We can do it! Inclusive leader language promotes voice behavior in multi-professional teams

The relationships between certified nursing assistants' voice behaviour and job satisfaction, work engagement and turnover intentions: A two-wave survey study

AIM

Whereas voice behaviour has been identified as a key precursor to safe and high-quality patient care, little is known about how voice relates to key workforce outcomes. This study aimed to investigate the relationships between certified nursing assistants' perceived promotive voice behaviour (speaking up with suggestions for future improvement) and prohibitive voice behaviour (speaking up about problems or potentially harmful situations) and their self-reported levels of job satisfaction, work engagement and turnover intentions.

DESIGN AND METHODS

Dutch certified nursing assistants were recruited for a two-wave survey study through non-random convenience sampling. The final sample contained 152 respondents. The data were analysed using multiple linear regression analyses. In all analyses, the dependent variable at time one was controlled for.

RESULTS

Certified nursing assistants' promotive and prohibitive voice behaviour at time one were found to be positively related to their level of job satisfaction at time two while controlling for job satisfaction at time one. No relationships with work engagement or occupational turnover intentions were found.

CONCLUSION

While previous research has found positive effects of voice on patient safety outcomes and team and organizational improvements in care organizations, we demonstrate that voice is also related to a key workforce outcome, that is, certified nursing assistants' job satisfaction.

IMPLICATIONS AND IMPACT

Recognizing the interplay between voice behaviour and job satisfaction underscores the importance of creating work environments where certified nursing assistants feel able and willing to make their voices heard-with ideas and suggestions, as well as information regarding problems and concerns.

PATIENT OR PUBLIC INVOLVEMENT

Three certified nursing assistants have contributed to the development of the survey.

Learning to lead: The evolution of a pilot leadership curriculum for gynecologic oncology fellows at the Ohio State University

•Leadership training is under-emphasized in traditional medical education.•An effective leadership curriculum must be dynamic and requires genuine investment from participants.•Through didactic education, self-reflection, and real-world perspective we can actively mold future leaders in gynecologic oncology.

Effects of nurse managers' inclusive leadership on nurses' psychological safety and innovative work behavior: The moderating role of collectivism

INTRODUCTION

In the rapidly evolving healthcare landscape, the capacity to foster innovative work behavior among nurses is increasingly important. This study examined the dynamics between inclusive leadership, psychological safety, collectivism, and innovative work behavior among nurses.

DESIGN

The study used a cross-sectional, correlational design.

METHODS

This study utilized data from 730 medical-surgical nurses who provided direct care to patients. Standardized instruments were used to assess key study variables. Statistical analyses, including moderated mediation regressions, were employed to investigate the complex interplay among these variables.

RESULTS

We found a positive association between inclusive leadership and innovative work behavior, and psychological safety mediated this relationship. Collectivism moderated inclusive leadership's direct relationship with psychological safety and its indirect relationship with innovative work behavior. The results revealed that nurses with lower levels of collectivism were more responsive to their managers' inclusive behaviors, strengthening the relation between inclusive leadership, psychological safety, and innovative work behavior.

CONCLUSION

Our findings suggest that promoting inclusive leadership behaviors among nurse managers to create a psychologically safe environment can motivate nurses to engage in innovative work behavior. However, it is also important to understand that the effectiveness of leadership may differ depending on the collectivist values of individual nurses.

CLINICAL RELEVANCE

Nurse managers should adopt inclusive leadership behaviors, such as valuing trust, open communication, and diversity, in order to foster psychological safety and innovative work behavior among nurses.

A chain mediation model of inclusive leadership and voice behavior among university teachers: evidence from China

As a vital mode in which teachers can participate in university management, voice behavior is an important way of enhancing the efficiency of organizational decision-making, promoting democratic management, and facilitating sustainable development in universities. Although previous studies have confirmed the positive impact of inclusive leadership on employees' voice behavior, the mechanism underlying this effect remains unclear. Therefore, based on the cognitive-affective system theory of personality, this study aims to examine the mediating effects of psychological empowerment and organizational identification on the relationship between inclusive leadership and voice behavior among university teachers. A total of 517 valid questionnaires were administered to university teachers in mainland China using a convenience sampling approach. Structural equation modeling and bootstrap testing were used to analyze the data, and the results reveal that inclusive leadership is positively related to teachers' promotive and prohibitive voice behavior. This relationship is mediated by psychological empowerment and organizational identification, in which context a partial mediating effect is observed in the relationship between inclusive leadership and promotive voice and a full mediating effect is observed in the relationship between inclusive leadership and prohibitive voice. These findings can enrich the extant research on the impact of inclusive leadership in the field of higher education to a certain extent. Moreover, they provide a new perspective that can support an in-depth analysis of the mechanism underlying the effect of inclusive leadership and generate valuable practical insights into ways of stimulating voice behavior among university teachers.

The psychological impacts of the COVID-19 pandemic on business leadership

The COVID-19 pandemic had a profound impact on business leadership, specifically on chief executive officers (CEOs). To document the psychological impacts of the pandemic on corporate leadership, this study analyzed the language of CEOs during company quarterly earnings calls (N = 19,536) one year before and after the onset of the pandemic. Following the start of lockdowns, CEOs exhibited significant language shifts. Analytic thinking declined, and their language became less technical and more personal and intuitive. CEOs also showed signs of increased cognitive load as they grappled with the pandemic's impact on their business practices. The study observed a substantial decrease in collective-focused language (we-usage) among CEOs, indicative of disconnection from their companies. Concurrently, there was an increase in self-focused (I-usage) language, suggesting heightened preoccupation among business leaders. The observed language changes reflect the unique effect of the pandemic on CEOs, which had some notable differences compared to the general population. This study sheds light on how the COVID-19 pandemic influenced business leaders' psychological states and decision-making strategies-processes that have a substantial impact on a company's performance. The findings underscore the importance of language data in understanding large-scale societal events.

