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Table 2 Techniques and practices to enable cultural and organisational change

From: Enhancing psychological safety in mental health services

Intervention Actions Evidence
Organisational and leadership messaging Create a communication strategy using multiple approaches to reach the whole workforce and the wider community. Strategies include sending letters and factsheets, and in-person roadshows Letter and fact sheet campaign [54]. Leadership videos [55]
Developing an organisational charter Code of conducts can provide a framework for behavioural expectations. Codes of conduct offer the opportunity to embed behaviours taught in workshops and educational sessions (see below) into current practice Team charter to empower teams [56]. Code of conduct [57]
Mental health ethics committee Open and accessible ethics committees provide objective and supportive scrutiny, particularly around explore complex dilemmas and experimenting with new approaches to patient care (i.e., service change and quality improvement) Ethics committees and consultations [58, 59]
Dialogue meetings Create a series of dialogue meetings to open up questions that are frequently either unanswered or unanswerable to generate open discussion on difficult topics in mental health Opportunities to discuss complex dilemmas [60, 61]
Schwartz rounds Provide interdisciplinary meetings for groups to discuss the emotional and social aspects of care with the purpose of providing safer patient care. It is led by a multidisciplinary panel who open with their experiences around a particular theme. Schwartz rounds are complementary to dialogue meetings, focusing on share experience and compassion instead of unearthing the thought processes regarding difficult situations Schwartz rounds in mental health and community care [62]
Staff engagement and action research groups Town halls offer an opportunity to bring together representatives across the organisation to discuss psychological safety. Action research groups, allowing clinicians to act as researchers, calibrate approaches and share best practice Staff engagement [63, 64]. Action Research Groups [64, 65]
Patient participatory councils These groups provide an opportunity to bring professionals, managers and clinical and non-clinical staff together to ensure healthcare is patient-oriented and maximise patient involvement and choice Patient engagement and participatory action research group [66]
Skills workshops Workshops and train the trainer workshops offer opportunities to bolster skills and embed this into practice by training champions Train the trainer workshops [57]. Skills workshop [67, 68]
Simulation and role play Utilising the role of simulated or unstructured role-play to explore complex scenarios in mental health in safe no-risk environments Simulation [51]. Role-play [69]
Video presentations and case studies This approach provides teams with the time to self-reflect and reflects on everyday events that are complex and generally made under pressure Video dramatisation of medical events [70]. Vignettes [71]