Safety is a team effort

Are hyper-efficiency and operational reliability competing goals? The wide adoption of neoliberal work practices in public organizations has brought about decisive changes in the workplace that, despite their rhetoric for optimizing performance, threaten sustainable organizational success. The single most decisive impetus for such practices in the public sector is the New Public Management (NPM) reforms in most OECD countries. Tasked with the objective of improving the efficiency and overall performance of the public sector, NPM reforms led to accountability pressures and excessively high workloads which often resulted in negative employee outcomes, including workplace harassment, lower levels of employee wellbeing and reduced workplace engagement.

Some organizations, however, cannot afford to have their operations tightly coupled, such as organizations working with human life and health (e.g., acute hospitals) or operations routinely incubating risks to human life (e.g., nuclear power stations). Such organizations, referred to as high-reliability organizations (HROs), should have the 'ability to maintain and execute error-free operations' when operating in complex, high-risk environments. But to do so, they require organizational slack. Organizational slack is 'the pool of resources in an organization that is in excess of the minimum necessary to produce a given level of organizational output'. By depleting organizations of slack in pursuit of efficiency, managers create pathways of vulnerability, with people more likely to make errors and minor incidents more likely to escalate into major accidents, in the organizational equivalent of a domino effect. As NPM reforms are here to stay and may deepen further under austerity policies promoted in some countries, it becomes increasingly important to offset the effects of ever-reducing organizational slack on public sector professionals with initiatives aimed at restoring positive associations with work.

Important progress in this direction is seen with the emergence of the Positive Organizational Behavior (POB) movement in organizational studies, which aims to investigate the contribution of positive individual resources to coping with work demands. The psychological capacities that appear suitable for treatment under the POB framework are hope, optimism, resilience, and self-efficacy. Hope indicates willingness and engagement to achieve defined targets; optimism suggests anticipation of a positive consequence from one's own actions; resilience implies aptitude to counteract major problems; and, lastly, self-efficacy indicates confidence and has been shown to predict performance. Together, they make up a person's Psychological Capital a positive psychological state of development that individuals can count on to reach their goals. PsyCap positively affects safety-focused behaviors, promoting greater safety awareness.
Against the backdrop of decreased "organizational slack" in public sector organizations, our research investigates the positive contribution of teams to individuals' safety behavior in high-reliability settings as part of a wider conversation about public sector professionals under crisis. Our study identifies the strong positive effect of teamwork on individual professionals' safety behaviors within Italian acute care public hospitals. We tested the crucial role of teamwork in enhancing the effectiveness of safety improvements among healthcare staff and within surgical teams. Because of the high level of specialization and interdependence of healthcare professionals working together, teamwork is argued to be strongly related to trust. Furthermore, effective teamwork is related to members' abilities to deal with conflict and the presence of helpful behaviors, empathy, and emotional support within the team. Key role of communication and teamwork in the prediction of adverse events in healthcare settings, indicating that it counts more than staff's clinical skills. A strong safety culture (and subsequent safety behavior) presupposes communication founded on mutual trust, shared perceptions of the importance of safety and confidence in the efficacy of preventative methods, all of which are indicative of high levels of teamwork. According to the respondents, the most important issue jeopardizing patient safety in the acute hospital was 'collaboration defects' In terms of interactions, the issues affecting teamwork among healthcare professionals was related with interpersonal issues such as trust and assertiveness.

These findings confirm the key role of communication and teamwork in the prediction of adverse events in healthcare settings. This study provides evidence to support the view that individual positive resources (PsyCap) have a positive effect on safety outcomes. Teamwork has a strong, positive effect on PsyCap. Yet, there is a need to understand the issues that affect safety behaviors during 'business as usual' and not retrospectively through the analysis of known crises. Regarding patient safety, our results emphasize the role and responsibilities of hospitals' top and middle management. Notably, hospital leaders are responsible for creating the right organizational climate to allow staff to work across interprofessional boundaries, as well as those between clinical and non-clinical staff. In light of our findings, we argue that poor teamwork affects not only professionals' safety behaviors but also their positive individual resources such as PsyCap, which can make them more likely to behave unsafely. Therefore, hospitals may have to take active steps to not only engage in initiatives that increase PsyCap upskilling opportunities for their staff but also increase organizational slack for more effective teamwork through team communication. These avenues may be appropriate for other public sector high-reliability settings and professionals 'in crisis'.