Exploring psychological safety as a component of facilitation within the Promoting Action on Research Implementation in Health Services framework

Aims and objectives
To explore holistic facilitation as an approach to enable the healthcare team to critically analyse practice and enhance patient care.

Background
Globally, the challenge of changing healthcare practices for enhanced patient care is the focus of much attention. Facilitation is emerging as an important approach to assist healthcare teams to explore and improve their practice. Within the Promoting Action on Research Implementation in Health Services framework, which has been tested in an international arena, facilitation is a key element of operationalising collaborative changes in practice. This study uses the framework to explore holistic facilitation and the concept of psychological safety.

Design
An Emancipatory Action Research approach was used.

Methods
Facilitated critical reflection was undertaken with the healthcare team working in an abdominal surgical unit. In addition, the lead researcher maintained a reflexive journal. Data were analysed using thematic analysis. Eighty‐five per cent (n = 48) of nursing staff and individual participants from other parts of the healthcare team (n = 3) participated in the two‐year study.

Results
Data revealed 14 sub‐themes that impacted upon the culture of the unit. These were as follows: support, leadership, oppressed behaviours, communication, interruptions, power imbalance, horizontal violence, threat, autonomy, distorted perceptions, vulnerability, value, trust and time. Psychological safety, leadership and oppressed behaviours emerged as three key themes in the practice context.

Conclusions
There is a need to create psychologically safe spaces in environments where insufficient support, weak leadership and oppressed behaviours are apparent. Psychological safety enables individuals to feel safe to engage in difficult conversations and consider changes to practice. In a theoretical contribution to the area of facilitation, it is proposed that the additional element of psychological safety needs to be incorporated into facilitation models, in particular, the Promoting Action on Research Implementation in Health Services framework, to more accurately reflect the complexities of working with healthcare teams.