An ethnographic study of multidisciplinary collaboration: the role of psychological safety at a high secure forensic inpatient hospital in Germany

Abstract

Purpose: This study aims to provide an in-depth understanding of staff perspectives of enablers and barriers to multidisciplinary team (MDT) collaboration and the role of psychological safety (PS) within a high secure forensic inpatient hospital. Design/methodology/approach: A qualitative ethnographic design was adopted. Data were sourced for thematic analysis from 10 observations of treatment meetings, 13 in-depth interviews, and informal conversations among 49 professionals belonging to seven professions, between March 2017 and June 2018. Findings: Four central themes were discovered: a shared approach to care, informal relationships, leadership–power–hierarchy, and PS – influenced by all and influencing all. The absence of a shared approach to care, informal relationships, inclusive leadership, construction of meetings, perceived equality between professions, and feelings of belonging and value to the MDT exert the greatest influence on PS and MDT collaboration. Practical implications: Leaders and knowledgeable staff are advised to: - adopt an inclusive leadership style, - give meeting ownership and chairing to professions low in the hierarchy – design a multidisciplinary concept of treatment with informal relationships, and establish clear roles/responsibilities that enhance equality, value, and belonging to promote PS and diminish perceived power distance between professions. Originality/value: MDT collaboration that aims to socially construct knowledge and share information about patients through communication in meetings is not possible without first consciously creating a safe organisational culture and local context that enables staff to overcome the perceived power distance between professions.