Psychological Health and Safety Toolkit for Primary Care Teams and Training Programs

This toolkit aims to empower comprehensive primary care teams and training programs to promote psychological health and safety through a set of curated, evidence-informed resources focused on team-based activities, policies, and practices.

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What is psychological health and safety?

Psychological health is a form of well-being that allows individuals to think, feel, and behave in a manner that enables them to perform effectively in their work environments, personal lives, and in society at large (Samra et al, 2022).

Psychological safety is a condition in which people are free from threats of harm to their psychological health (MHCC, 2019).

Psychological health and safety is a way people interact with one another as well as the way working conditions and management practices are structured within the workplace (CSA, 2013).

Seven themes for workplace psychological health and safety

The resources in this toolkit are organized by seven themes, based on a clustering of the psychosocial factors identified in Canada’s National Standard for Psychological Health and Safety in the Workplace.

Organizational and team culture

1. Organizational and team culture

An organization’s culture is made up of the norms, values, beliefs, meanings, and expectations employees share and base their behaviour on (CSA, 2013). Positive traits of an organizational culture like trust, honesty, and fairness can promote psychological health and safety in the workplace.

What defines a psychologically healthy and safe organizational culture?

Civility and respect: Staff are respectful and considerate of each other, patients, caregivers, and other health-care disciplines.
Psychological and social supports: Co-workers and supervisors are supportive of employees’ psychological health and safety, and respond appropriately as needed. This support could include vacation time, health leave, and wellness time.
Engagement: Staff enjoy their work and are motivated to do their jobs well.
Involvement and influence: Workers are included in discussions about the way in which their work is done and have a role in relevant decisions related to their jobs.
Recognition and reward: Workers’ efforts are acknowledged and appreciated in a fair and timely manner. This could include events such as worker or team celebrations, recognition of good performance and years served, and milestones reached.

Sources: CSA, 2013; CCOHS, 2023

Workload management and work-life balance

2. Workload management and work-life balance

Having too much work and not enough time to do it is one of the most significant stressors in workplaces across Canada. To effectively balance work demands with their personal and family lives, primary care staff must have enough time to complete the tasks and responsibilities they are assigned (CSA, 2013).

Supporting success, promoting well-being

Resource management and access: It is not just the amount of work that makes a difference, but also the resources an employee has access to in order to perform well. This can include physical space, equipment, funding, technology, and human resources support.
Growth and development: Workers are encouraged and supported in the development of their interpersonal, emotional, and job skills. Internal and external opportunities to develop or hone their competencies, which will help with both current and future job preparation.
Psychological demands: A work environment where there is a good fit between employees’ interpersonal and emotional competencies and the requirements of their role, such as working hours that support workers’ psychological health and safety.
Work-life balance: Employees must be able to effectively manage the demands of personal, family, and work life. Workers should be encouraged to take their entitled breaks, such as lunchtime, health time off, and parental leave.

Sources: CSA, 2013; CCOHS, 2023

Successful attractive female doctor or surgeon in scrubs standing with folded arms in front of an African male doctor or consultant conceptual of an expert medical team, on white

Clear leadership and expectations

3. Clear leadership and expectations

Leaders provide clear, effective communication. They ensure that employees understand their roles and how they contribute to the organization (CSA, 2013). Leaders provide helpful feedback on their expected and actual performance. Also, they ensure that employees are informed about important changes at work in a timely manner.

Each leadership style impacts the psychological health and safety of team members. For example, instrumental leaders focus on outcomes and pay little attention to the organizational and team culture or team members as individuals. Transformational leaders, on the other hand, focus on long-term goals and care about team members’ growth and development. They are agents of change who transmit a sense of purpose and motivate others (CSA, 2013).

Psychological protection

4. Psychological protection

A workplace is psychologically safe when staff feel comfortable enough to ask questions, seek feedback, report mistakes and problems, or propose a new idea. Leaders must also actively work to protect employees from stressors that could harm their mental health, including harassment, bullying, discrimination, violence, and stigma (CSA, 2013; CCOHS, 2023)

Stigma related to mental health and/or substance use

In the context of mental health (MH) and substance use (SU), stigma can be defined as “devaluing, stereotyping, labelling, and discriminating against people living with MH and/or SU problems or illnesses based on negative assumptions and beliefs” (Henderson & Gronholm, 2018; Knaak et al., 2017, as cited in MHCC, 2023). MHSU-related stigma can interfere with other factors important to workplace well-being, such as psychological and social supports, psychological protection, and psychological self-care.

The four types of MHSU-related stigma

Self-stigma: Occurs when an individual living with MH and/or SU problems or illnesses internalizes negative stereotypes about themselves (MHCC, 2023).
Interpersonal stigma: When a person holds prejudicial or discriminatory attitudes toward people living with MH and/or SU problems or illnesses, such as stereotyping, judging, labelling, and distancing behaviours (MHCC, 2023).
Intersectional stigma: Arises when MHSU-related stigma overlaps with other types of stigma and forms of inequity and discrimination, such as racism or homophobia (MHCC, 2020, as cited in MHCC, 2023).
Structural stigma: Occurs “when laws, policies, and practices of social institutions are inequitable, restricting the rights of and negatively impacting people living with MHSU” (Livingston, 2013, as cited in MHCC, 2023). “Structural stigma in health care happens when MHSU laws, policies, and systems of care reflect and perpetuate negative biases and beliefs about people with MHSU problems and/or illnesses” (MHCC, 2020, as cited in MHCC, 2023).

Source: Mental Health Commission of Canada, 2023.

