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This studied the relationship between power distance and leader inclusiveness on psychological safety and the willingness to report adverse events.

106 resident physicians from a teaching hospital were involved in the study.

For psychological safety, it’s argued that current barriers to reporting among perceived low-status members can be anxiety and fear. This occurs in situations where they are required to take interpersonal risks when asking for help or feedback. “Fear of being labelled ignorant, incompetent or disruptive in the workplace by colleagues can lead to low psychological safety” (p344).

It’s said that negative tensions between the high- and low-status members can “easily bleed over from interpersonal strains”, which can lead to negative outcomes for stakeholders.

Power distance is defined as “the extent to which an individual perceives unequal distributions in status and power within institutions and organisations” (p345). When a low-status member perceives a high power-related distance, that person will be less likely to question somebody of high-status. Power distance is said to be a substantial barrier against people speaking up in healthcare.

For the study methodology, it’s hypothesised that psychological safety mediates: 1) the positive relationship between leader inclusiveness and the intention of people to report adverse events, and also 2) mediates the negative relationship between power distance and intention to report.

Results

Perceived power distance and leader inclusiveness were both found to significantly predict psychological safety, which then significantly predicted the intention to report adverse events.

Psychological safety significantly mediated the direct relationship between power distance and reporting, and also between leader inclusiveness and reporting, such that “Psychological safety was found to be a predictor of intention to report adverse events” (p343). As the perceived power distance reduced and leader inclusiveness increased there was a greater intention for people to report adverse events.

For practical applications, it’s said that efforts to increase incident reporting “must support high psychological safety by communicating clearly the process of reporting and its terms of confidentiality, and providing safeguards to avoid any punitive backlash” (p348).

Organisations must also lead the facilitation of positive relationships between high- and low-status team members and one way of facilitating this is by making efforts to flatten hierarchy.

Finally, as the authors state, “Because adverse event reporting is shaped by relationships and culture external to the individual, it should be viewed as an organisational as much as a personal function” (p343).

Authors: Nital P Appelbaum, Alan Dow, Paul E Mazmanian, Dustin K Jundt, Eric N Appelbaum, 2016, ASME medical education

Study link: https://doi.org/10.1111/medu.12947

Link to the LinkedIn article: https://www.linkedin.com/pulse/effects-power-leadership-psychological-safety-event-ben-hutchinson