From Integrated Care to Integrating Care: A Conceptual Framework of Behavioural Processes Underlying Effective Collaboration in Care

Introduction

At all levels, effective collaboration between actors with different backgrounds lies at the heart of integrated care. Much attention has been given to the structural features underlying integrated care, but even under structurally similar circumstances, the effectiveness of collaboration varies largely.

Theory and methods

Social and organizational psychological research shows that the extent to which collaboration is effective depends on actors' behaviours. We leverage insights from these two research fields and build a conceptual framework that helps untangle the behavioural processes underlying effective collaboration.

Results

We delineate that effective collaboration can be realized when actors (1) speak up about their interests, values, and perspectives (voice behaviour), (2) listen to the information that is shared by others, and (3) thoroughly process this information. We describe these behaviours and explain the motivations and conditions driving these. In doing so, we offer a conceptual framework that can be used to explain what makes actors collaborate effectively and how collaboration can be enhanced.

Discussion and conclusion

Fostering effective collaboration takes time and adequate conditions, fitting the particular context. As this context continuously changes, the processes and conditions require continuous attention. Integrated care, therefore, actually requires a carefully designed process of integrating care.

Ethical leadership supports safety voice by increasing risk perception and reducing ethical ambiguity: Evidence from the COVID-19 pandemic

Misconduct by business and political leaders during the pandemic is feared to have impacted people's adherence to protective measures that would help to safeguard against the spread of COVID-19. Addressing this concern, this article theorizes and tests a model linking ethical leadership with workplace risk communication-a practice referred to as 'safety voice' in the research literature. Our study, conducted with 511 employees from UK companies, revealed that ethical leadership is positively associated with greater intention to engage in safety voice regarding COVID-19. We also find that this association is mediated by relations with the perceived health risk of COVID-19 and ambiguity about ethical decision making in the workplace. These findings therefore underscore the importance of good ethical conduct by leaders for ensuring that health and safety risks are well understood and communicated effectively by organizational members particularly during crises. We discuss the theoretical and practical implications of our study and highlight further opportunities for future research to address the ethical dimensions of leadership, risk management, and organizational risk communication.

How to enrich team research in healthcare by considering five theoretical perspectives

The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.

Videos of simulated after action reviews: a training resource to support social and inclusive learning from patient safety events

Innovation in the education and training of healthcare staff is required to support complementary approaches to learning from patient safety and everyday events in healthcare. Debriefing is a commonly used learning tool in healthcare education but not in clinical practice. Little is known about how to implement debriefing as an approach to safety learning across a health system. After action review (AAR) is a debriefing approach designed to help groups come to a shared mental model about what happened, why it happened and to identify learning and improvement. This paper describes a digital-based implementation strategy adapted to the Irish healthcare system to promote AAR uptake. The digital strategy aims to assist implementation of national level incident management policies and was collaboratively developed by the RCSI University of Medicine and Health Sciences and the National Quality and Patient Safety Directorate of the Health Service Executive. During the COVID-19 pandemic, a well-established in-person AAR training programme was disrupted and this led to the development of a series of open access videos on AAR facilitation skills (which accompany the online version of this paper). These provide: (1) an introduction to the AAR facilitation process; (2) a simulation of a facilitated formal AAR; (3) techniques for handling challenging situations that may arise in an AAR and a (4) reflection on the benefits of the AAR process. These have the potential to be used widely to support learning from patient safety and everyday events including excellent care.

Contextualizing the tone of the operating room in practice: drawing on the literature to connect the dots

The study of teamwork in the operating room has made significant strides in uncovering key constructs which shape safe and effective intraoperative care. However, in recent years, there have been calls to understand teamwork in the operating room more fully by embracing the complexity of the intraoperative environment. We propose the construct of tone as a useful lens through which to understand intraoperative teamwork. In this article, we review the literature on culture, shared mental models, and psychological safety, linking each to the construct of tone. By identifying tone as a theoretical orientation to demonstrate the overlap between these concepts, we aim to provide a starting point for new ways to understand intraoperative team dynamics.

The institutionalization and processual element of sustainable operational risk management as a best practice in the government-linked organization: a case study in Malaysia

Global risk concerns spurred a debate regarding empowering an organization's risk management system. Risk assessment, management, and planning are vital for running a firm, but they are not universal. This research investigates how operational risk management is institutionalized in an organization and reveals best practices from a Malaysian government-linked enterprise (GLC). This phenomenological study interviewed 39 risk management officers, executives, and employees. Data are thematically analyzed. Burawoy's Social Theory uses a case study to integrate micro- and macro-organizational elements. The case company's risk management officers, executives, and employees are involved in seven processual factors, according to the analysis. Strong leadership and external consultants, setting up the apparatus and assigning the task to the person in charge, risk framework, risk diagnostic, monitor and measure, developing and nurturing risk management culture, and consistent risk management enforcement and monitoring could explain the institutionalization process of risk management in the organization. Global and local entities have institutionalized risk management. This phenomenological study helps comprehend the role of risk management institutionalization in corporate risk management. This study contributes to a practical implication such as to the GLC. It suggests that top management support and a standard risk framework are necessary for risk management homogeneity. Leaders and frameworks must address organizational processes and capabilities to ensure risk management consistency. This study contributes to the literature on risk management practices in developing nations. The paper concludes with limitations and research recommendations.