Protection of physical safety

5. Protection of physical safety

A physically unsafe environment creates concerns and anxiety among team members. For on-the-job safety, staff must be protected from hazards and risks in the physical work environment. Risks could stem from policies, training, a lack of demonstrated concern for employees’ physical safety, and other factors (CSA, 2013). Leaders and organizations can protect staff members’ psychological and physical safety by ensuring that safety concerns are taken seriously, providing sufficient training for them to perform work safely, allowing staff to refuse work they believe is unsafe, and ensuring that work schedules allow for lunch time and rest periods.

Portrait of doctor and surgeon in a hospital together

Protection from moral distress

6. Protection from moral distress

Staff should be able to perform their roles with a sense of integrity and the support of their profession, employer, and peers. Along with psychological self-care, this factor is especially critical in health-care settings. Organizations and teams can protect staff from moral distress by showing support during adverse situations, ensuring that staff has the human resources and equipment to provide quality care, providing access to bioethics consultations and training, and developing policies and guidelines to address morally distressing events (Grady et al., 2022).

Support for psychological self-care

7. Support for psychological self-care

Organizations and teams should encourage staff to care for their own psychological health and safety, including encouraging them to take breaks and vacations. Psychological self-care should be promoted and embedded into the organizational and team culture (Grady et al., 2022).

Learn more about the seven themes

Resources

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Guide/Tool/Toolkit, and Quiz/Survey Icon

Guidelines for Inclusivity

Practical guidelines to help incorporate inclusive, anti-racist, and anti-oppression practices into medical education.

January 2024

Practical guidelines to help incorporate inclusive, anti-racist, and anti-oppression practices into medical education.

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This link opens an external web page. The Canadian Health Workforce Network and the Mental Health Commission of Canada do not control the quality or omission of translations.

Author(s)/Organization(s)

Billick et al. (Temerty Faculty of Medicine, Department of Medicine, University of Toronto)

Tags

inclusion, anti-racism, curriculum, education, anti-oppression

Audience

Trainee, Health-care educator/Trainer

Theme

Organizational and team culture, Psychological protection

Cost

Free

Format

Guide/Tool/Toolkit

Sector

Specific to healthcare

Setting

Home care, Online setting, Hospital, Long-term care, Private clinic, Community care

Identity

Immigrant, refugee, ethnocultural, and racialized populations (IRER)

Language

English

Article, Article (peer reviewed), Document/Report, Policy/Framework, Program, and Other (Poster presentation)* Icon

Bias and the Psychological Safety in Healthcare Teams

An article that defines bias and psychological safety in healthcare teams and includes a case study. It also offers strategies...

March 2022

An article that defines bias and psychological safety in healthcare teams and includes a case study. It also offers strategies to combat biases, steps that health-care teams can employ to promote belonging in interprofessional teams, and strategies for supporting team members who are experiencing biases.

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This link opens an external web page. The Canadian Health Workforce Network and the Mental Health Commission of Canada do not control the quality or omission of translations.

Author(s)/Organization(s)

Luther & Flattes

Tags

interprofessional team, psychological safety, bias

Audience

Health worker, Health-care educator/Trainer, Trainee

Theme

Organizational and team culture, Psychological protection

Cost

Free

Format

Article (Peer reviewed)

Sector

Specific to healthcare

Setting

Hospital, Long-term care, Private clinic, Community care, Home care, Online setting

Identity

Immigrant, refugee, ethnocultural, and racialized populations (IRER), Women

Language

English

An Institutional Model for Health Care Workers’ Mental Health During Covid-19

A commentary presenting a proactive, team-based support intervention called CREATE, which focuses on compassion, resilience, and team building. The model...

March 2021

A commentary presenting a proactive, team-based support intervention called CREATE, which focuses on compassion, resilience, and team building. The model was designed to support health-care workers’ mental health during the COVID-19 pandemic but is also useful outside that context.

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This link opens an external web page. The Canadian Health Workforce Network and the Mental Health Commission of Canada do not control the quality or omission of translations.

Author(s)/Organization(s)

Shapiro et al.

Tags

resilience, Team-based model, mental health, COVID-19

Audience

Manager/Supervisor/Director, Health worker

Theme

Psychological protection

Cost

Free

Format

Article (Peer reviewed)

Sector

Specific to healthcare

Setting

Hospital

Identity

Not explicitly

Language

English

Advancing Collaborative Teams (ACT) Toolkit

A toolkit to help teams reflect on their performance and prioritize opportunities and strategies for further development as part of...

January 2024

A toolkit to help teams reflect on their performance and prioritize opportunities and strategies for further development as part of a team action plan. It includes reliable and valid assessment tools to evaluate interprofessional care competencies and psychological safety.

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This link opens an external web page. The Canadian Health Workforce Network and the Mental Health Commission of Canada do not control the quality or omission of translations.

Author(s)/Organization(s)

Toronto Academic Health Science Network Practice Committee and University of Toronto Centre for Interprofessional Education at the University Health Network

Tags

collaborative teams, psychological safety, interprofessional care (IPC)

Audience

Health worker, Manager/Supervisor/Director

Theme

Psychological protection

Cost

Free

Format

Guide/Tool/Toolkit

Sector

Specific to healthcare

Setting

Hospital, Long-term care, Private clinic, Community care, Home care, Online setting

Identity

Not explicitly

Language

English

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Disclaimer: This inventory is by no means exhaustive. The Canadian Health Workforce Network and the Mental Health Commission of Canada are unable to comment on the quality of individual programs or services. Consequently, their inclusion in this toolkit should not be considered an endorsement of particular programs or organizations.