An ethnographic investigation into multidisciplinary team collaboration - the role of psychological safety in a high-secure forensic in-patient hospital in Germany
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AbstractBackground: Multidisciplinary team (MDT) collaboration in high-secure forensic in-patient hospitals is, although essential to the work, hardly studied. The culture of MDT collaboration differs due to their composition and the environment. Psychological safety (PS), that is the interpersonal feeling that the environment is safe enough to engage in MDT collaboration, without fear for personal consequences, could support staff to construct and better accumulate knowledge about patients between the different professions. Aim: To explore factors of influence on the culture of MDT collaboration and PS in the constantly changing MDT in day-to-day life. To understand how interactions with the environment and people in the environment become meaningful and are enhanced or create barriers which prevent staff from engaging in MDT collaboration. To study the role of PS and which factors, if any, influence it and how they interact with each other. Methodology/methods: A symbolic interactionist ethnographic methodology was used, with an emic approach to data collection and an eclectic approach to data analysis. Ten observations of weekly treatment meetings and 13 interviews (with a psychiatrist, a psychotherapist, a social worker, a teacher, five nurses, two ward mangers, two occupational therapists) were conducted and analysed through thematic analysis (TA). Reflexivity was used to constantly feedback on the role and presence of the researcher in the study. Findings: Four central themes were discovered: a shared approach to care; support and informal relationships; leadership and power and hierarchy; and PS, influenced by all and influencing all. The themes are visualised in a model of the social construction of MDT collaboration and PS. They are distinct and interrelated and discovered on four levels of social interaction in the hospital. The absence of a shared model of care, the supportive relationships, leadership, and the personal interpretation of the interactions between staff exerted the most influence on MDT collaboration and on PS. The absence of a multidisciplinary shared model of care kept the features of the total institution (TI) and the totality of the medical model in place. The traditional inequality and power issues between the professions responsible for the treatment and their knowledge, and the supporting staff created barriers to effective MDT collaboration and PS. The locally constructed meeting chaired by the nursing staff, the relationships, support, sub-teams, and inclusive leadership and behaviour enhanced both MDT collaboration and PS as a team emergent state (TES). These factors promote a culture of equality, belonging and perceived value. However, without a shared model of care, the relationships and perceived equality and support in sub-teams promoted dependencies on the knowledge and the support of others and revealed detrimental effects of high PS in sub-teams on MDT collaboration. Implications: MDT collaboration is complex and requires an unequivocal, carefully designed setting informed by a shared model of care with meaningful roles for all professions, inclusive leadership, and supportive informal relationships. Findings include the need to: diminish the deeply embedded unequal culture of collaboration informed by the TI and the medical model; diminish the dependencies on knowledge and support of others; promote an innovative culture of safe MDT collaboration with no fear for personal consequences for its members. Further recommendations for practice, education, and further research have been made.
CitationTheunissen-Schuiten, L. (2022). An ethnographic investigation into multidisciplinary team collaboration - the role of psychological safety in a high-secure forensic in-patient hospital in Germany [Unpublished doctoral thesis]. University of Chester.
PublisherUniversity of Chester
TypeThesis or dissertation
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