I like what you are saying, but only if i feel safe: Psychological safety moderates the relationship between voice and perceived contribution to healthcare team effectiveness

Introduction

Are nurses who voice work-related concerns viewed as positive contributors to a team? We propose that the extent to which healthcare professionals consider voice by nurses as helpful for the team depends on how psychologically safe they feel. Specifically, we hypothesized that psychological safety moderates the relationship between voice of a lower ranking team member (i.e., a nurse) and perceived contribution by others, such that voice is more likely to be seen as valuable for team decision-making when psychological safety is high but not when it is low.

Methods

We tested our hypotheses with a randomized between-subjects experiment using a sample of emergency medicine nurses and physicians. Participants evaluated a nurse who either did or did not speak up with alternative suggestions during emergency patient treatment.

Results

Results confirmed our hypotheses: At higher levels of psychological safety the nurse's voice was considered as more helpful than withholding of voice for team decision-making. This was not the case at lower levels of psychological safety. This effect was stable when including important control variables (i.e., hierarchical position, work experience, gender).

Discussion

Our results shed light on how evaluations of voice are contingent on perceptions of a psychologically safe team context.

Employee voice: a knowledge map to provide conceptual clarity and future research directions

The increasing globalisation, the multiculturality of workplaces and the current challenges for organisations generated the need for researchers to support them to manage the workforce. Although the relevance of employee voice for these themes, a lack of shared understanding about this topic results in fragmented literature across and within research fields that limits theoretical advancement and deep comprehension of the phenomenon. Our first aim is to offer a literature review of employee voice by combining systematic and bibliometric methods; the second aim is to understand voice's main issues and implications by considering different research streams. The results present an integrated framework of the leading intellectual knowledge and reveal the main research focuses on voice in domestic contexts. The discussion underlines the cultural issue and context as critical elements for future research by proposing avenues for scholars and some implications for organisations to benefit from the contributions of their members.

Intergroup Leadership: The Challenge of Successfully Leading Fractured Groups and Societies

Leadership often involves providing leadership to a group that is structured into separate subgroups that have distinctive self-contained identities that are cherished by their members. In this respect, leadership can be characterized as intergroup leadership. The challenge of intergroup leadership is to forge a superordinate identity that does not erase or blur the subgroups’ identity boundaries and create a threat to the subgroups’ social identity distinctiveness, as such identity threat can provoke intersubgroup conflict that fragments the superordinate group. According to intergroup-leadership theory, successful intergroup leaders need to construct, promote, and exemplify an intergroup relational identity that preserves subgroups’ distinctiveness and celebrates that distinctiveness and intersubgroup cooperation as fundamental aspects of subgroup and superordinate-group identity. In this article, we describe intergroup-leadership theory (which applies to groups of all sizes and complexions), summarize empirical support for its main tenets, and outline extensions and future directions.

Effects of Inclusive Leadership on Quality of Care: The Mediating Role of Psychological Safety Climate and Perceived Workgroup Inclusion

Purpose: The aim of the study is to investigate the multilevel effects of the inclusiveness of workgroup leaders on quality of care by intervening through a “psychological safety climate” at the group level and “perceived workgroup inclusion” at the individual level within professionally diverse workgroups of healthcare professionals. Material and Methods: Data are collected from 305 healthcare professionals nested in 61 workgroups and 305 patients treated by the same workgroups working in public-sector hospitals in Pakistan. Hypothesized relationships are tested through multilevel analyses using Mplus 7. Results: The results of the study show that inclusive leadership can enhance the quality of care delivered by multiprofessional workgroups of healthcare professionals through perceived workgroup inclusion. Further, the psychological safety climate does not mediate the relationship between inclusive leadership and quality of care individually, but it transmits the effects of inclusive leadership through perceived workgroup inclusion on quality of care. Conclusion: The results of the study suggest that the inclusiveness of workgroup leaders, the psychological safety climate, and perceived workgroup inclusion can create safe and inclusive interpersonal mechanisms that play a key role in transmitting the positive effects of inclusive leadership on quality of care.

Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study

BACKGROUND

Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response.

METHODS

In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling.

RESULTS

The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%).

CONCLUSION

Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.

Factors influencing newly graduated registered nurses' voice behavior: An interview study

AIM

To gain insight into the factors that affect newly graduated registered nurses' voice behavior.

BACKGROUND

Employees with little work experience may experience difficulties with speaking up. Given that a lack of voice can negatively affect the delivery of safe client care and lower nurses' job satisfaction, it is important to understand which factors facilitate and hinder newly graduated nurses' voice behavior.

METHODS

A qualitative descriptive study was conducted using semi-structured interviews with 17 newly graduated registered nurses working in inpatient hospital settings.

RESULTS

In total, seven factors emerged from our data, which were grouped in four, overarching themes. Whether newly graduated nurses speak up depends on (1) their levels of self-confidence; (2) whether they feel encouraged and welcome to speak up; (3) their relationship with the voice target; and (4) the content of their voice message.

CONCLUSION

Factors that affect newly graduated nurses' voice behavior are multifaceted, but mostly center around time spent in and relationships at the workplace.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and colleagues can build an environment that fosters newly graduated nurses' voice behavior. Specifically, induction programs, assigning mentors and offering additional training can support newly graduated nurses in developing voice behavior.

Hospital management and supervisor support and nurse speaking-up behaviors: The mediating role of safety culture perception

AIMS

This study aimed to (a) elucidate the effects of hospital management and unit supervisor support for patient safety on nurse speaking-up behaviors and (b) identify potential mediators of this relationship.

