How is psychological safety related to physicians’ vaccination behavior?

By Manuel Stühlinger, Jan B. Schmutz, and Gudela Grote

Many high-performing teams have one thing in common. They feature psychological safety—a specific type of team climate where members feel safe to be themselves and take interpersonal risks such as asking for help, suggest improvements or admit mistakes. Studies have shown that psychological safety allows for speaking one’s mind, learning and innovation.

In our study, we were interested in the mechanisms that explain the effects of psychological safety on individual behavior. The core idea is that psychological safety within a work team may affect an individual’s work-related behavior by modifying the influence of personal attitudes.

We know that psychological safety in a team reduces the fear of negative reactions by other team members. Hence, members feel safe to engage in potentially risky behaviors such as admitting mistakes or questioning a team decision. Psychological safety thus makes members feel comfortable being who they are and behaving in a way consistent with their self-image. We argue that this translates to people feeling more comfortable to act according to their own personal attitude—even if the behavior might not correspond to team norms or organizational goals.

We tested our model with the influenza vaccination behavior of physicians. In many hospitals in Europe, healthcare workers are not obliged to get the seasonal influenza vaccination shot—although it may be an essential measure to reduce hospital-acquired infections. Vaccination behavior thus is a good testbed for our model. In a Swiss hospital, we measured physicians’ personal attitudes toward getting vaccinated in the upcoming season, their perception of psychological safety within their team, and their intention to get vaccinated in the upcoming season. Three months later, we asked them whether they had gotten vaccinated in the meantime.

We found that the physicians’ attitudes significantly predicted their intention and subsequently their reported vaccination behavior. Most importantly, while psychological safety had no direct association with either attitude, intention or vaccination behavior, we found the following pattern illustrated below.

Figure

Psychological safety modifying the relationship between attitude and intention to get vaccinated.

Note: PS stands for psychological safety, SD stands for standard deviation

Psychological safety modified the relationship between attitude and intention to get vaccinated. If physicians had a positive attitude towards vaccination and perceived a high psychological safety in their team, they had an even greater intention to get vaccinated. Most interestingly, this also worked the other way around: Physicians with a negative attitude towards vaccination and a high perceived psychological safety had an even weaker intention to get vaccinated. The intention, in turn, was closely related to physicians’ reported vaccination behavior. This means that high psychological safety actually promoted the omission of influenza vaccination for physicians with a negative attitude towards getting vaccinated.

These findings illustrate that psychological safety might be a mixed blessing. It seems to represent a climate where team members feel safe to act according to their attitude. If this attitude is not in line with team norms or organizational goals, psychological safety might actually promote detrimental behavior.

There are two key messages to take from these findings. First, psychological safety might have negative effects, which practitioners should consider when working on increasing psychological safety in their teams. We should take appropriate measures to minimize potential negative side-effects. Second, our findings illustrate that social processes may influence seemingly unrelated behavior like physicians getting vaccinated. In the current global pandemic, it is considered vital that as many people as possible get vaccinated against COVID-19. Once enough vaccine is available to surpass current demand, the critical question may arise, how to encourage more people to get vaccinated. Our findings suggest that not only individual beliefs should be addressed but also broader, seemingly unrelated social dynamics.

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Article details

To get vaccinated or not? Psychological safety as a catalyst for the alignment between individual beliefs and behavior.

Stühlinger, M., Schmutz, J. B., Grote, G., Nicca, D., & Flury, D. (2021).

Group & Organization Management, 46 (1), 38–69.

https://doi.org/10.1177/1059601120983964

About the authors

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Dr. Manuel Stühlinger is a quality and data management specialist at the Zurich University of Teacher Education, incorporating and applying the insights from his research. Prior to this, he worked as a researcher at ETH Zurich. His research focuses on antecedents and consequences of psychological safety within teams. A special interest lies in the relationship of psychological safety with individual safety-relevant and risk-taking behavior in healthcare and other contexts. He completed his PhD in work and organizational psychology at ETH Zurich.

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Dr. Jan Schmutz holds a PhD in Industrial/Organizational Psychology from the University of Fribourg, Switzerland. He works as a senior researcher and lecturer at ETH Zurich. In 2018, Jan was awarded a travel grant from the Swiss National Science Foundation to fund an 18-month project at Northwestern University, Evanston, IL. Jan studies how teamwork and, in particular team reflection helps teams manage crisis situations in extreme environments. In his research, he investigates military rescue teams, medical emergency teams as well as Antarctica expedition teams. Further, Jan is involved in collaborations with the European Space Agency in order to identify success factors for crews on long and short duration space missions. As a healthcare simulation educator, he facilitates regular team trainings in healthcare institutions around Europe.

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Dr. Gudela Grote is Professor of Work and Organizational Psychology at the ETH Zurich, Switzerland. She received her PhD from the Georgia Institute of Technology, USA. Her research focuses on the increasing flexibility and virtuality of work, for instance in the context of leadership and coordination in high-risk and innovation teams and in socio-technical system design. She has published widely on topics in organizational behavior, human factors, human resource management, and safety management. She is Past President of the European Association of Work and Organizational Psychology, Fellow of the Society for Industrial and Organizational Psychology, and member of the Swiss National Research Council.