A Mixed-Methods Study to Identify the Barriers and Enablers to Psychological Safety of Individuals in...

Healthcare professionals often hesitate to participate in team-based simulation activities because of perceived psychological risk, which can undermine learning, collaboration, and innovation. Psychological safety-defined as a shared belief that the team is safe for interpersonal risk-taking-is critical in healthcare simulation but remains understudied in the Indian context. This study aims to assess baseline perceptions of psychological safety and explore barriers and enablers within interprofessional simulation teams in South India.

We employed an explanatory sequential mixed-methods design. In the quantitative phase, 127 healthcare professionals (doctors, nurses, and paramedics) participated in an online survey using Edmondson's Psychological Safety Questionnaire. We analyzed psychological safety scores in relation to team familiarity, profession, and seniority. In the qualitative phase, we purposively sampled participants with high and low psychological safety scores for focus group discussions. Thematic analysis was conducted to identify key barriers and enablers.

Psychological safety scores were higher among teams with familiar members, nurses, and junior team members. Conversely, lower scores were reported among paramedics, unfamiliar teams, and both senior and junior-most members. Team familiarity showed a significant positive association with psychological safety. Thematic analysis revealed 6 main themes with various subthemes for barriers: Internalized Hierarchy, Fear of Judgment, Knowledge Deficits, Facilitator Behavior, Silencing Mechanisms, Role Confusion. Two main themes with various subthemes for enablers included Facilitation that Builds Trust and Structure and Clarity. Unique local barriers included debriefing in English (a non-native language), physician-only facilitators, and challenges experienced by introverted participants.

Team familiarity and facilitator skill sets are vital to promoting psychological safety in interprofessional simulation. To address contextual barriers in resource-limited and hierarchical settings, interventions should include inclusive faculty development, diverse facilitation teams, tailored debriefing based on personality traits, and use of the local language during debriefing. These findings contribute to the broader global understanding of psychological safety by offering insights from a previously underrepresented setting.