BACKGROUND: Psychological safety is the concept by which individuals feel comfortable expressing themselves in a work environment, without fear of embarrassment or criticism from others . Psychological safety in healthcare is associated with improved patient safety outcomes, enhanced physician engagement and fostering a creative learning environment . Therefore, it is important to establish the key levers which can act as facilitators or barriers to establishing psychological safety . Existing literature on psychological safety in healthcare teams has focused on secondary care, primarily from an individual profession perspective . In light of the increased focus on multidisciplinary work in primary care and the need for team-based studies, given that psychological safety is a team-based construct, this study sought to investigate the facilitators and barriers to psychological safety in primary care multidisciplinary teams .

METHODS: A mono-method qualitative research design was chosen for this study . Healthcare professionals from four primary care teams (n = 20) were recruited using snowball sampling . Data collection was through semi-structured interviews . Thematic analysis was used to generate findings .

RESULTS: Three meta themes surfaced: shared beliefs, facilitators and barriers to psychological safety . The shared beliefs offered insights into the teams' background functioning, providing important context to the facilitators and barriers of psychological safety specific to each team . Four barriers to psychological safety were identified: hierarchy, perceived lack of knowledge, personality and authoritarian leadership . Eight facilitators surfaced: leader and leader inclusiveness, open culture, vocal personality, support in silos, boundary spanner, chairing meetings, strong interpersonal relationships and small groups .

CONCLUSION: This study emphasises that factors influencing psychological safety can be individualistic, team-based or organisational . Although previous literature has largely focused on the role of leaders in promoting psychological safety, safe environments can be created by all team members . Members can facilitate psychological safety in instances where positive leadership behaviours are lacking - for example, strengthening interpersonal relationships, finding support in silos or rotating the chairperson in team meetings . It is anticipated that these findings will encourage practices to reflect on their team dynamics and adopt strategies to ensure every member's voice is heard.