’s psychological safety. This will be accomplished through the analysis of a survey data from a questionnaire on psychological safety and personal cultural orientations.
As the purpose of this research is exploratory, I used a cross sectional, survey-based design method to explore the relationship(s) between psychological safety and deep cultural constructs. We chose to disseminate surveys to internal medicine teams working in a health system located in the Midwest region of the United States. All materials were reviewed and approved by the Internal Review Board at University of Illinois at Chicago.
I leveraged validated metrics of deep cultural constructs and psychological safety as a means for answering our research questions. The Personal Cultural Orientation scale (developed member. The psychological safety of team members was measured using the Psychological Safety scale developed by Dr. Amy Edmondson.
The survey is currently being administered to a pre-determined set of Internal Medicine healthcare teams comprised of Physicians/faculty, Senior residents, Junior Residents, and Pharmacists. The data collection is ongoing and preliminary findings will be presented.
De-identified data will be imported into a statistical software program and screened for quality through use of statistical checks for random or non-random missing data. Data missing at random will be excluded from pairwise analyses. Appropriate descriptive statistics of data to characterize respondent demographics will be run; further, descriptive statistics and response rates will be examined to test statistical assumptions prior to use of parametric test(s) and inferential statistics (e.g., t-tests). As the current study questions multi-level phenomenon (i.e., variables which exist at a level higher than individual response[s]), we will perform statistical tests for interrater agreement to determine the suitability of aggregating matched responses to a team level for objectives 2 and 3 (team-level psychological safety for objective 2 and team level power distance and team level psychological safety for objective 3). Depending on distribution of data and response rate(s), the study team will conduct appropriate statistical tests including but not limited to: correlations, mean differences, regressions, Chi-squared (non-parametric), Wilcoxins’ tests (non-parametric with low sample sizes) to satisfy study objectives.
Funding for this project was received from the University of Illinois through the Liberal Arts and Sciences Undergraduate Research Initiative (LASURI). The views expressed in this work are those of the authors and do not necessarily reflect the organizations with which they are affiliated or their sponsoring institutions or agencies. The views expressed in this presentation are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.