BACKGROUND

Speaking-up behavior among nurses has emerged as a critical source of patient safety. Fuller understanding of the developmental mechanisms contributing to nurses' speaking-up behaviors could help to enhance patient safety in healthcare organizations.

METHODS

A correlational approach was used to conduct a secondary analysis of cross-sectional survey data collected from 450 staff nurses in Korea. Path analysis was performed to test potential mediation effects.

RESULTS

After controlling for nurses' hospital and unit tenure, hospital management and supervisor support for patient safety had significant direct and indirect effects on nurses' speaking-up (promotive and prohibitive voice) behaviors through their perceptions of response to error and communication openness.

CONCLUSIONS

Study findings indicate that when hospital management and supervisors emphasize patient safety and provide necessary resources, nurses are likely to perceive the hospital's safety culture more positively, in turn enhancing their speaking-up behaviors.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital administrators and nurse managers should clearly display hospital management and supervisory support for patient safety through implementation of related policies, resources, and communication standards.

Linking Abusive Supervision to Promotive and Prohibitive Voice Behavior: Testing the Mediating Roles of Work Engagement and Negative Reciprocity

As an important type of extra-role behavior, employee voice behavior is of great significance to the sustainable development of organizations. Employee voice behavior has two different dimensions, namely promotive voice and prohibitive voice, both of which are conducive to decision making, innovation, and improvements to the work process. Among the antecedents of voice behavior, abusive supervision is one of the most essential influencing factors. In response to the call to further explore the antecedents and influencing mechanisms of different dimensions of voice behaviors, this study aims to investigate the different paths of abusive supervision on the two types of voice behavior. Drawing on the conservation of resources theory and social exchange theory, we identified an expanded array of mediators, including work engagement and negative reciprocity, which link abusive supervision to promotive voice behavior and prohibitive voice behavior separately. Data were collected through two-wave questionnaire surveys of 334 employees of 14 enterprises in China. The results show that (a) abusive supervision is negatively correlated with employees’ promotive and prohibitive voice behaviors; (b) work engagement mediates the negative relationship between abusive supervision and promotive voice; and negative reciprocity mediates the negative relationship between abusive supervision and prohibitive voice. These findings clearly reveal the influencing mechanisms of abusive supervision on both promotive and prohibitive voice behavior, which not only enriches relevant theoretical research but also provides feasible insights into how to reduce abusive supervision to motivate voice behavior in management practice.

The Impact of Leader Proactivity on Follower Proactivity: A Chain Mediation Model

This study aims to explore the linking mechanisms underlying the relationship between leader proactivity and follower proactivity. Drawing on social learning theory, the present research investigates the effects of leader proactivity on follower proactivity by developing a chain mediation model. An analysis of three-wave lagged data (N = 575) on 575 employees of six firms in China shows that leader proactivity is positively related to follower proactivity and that employees' role breadth self-efficacy (RBSE) and felt responsibility for constructive change (FRCC) mediate this relationship. The analytical results also show that leader proactivity facilitates follower value congruence, which in turn enhances followers' RBSE and FRCC and ultimately promotes followers' proactivity. The results extend the current proactivity literature and fill the research gap by investigating the relationship between leader proactivity and follower proactivity. The current study also contributes to the literature by identifying the mediating mechanism of the "can do" and "reason to" mechanisms that link leader proactivity to follower proactivity.

Supervisor’s Negative Mood and Healthcare Workers’ Voice Behavior: A Moderated Mediation Model

Healthcare workers’ voice is of importance in decreasing medical accidents and improving the efficacy of hospital units. To investigate the impact and the underlying mechanisms of supervisors’ negative mood on healthcare workers’ voice behavior, based on the mood contagion perspective, we designed a cross-sectional study, with 299 healthcare workers from mainland China completed the questionnaires. The results indicated supervisors’ negative mood was positively related to healthcare workers’ negative mood, which further led to less constructive voice and more defensive voice. Moreover, the healthcare worker’s emotional intelligence aspect of self-emotion appraisal moderated this relationship, but not others-emotion appraisal. We believe healthcare workers’ supervisors should pay attention to their negative mood expression and regulation. In the hope of reducing being influenced by supervisors’ negative mood, training about noticing and recognizing their own emotions are needed for healthcare workers.

Leadership and Follower Voice: The Role of Inclusive Leadership and Group Faultlines in Promoting Collective Voice Behavior

We developed and tested a theoretical model to examine how and when inclusive leadership affected collective voice behavior in this study. We identified two voice-relevant mediators—group psychological safety (an emergent state) and information elaboration (a group process) to clarify the mechanisms between inclusive leadership and collective voice behavior. Further, according to the person–situation interaction approach, we brought the faultlines theory to the inclusive leadership literature and considered group faultlines as a positive moderator to maximize the effects of inclusive leadership. With a two-wave, two-source design, we collected data from 301 employees within 67 research and development groups in China. We found that inclusive leadership positively affected collective voice behavior through the mediating mechanisms of both group psychological safety and information elaboration. Additionally, this effect was stronger in high faultlines situation. The findings suggest that leaders should show inclusiveness to motivate collective voice, especially in groups with high faultlines.

Setting the stage for speaking up: psychological safety and directing care in acute care collaboration

Managing a safe and efficient anaesthetic induction within a team involves the challenge of when, if, and how to surface, discuss, and implement the best plan on how to proceed. The Lemke and colleagues study in this issue of the British Journal of Anaesthesia is a unique view into real-world conversations that naturally occur in anaesthesia teams in moments of high task and cognitive load, such as induction of anaesthesia. The study spotlights important small moments of physician, nurse, and trainee team coordination. It illuminates key patterns of conversation in naturally occurring anaesthesia teams, and raises important questions about what the speaking up standard should be and the psychological safety-shaping role consultants play in setting the norms for speaking up.

