CENTRE: creating psychological safety in groups.

BACKGROUND: Ten years of clinical and teaching experience has shown us that when teams or groups come together, it is often for a commonly understood and agreed upon purpose, but often without an agreed upon process of how to work together. Explicit guidelines in this regard promote psychological safety. CONTEXT: This article presents a method of developing agreements that can be used in a variety of settings to create psychological safety and cohesion. In our experience, agreements about how people join together seem to be developed implicitly. Assumption-based and implicit agreements can engender friction because unspoken or unclear agreements are not easily addressed because they are not universally understood. INNOVATION: A literature review helped to identify key factors contributing to psychological safety and led to creating 'CENTRE' to help clinical teams apply these factors. We are now starting to evaluate its impact. We believe a tool such as CENTRE facilitates the development of explicitly articulated group formation and maintenance guidelines, thus reducing the risk of interpersonal discord. IMPLICATIONS: We propose that a tool such as CENTRE be considered for a range of group situations, including clinical family meetings, teaching, professional teams and Balint-type groups. We are currently using this approach in clinical, academic and other professional environments. Findings from a survey of groups where CENTRE was used suggested that participants find the process useful. We believe a tool such as CENTRE can be used to help address relational issues, promote psychological safety, inclusion and trust among members, and reduce the risk of undeclared expectations and assumptions from dictating how groups function. Assumption-based and implicit agreements can engender friction because unspoken or unclear agreements are not easily addressed.

Preventing diabetes in primary care: a feasibility cluster randomized trial.

OBJECTIVE: To determine the feasibility of implementing a large-scale primary care-based diabetes prevention trial. METHODS: A feasibility cluster randomized controlled trial was conducted in British Columbia, Canada, amongst adults with prediabetes using the Facilitated Lifestyle Intervention Prescription (FLIP) vs. usual care. FLIP included lifestyle advice, a pedometer, and telephone support from a lifestyle facilitator for 6 months. Indicators of feasibility included recruitment rates of family practices, participants and facilitators, as well as feasibility and retention rates in the FLIP program and study protocols. RESULTS: Six family practices participated; 59 patients were enrolled between October 2012 and March 2013. The trial protocol was acceptable to practices and participants and had a 95% participant retention rate over the 6 months (56/59). Adherence to the intervention was high (97%), with 34 of 35 patients continuing to receive telephone calls from the facilitator for 6 months. The mean cost of the intervention was C$144 per person. Compared with control, intervention participants significantly reduced weight by 3.2 kg (95% CI, 1.7 to 4.6); body mass index by 1.2 (95% CI, 0.7 to 1.7) and waist circumference by 3 cm (95% CI, 0.3 to 5.7). CONCLUSIONS: It is feasible to implement FLIP and to conduct a trial to assess effectiveness. A larger trial with longer follow up to assess progression to diabetes is warranted.