295 - Gender Differences in Psychological Safety in Neonatal Resuscitation Teams

Publication Number: 295.4737

Cecelia Corson, Childrens Hospital of Philadelphia, Cardiff by the Sea, CA, United States; Ingrid Nembhard, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States; Joshua Radack, Childrens Hospital of Philadelphia, Boston, MA, United States; Elizabeth Foglia, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Sara Handley, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Psychological safety (PS) exists when team members feel comfortable taking interpersonal risks (e.g. speaking up about issues), which is critical to neonatal resuscitation. Studies of PS, typically conducted in male-majority or male-led teams, show that females feel less PS than males. Whether this pattern holds in female-majority and female-led teams is unknown yet relevant in neonatal care where >70% of attendings, fellows, and nurses (RNs) identify as female.

Objective: To investigate the association between team member gender and PS in neonatal resuscitation teams, and the influence of respondent and unit leadership characteristics on gender differences.

Design/Methods: This was a cross-sectional survey of neonatal resuscitation team members in a Mid-Atlantic health system. The survey included 3 PS items assessed on a 7-point Likert scale, averaged to a PS score. Higher scores indicate higher PS. Respondents self-reported gender (female, male, decline to answer), role (RN, respiratory therapist [RT], advanced practice practitioner (APP), physician, other), time in role, and time at institution. We examined the unit leadership characteristics of medical director gender and gender composition (% male) of the multidisciplinary leadership team. Ordinal logistic regression assessed the association of gender with PS score tertiles (1: ≤5.67, 2: 5.68-6.33, 3: ≥6.34), considering respondent and unit leadership characteristics.

Results: Across 16 hospitals there were 595 complete responses (39% response rate), of which 90.3% identified as female (Table 1). Compared to females, males had a significantly higher odds of higher PS (odds ratio [OR] 3.28, 95% confidence interval [CI] 1.77, 6.06), which persisted after accounting for all characteristics (adjusted OR 2.62, 95% CI 1.29, 5.31). Unit leadership characteristics of male medical director and ≥25% male leadership team were associated with a significantly lower odds of high PS for females, but significance did not persist in the adjusted model (Table 2). Besides male gender, only role was significant after adjusting for leadership. RTs had significantly lower and APPs and physicians had significantly higher odds of higher PS relative to nurses.

Conclusion(s): Females in neonatal resuscitation teams had lower PS than males, irrespective of role and experience. Gender-congruent unit leaders and leadership teams did not mitigate gender differences; lower PS for female team members remained. Attention to PS differences within teams and new approaches to facilitate PS, especially among females, is needed.

Respondent Characteristics
Psych Safety Gender Table 1 10.31.24.pdfRespondent characteristics stratified by self-reported gender

Results
Psych Safety Gender Table 2 10.31.24.pdfAssociations of respondent gender with each respondent and leadership team characteristic with psychological safety.