Enhancing Team Learning through Leader Inclusiveness: A One-Year Ethnographic Case Study of an Interdisciplinary Teacher Team

PHENOMENON

Developing modern medical curricula requires collaboration between different scientific and clinical disciplines. Consequently, institutions face the daunting task to engage colleagues from different disciplines in effective team collaboration. Two aspects that are vital to the success of such teamwork are "team learning behavior" by all team members and "leader inclusiveness behavior" by the team leader. Team members display team learning behavior when they share information, build upon and integrate each other's viewpoints. The team leader can promote such team learning by exhibiting inclusiveness behavior, which aims to encourage diversity and preserve individual differences for an inclusive workplace, nurturing engagement in teamwork. There is a paucity of in-depth research on leader inclusiveness behavior in the field of medical education. This case study aimed to offer unique insight into how leader inclusiveness behavior manifests itself in a successful interdisciplinary teacher team, demonstrating team learning behavior in undergraduate medical education.

APPROACH

We conducted a qualitative, ethnographic case study using different but complementary methods, including observations, interviews and a documentary analysis of email communication. By means of purposive sampling, we selected an existing interdisciplinary teacher team that was responsible for an undergraduate medical course at Maastricht University, the Netherlands, and that was known to be successful. Chaired by a physician, the team included planning group members and tutors with medical, biomedical, and social sciences backgrounds as well as student-representatives. In the course of one academic year, 23 meetings were observed and recorded, informal interviews were conducted, and over 100 email conversations were collected. All data were submitted to a directed content analysis based on team learning and leader inclusiveness concepts.

FINDINGS

Leader inclusiveness behavior became evident from verbal and non-verbal interactions between the team leader and team members. Leader inclusiveness behavior that facilitated team learning behavior manifested itself in five actions undertaken by the team leader: coordinating, explicating, inviting, connecting, and reflecting. Similarly, team members facilitated team learning behavior by participating actively, speaking up behavior, and mimicking leader inclusiveness behavior. These behaviors demonstrated engagement and feelings of inclusion, and reinforced leader inclusiveness behavior by creating additional opportunities for the leader to exhibit such behavior.

INSIGHTS

This case study responds to the need for inclusive leadership approaches in medical education. Our findings build upon theoretical knowledge on team learning and leader inclusiveness concepts. By studying behaviors, interactions and documents we obtained in-depth information on leader inclusiveness. Our findings are unique in that they demonstrate how leader inclusiveness behavior manifests itself when leaders interact with their team members. This study provides health professionals who are active in education with practical suggestions on how to act as a successful and inclusive leader. Finally, the behaviors identified open up avenues for future professional development initiatives and future research on team leadership.

Supplemental data for this article is available online at here.

Associations of form and function of speaking up in anaesthesia: a prospective observational study

BACKGROUND

Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up.

METHODS

Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding.

RESULTS

Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018).

CONCLUSION

Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions.

Reflection on the Fly: Development of the Team Reflection Behavioral Observation (TuRBO) System for Acute Care Teams

PURPOSE

Acute care teams work in dynamic and complex environments and must adapt to changing circumstances. A team process that helps teams process information and adapt is in-action team reflection (TR), defined as concurrent collective reflection on group objectives, strategies, or processes during an ongoing care event. However, the health care field lacks a means for systematically observing and ultimately training in-action TR in acute care teams. To bridge this gap, the authors developed a theoretically and empirically informed framework, Team Reflection Behavioral Observation (TuRBO), for measuring in-action TR.

METHOD

In 2018 at ETH, Zurich, Switzerland, the authors developed a theoretical framework based on the literature and theory. They then conducted exploratory reviews of preexisting videos of acute care teams training simulated emergencies. The authors adapted observation codes using an iterative approach. Using the developed coding framework, they coded 23 video recordings of acute care teams and provided validity evidence from the 3 sources: content, internal structure (interrater reliability), and relations to other variables.

RESULTS

The final TuRBO framework consists of 3 general dimensions-seeking information, evaluating information, and planning-that are further specified in 7 subcodes. Interrater agreement of the coding was substantial (κ = 0.80). As hypothesized, the data showed a positive relationship between in-action TR and team performance. Also, physicians spent significantly more time on in-action TR than nurses.

CONCLUSIONS

The TuRBO framework for assessing in-action TR in acute care teams provides positive validity evidence of the data. TuRBO integrates different team communication and calibration processes under the overarching concept of in-action TR and provides descriptive behavioral markers. TuRBO taps into powerful cultural and normative components of patient safety. This tool can augment team training that allows all team members to serve as an important resource for flexible, resilient, and safer patient care.

Does social media usage evoke employees' spirituality? A cross-level moderation model of inclusive leadership

Purpose

The purpose of this study is to investigate the impact of social media usage (SMU) and relational energy on employees' workplace spirituality within an organization from a psychological perspective.

Design/methodology/approach

This study proposes a research model based on self-determination theory. This research model was tested using a cross-level hierarchical regression analysis. Data were collected from 276 knowledge workers on 39 teams in 37 enterprises in China.

Findings

SMU has a significant positive impact on employees' relational energy and workplace spirituality. Relational energy partially mediates the relationships of cognitive usage and social usage of social media with workplace spirituality and fully mediates the relationship between hedonic usage of social media and workplace spirituality. Inclusive leadership positively affects workplace spirituality and acts as a negative cross-level moderating variable on the relationship between hedonic usage and workplace spirituality.

