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About

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Who is behind the Psychological Health and Safety Toolkit for Primary Care Teams and Training Programs?

The Psychological Health and Safety Toolkit for Primary Care Teams and Training Programs was developed in partnership by the Canadian Health Workforce Network (CHWN), the Mental Health Commission of Canada (MHCC), and the University of Ottawa (uOttawa).

This project is supported by Team Primary Care (TPC), an initiative of the Foundation for Advancing Family Medicine (FAFM) funded by Employment and Social Development Canada (ESDC). It is co-led by the College of Family Physicians of Canada and the CHWN.

The overarching goal of this toolkit is to support comprehensive primary care teams and training programs foster the psychological health and safety of teams through the adoption and adaptation of a set of evidence-informed and sector-specific tools.

Portrait of teamwork - doctor and nurses at hospital

Built for comprehensive primary care teams and training programs

As primary care systems across Canada evolve toward team-based approaches, it is critical to ensure that teams and training programs have the support they need to create and work in psychologically healthy and safe environments.

The Psychological Health and Safety Toolkit for Primary Care Teams and Training Programs is here to help, offering access to evidence-informed resources handpicked for comprehensive primary care teams.[1]

The benefits of psychological health and safety for teams and trainees

A psychologically healthy and safe environment leads to improved team learning, team performance, and continuous quality improvement environments (Donovan and Mcauliffe, 2020).

When team psychological health and safety are prioritized, whether at work or in training programs, individuals feel safe to speak up and express concerns or new ideas without fear of negative reactions from peers, leaders, or instructors/preceptors (Houbby et al, 2021).

Under these conditions, teams and trainees can feel more committed as a team member, be more engaged in improvements to health-care quality and work processes, and experience joy at work (Donovan and McAulifee, 2020; Luther & Flattes, 2022). When they do not, they shut off, burnout, and disconnect from the team — which reduces the communication needed to promote health-care quality (Luther and Flattes, 2022). Unreasonable workload expectations or expressions of microaggressions can also make team members and trainees feel overwhelmed and silenced (Houbby et al, 2021).

High five, teamwork and doctors hands in collaboration for mission, goal or team building together. Mindset, target or medical group with trust, motivation or support for vision, winning or success.
a senior doctor is looking at some ideas with a nurse . They are using stick notes on a glass display board in a medical meeting environment.

Key factors for psychologically healthy and safe workplaces

Canada’s National Standard for Psychological Health and Safety in the Workplace, recognized as a leading practice by the Health Standards Organization, is a set of voluntary guidelines designed to help organizations prevent psychological harm and promote psychological well-being. It identifies 13 psychosocial factors that can promote or hinder psychological health and safety in a workplace.

Based on consultations with health-care organizations, the Mental Health Commission of Canada (MHCC) and HealthCareCAN developed two additional factors especially relevant to health care: protection from moral distress and support for psychological self-care.

These 15 factors guided the selection of resources for the Psychological Health and Safety Toolkit for Primary Care Teams, which are organized by seven main themes outlined below.

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

1. Organizational and team culture

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

2. Workload management and work-life balance

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).

3. Clear leadership and expectations

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.

4. Psychological protection

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.

5. Protection of physical safety

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).

6. Protection from moral distress

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).

7. Support for psychological self-care

[1] 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.

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