Practical implications

This work suggested that with appropriate SMU implications, enterprises might be able to integrate spirituality into human resource management practices to improve employees' meaningful life experiences within organizations.

Originality/value

The authors’ findings not only help to theoretically clarify the relationship between SMU and workplace spirituality but also enrich the relevant research on SMU in enterprises to improve employees' spiritual life within the organization.

How and when organization identification promotes safety voice among healthcare professionals

AIM

The aim of this study is to examine the effect of organizational identification on safety voice behaviour, focusing on the mediating role of safety motivation and the moderating role of management commitment to safety and psychological safety.

DESIGN

The study used a cross-sectional questionnaire and a convenience sampling method.

METHOD

Data were collected online during November 2019 from 165 staff members from a disability healthcare organization in Australia that employs over 800 staff. Nearly 80% of the study sample were healthcare workers without supervisory responsibilities, and the remainder were senior staff with some operational duties. Measures of organizational identification, safety motivation, perceived management commitment to safety, psychological safety and safety voice were collected. Data were analysed using a moderated mediation model available with the SPSS PROCESS macro.

RESULTS

Findings show that organizational identification interacted with management commitment to safety to predict safety motivation, such that only healthcare employees who identified with their organization and perceived that their management cares about safety would feel that safety was personally important to them. In turn, safety motivation predicted safety voice. However, the effect of safety motivation on safety voice was only significant when psychological safety was low.

CONCLUSION

These findings offer initial evidence for the important role of organizational identification in prompting safety voice, how the relationship is contingent on management commitment to safety and psychological safety.

IMPACT

Healthcare professionals' discretionary sharing of ideas and suggestions are crucial to organizational performance and both staff and patient safety. However, safety voice involves inherent social risks because speaking up might not always be perceived positively by co-workers and leaders. We recommend that managers implement specific strategies to cultivate employee identification with the organization and demonstrate a genuine and visible commitment to safety so that employees will be motivated to raise safety concerns.

Sound and Safe: The Role of Leader Motivating Language and Follower Self-Leadership in Feelings of Psychological Safety

This manuscript presents a study on how leader motivating language and follower self-leadership act to influence a follower’s feelings of psychological safety. This study found that both constructs significantly influenced psychological safety in samples from India and the USA. Additionally, this study found that this influence occurred through the mediating processes of trust in leadership, leader inclusiveness, and role clarity. These mediators fully explained motivating language’s relationship with psychological safety, but only partially explained self-leadership’s relationship. Differences existed in the model between samples, but self-leadership showed an overall consistency between the samples for most relationships. Follow-up analysis indicated that self-leadership without leader communication support lead to a weak or non-existent relationship between self-leadership and psychological safety, but a positive and relatively strong relationship in the presence of motivating language.

Influence of Core Competence on Voice Behavior of Clinical Nurses: A Multicenter Cross-Sectional Study

Background

Voice behavior, referred to as a positive guarantee for organizational development, is influenced by several kinds of individual, collective and organizational features. However, the impact of individual competence on voice behavior is unclear. The aim of the present study was to investigate the status quo of core competence and voice behavior of clinical nurses and explore the impact of core competence on nurses’ voice behavior.

Methods

A multicenter cross-sectional survey. A total of 1717 nurses were recruited from nine tertiary and secondary hospitals between March and June 2019. An online questionnaire, including socio-demographic variables, employee voice behavior scale and competence inventory for registered nurses, was used to investigate prohibitive and promotive voice behavior and core competence of clinical nurses. Pearson correlation and hierarchical multiple regression were performed in the data analysis.

Results

The mean score for prohibitive and promotive voice behavior of nurses were 3.46 (SD 0.77) and 3.46 (SD 0.88), respectively. The mean score for core competence was 2.46 (SD 0.77). Critical thinking/research aptitude was the most important predictor for both prohibitive and promotive voice behavior (each p < 0.05), but its influence on promotive voice behavior was greater (p < 0.05). Leadership was another significant predictor for prohibitive voice behavior (p < 0.05). Legal/ethical practice, teaching-coaching, professional development and shift work were other predictors for promotive voice behavior (each p < 0.05).

Conclusion

Clinical nurses experience modest levels of prohibitive and promotive voice behavior and their core competence is moderate. Core competence, especially critical thinking/research aptitude, impacts significantly on voice behavior of clinical nurses. Cultivating nurses’ core competence could positively increase their voice behavior for organizational development.

Gaining insights into organizational communication dynamics through the analysis of implicit and explicit communication

This report in the journal Gruppe. Interaktion. Organisation. Zeitschrift für Angewandte Organisationspsychologie aims at presenting how the analysis of implicit and explicit communication in organizational interaction can advance our insights into and implications for these interactions for research and science. Communication is a central process in modern organizations. Especially recurring forms of interaction in organizations (e.g., meetings or appraisal interviews) are of great importance for personal and organizational success. In these interactions, the communication between the interacting organizational members has a decisive impact on the interactions’ course and outcomes (e.g., satisfaction with the interaction, performance during the interaction). Therefore, the aim of this paper is to present two aspects of communication that are empirically shown to contribute to successful outcomes of organizational interactions. Based on a practical problem, we illustrate the analysis and implications of (1) implicit communication (that is, the use and coordination of unconsciously used function words such as pronouns, articles, or prepositions) and (2) explicit communication (that is, the overarching meaning of a statement). To further illustrate the practical relevance of both communication behaviors, we present empirical insights and their implications for practice. Taking a glance at the future, possible combinations of these communication behaviors, the resulting avenues for future research, and the importance of a strengthened cooperation between research and practice to gain more naturalistic insights into organizational communication dynamics are discussed.

Text Preprocessing for Text Mining in Organizational Research: Review and Recommendations

Recent advances in text mining have provided new methods for capitalizing on the voluminous natural language text data created by organizations, their employees, and their customers. Although often overlooked, decisions made during text preprocessing affect whether the content and/or style of language are captured, the statistical power of subsequent analyses, and the validity of insights derived from text mining. Past methodological articles have described the general process of obtaining and analyzing text data, but recommendations for preprocessing text data were inconsistent. Furthermore, primary studies use and report different preprocessing techniques. To address this, we conduct two complementary reviews of computational linguistics and organizational text mining research to provide empirically grounded text preprocessing decision-making recommendations that account for the type of text mining conducted (i.e., open or closed vocabulary), the research question under investigation, and the data set’s characteristics (i.e., corpus size and average document length). Notably, deviations from these recommendations will be appropriate and, at times, necessary due to the unique characteristics of one’s text data. We also provide recommendations for reporting text mining to promote transparency and reproducibility.

The Impact of Paradoxical Leadership on Employee Voice Behavior: A Moderated Mediation Model

Paradoxical leadership is associated with positive behavioral outcomes. However, the link between paradoxical leadership and voice behavior is not comprehensively studied in extant literature. This paper builds a theoretical model to reveal how paradoxical leadership facilitates promotive and prohibitive voice behavior of employees, drawing upon social cognitive theory and regulatory focus theory. We proposed a moderated mediation model that employees' voice behavior is related to paradoxical leadership through self-efficacy and psychological safety. With data from 268 leader - employee pairs of questionnaires, this study conducted a structural equation model to test the conceptual framework. The results show that (a) leader's paradoxical leadership related to employee's promotive and prohibitive voice behaviors positively; (b) employee's self-efficacy and psychological safety mediate the extent of effect the superior's paradoxical leadership has on subordinate's voice behavior; (c) the more obvious the subordinate's promotion focus orientation, the stronger the mediating effect of self-efficacy; and (d) the more obvious the subordinate's prevention focus orientation, the weaker the mediating effect of psychological safety. These conclusions reveal the influencing mechanism of a superior's paradoxical leadership on a subordinate's voice behavior. It expands paradoxical leadership-related studies, enriches studies related to the field of "leader - employee voice behavior," and highlights the relationship between the duality of paradoxical leadership behavior on employees with different regulatory focus orientation with a new perspective.

Investigating voice in action teams: a critical review

Team communication is considered a key factor for team performance. Importantly, voicing concerns and suggestions regarding work-related topics-also termed speaking up-represents an essential part of team communication. Particularly in action teams in high-reliability organizations such as healthcare, military, or aviation, voice is crucial for error prevention. Although research on voice has become more important recently, there are inconsistencies in the literature. This includes methodological issues, such as how voice should be measured in different team contexts, and conceptual issues, such as uncertainty regarding the role of the voice recipient. We tried to address these issues of voice research in action teams in the current literature review. We identified 26 quantitative empirical studies that measured voice as a distinct construct. Results showed that only two-thirds of the articles provided a definition for voice. Voice was assessed via behavioral observation or via self-report. Behavioral observation includes two main approaches (i.e., event-focused and language-focused) that are methodologically consistent. In contrast, studies using self-reports showed significant methodological inconsistencies regarding measurement instruments (i.e., self-constructed single items versus validated scales). The contents of instruments that assessed voice via self-report varied considerably. The recipient of voice was poorly operationalized (i.e., discrepancy between definitions and measurements). In sum, our findings provide a comprehensive overview of how voice is treated in action teams. There seems to be no common understanding of what constitutes voice in action teams, which is associated with several conceptual as well as methodological issues. This suggests that a stronger consensus is needed to improve validity and comparability of research findings.

Employee Political Skill, Supervisor-Subordinate Guanxi, and Work-Family Conflict: The Cross-Level Moderating Role of Family-Friendly Practices

Many studies have examined the negative effects of work-family conflict on society, organizations, and individuals. Nonetheless, alleviating employee work-family conflict is a topic worthy of further investigation. Few studies examine the antecedent variables of work-family conflict from personal skill and Guanxi perspectives. Studies that test the moderating role of family-friendly practices at the organization level are also rare. Accordingly, we collected data from 404 employees of 51 organizations. The research data are time-lagged and multileveled. The results of hierarchical linear model (HLM) show: (1) Employee political skill negatively affects employee perceived work-family conflict; (2) Employee political skill positively affects supervisor-subordinate Guanxi; (3) Supervisor-subordinate Guanxi partially mediates the relationship between employee political skill and employee work-family conflict (that is, employees can use their political skill to build high-quality supervisor-subordinate Guanxi, further reducing their perceived work-family conflict); (4) Organization family-friendly practices negatively moderate the relationship between supervisor-subordinate Guanxi and work-family conflict (that is, in organizations with high level family-friendly practices, the negative relationship between supervisor-subordinate Guanxi and work-family conflict becomes weak); Furthermore, by coding with Mplus software (Muthen & Muthen, Los Angeles, CA, USA), we also find: (5) Organization family-friendly practices moderate the indirect effect of employee political skill on employee work-family conflict. The results have both theoretical and empirical implications. Further research directions are addressed at the end.

Upward Voice: Participative Decision Making, Trust in Leadership and Safety Climate Matter

A supportive upward voice environment is critical in nuclear power plants in order to provide energy in a sustainable manner. In high–reliability organizations, front–line employees’ suggestions and concerns enable the early identification of potential problems that might have catastrophic consequences (e.g., a nuclear accident). Despite this, previous research has mostly focused on person–centered antecedents of upward voice and, to a lesser extent, the influence of the supervisor–subordinate relationship, while neglecting the importance of the organizational context. This study responds to the aforementioned research lacuna. It examined the relationship between participative decision making and upward voice, and the mediating role of trust in leadership in this relationship. Moreover, it further extends previous research by examining the role of safety climate, which is expected to moderate both the direct and the indirect effect of participative decision making on upward voice. The sample was composed of 495 workers from two nuclear power plants from the same organization. Findings supported the hypothesized moderated mediation model: the indirect effect of participative decision making (PDM) on upward voice via trust in leadership was contingent upon the level of the safety climate. The indirect effect became weaker as the safety climate increased. These findings support the relevance of the organizational context.

A systematic review of factors that enable psychological safety in healthcare teams

Purpose

The current systematic review will identify enablers of psychological safety within the literature in order to produce a comprehensive list of factors that enable psychological safety specific to healthcare teams.

Data sources

A keyword search strategy was developed and used to search the following electronic databases PsycINFO, ABI/INFORM, Academic search complete and PubMed and grey literature databases OpenGrey, OCLC WorldCAT and Espace.

Study selection

Peer-reviewed studies relevant to enablers of psychological safety in healthcare setting that were published between 1999 and 2019 were eligible for inclusion. Covidence, an online specialized systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers.

Data extraction

Thirty-six relevant studies were identified for full review and data extraction. A data extraction template was developed and included sections for the study methodology and the specific enablers identified within each study.

Results of data synthesis

Identified studies were reviewed using a narrative synthesis. Within the 36 articles reviewed, 13 enablers from across organizational, team and individual levels were identified. These enablers were grouped according to five broader themes: priority for patient safety, improvement or learning orientation, support, familiarity with colleagues, status, hierarchy and inclusiveness and individual differences.

Conclusion

This systematic review of psychological safety literature identifies a list of enablers of psychological safety within healthcare teams. This list can be used as a first step in developing observational measures and interventions to improve psychological safety in healthcare teams.

How Does Paradoxical Leadership Affect Employees' Voice Behaviors in Workplace? A Leader-Member Exchange Perspective

We theorized and tested a leader-member perspective beyond the existing studies in paradoxical leadership and employee voice behavior. We proposed that paradoxical leadership influences employees’ voice behavior through psychological safety and self-efficacy. We also theorized that team size influences an extent to which the subordinates internalize their self-efficacy and psychological safety to exhibit proactive behavior. In a longitudinal study conducted on 155 subordinates and 96 supervisors in China, we found that when leaders adopt paradoxical behavior, employees are more likely to engage into promotive voice behavior; however, employees’ prohibitive voice behavior is reduced when their leaders adopt paradoxes in leadership behavior. Additionally, psychological safety mediates the relationship between paradoxical leadership and promotive voice behavior. Further, team size has significant interaction effects with psychological safety on promotive voice behavior.

Nurses’ voice: the role of hierarchy and leadership

Purpose

Voicing concerns and suggestions is crucial for preventing medical errors and improving patient safety. Research suggests that hierarchy in health-care teams impair open communication. Hierarchy, however, can vary with changing team composition, particularly during acute care situations where more senior persons join the team later on. The purpose of this study is to investigate how changes in hierarchy and leadership were associated with nurses’ voice frequency and nurses’ time to voice during simulated acute care situations.

Design/methodology/approach

This study’s sample consisted of 78 health-care providers (i.e. nurses, residents and consultants) who worked in 39 teams performing complex clinical scenarios in the context of interprofessional, simulation-based team training. Scenarios were videotaped and communication behaviour was coded using a systematic coding scheme. To test the hypotheses, multilevel regression analyses were conducted.

Findings

Hierarchy and leadership had no significant effect on nurses’ voice frequency. However, there were significant relationships between nurses’ time to voice and both hierarchy (γ = 30.00, p = 0.002; 95 per cent confidence interval [CI] = 12.43; 47.92) as well as leadership (γ = 0.30, p = 0.001; 95 per cent CI = 0.12; 0.47). These findings indicate that when more physicians are present and leadership is more centralised, more time passes until the first nurses’ voice occurred.

Originality/value

This study specifies previous findings on the relationships between hierarchy, leadership and nurses’ voice. Our findings suggest that stronger hierarchy and more centralised leadership delay nurses’ voice but do not affect the overall frequency of voice.

Managing psychological safety in debriefings: a dynamic balancing act

Debriefings should promote reflection and help learners make sense of events. Threats to psychological safety can undermine reflective learning conversations and may inhibit transfer of key lessons from simulated cases to the general patient care context. Therefore, effective debriefings require high degrees of psychological safety—the perception that it is safe to take interpersonal risks and that one will not be embarrassed, rejected or otherwise punished for speaking their mind, not knowing or asking questions. The role of introductions, learning contracts and prebriefing in establishing psychological safety is well described in the literature. How to maintain psychological safety, while also being able to identify and restore psychological safety during debriefings, is less well understood. This review has several aims. First, we provide a detailed definition of psychological safety and justify its importance for debriefings. Second, we recommend specific strategies debriefers can use throughout the debriefing to build and maintain psychological safety. We base these recommendations on a literature review and on our own experiences as simulation educators. Third, we examine how debriefers might actively address perceived breaches to restore psychological safety. Re-establishing psychological safety after temporary threats or breaches can seem particularly daunting. To demystify this process, we invoke the metaphor of a ‘safe container’ for learning; a space where learners can feel secure enough to work at the edge of expertise without threat of humiliation. We conclude with a discussion of limitations and implications, particularly with respect to faculty development.