Abstract
Background. Today, psychological security, the prevalence of a supportive organizational climate, and the transformation of organizations into secure environments are of paramount importance. The purpose of this research is to present an interpretive-structural model of the drivers of fearless organization in Social Security hospitals.
Methods. This applied developmental study used an exploratory mixed-methods design. In the qualitative phase, a meta-synthesis approach based on Sandelowski and Barroso was conducted to review relevant literature published between 1980 and 2023. In the quantitative phase, Interpretive Structural Modeling (ISM) was applied using data obtained from pairwise comparisons provided by 12 senior managers of Tehran Social Security Hospitals.
Results. A total of 40 drivers for establishing a fearless organization were identified and categorized into five overarching components: Managerial Behavior, Employee Behavior, Organizational Culture, Infrastructure, and Processes. The stratification of these components revealed that managerial behavior has the greatest influence, while employee behavior and organizational culture exhibit the least. Furthermore, 'Managerial Behavior' and 'Infrastructure' were identified as fundamental (independent) components. 'Employee Behavior' and 'Organizational Culture' were classified as dependent components, whereas 'Processes' occupy an intermediate position.
Conclusion. To accelerate the establishment of a fearless organization, managers should prioritize the forty identified drivers outlined in this study. Notably, managerial behavior is more significant and influential than other drivers and can serve as a pivotal starting point for creating a fearless organization. The findings of this research can provide a foundation for future studies and the development of a comprehensive model of fearless organizations across various organizational contexts.
Extended Abstract
Background
Today, successful organizations are those that provide a safe environment for ideation, learning, and growth. The concept of a "fearless organization" refers to workplaces in which employees are free to express their opinions, mistakes, and ideas without fear of punishment, humiliation, or reprimand. In today’s fast-paced and highly competitive world, organizations in the healthcare sector—especially hospitals and medical centers—hold particular significance. Hospitals are not merely places for treating illness; they function as vital systems that affect all aspects of society, from saving lives to public education and even to the national economy. Hospitals are not only spaces for patient care but also workplaces for thousands of doctors, nurses, medical staff, and service personnel. Therefore, positive managerial approaches and fostering a psychologically safe environment in these organizations are critically essential.
Methods
The present study and its findings draw on the cognitive and informational foundations established through prior fundamental research to address human needs, improve tools and methods, and develop models to enhance welfare, comfort, and quality of life. Thus, this research qualifies as an "applied study" in its objective, as it examines the theoretical foundations of fearless organizations in Iran's healthcare sector and proposes an interpretive-structural model (ISM) for Social Security Hospitals, an exploratory mixed-methods approach.
The mixed-methodology is grounded in the principles of the pragmatist paradigm. In summary, based on the Research Onion proposed by Saunders et al (2007), this study falls under the pragmatism paradigm in terms of research philosophy and adopts an inductive approach. The research employed both qualitative and quantitative methods:
· In the qualitative phase, Sandelowski & Barroso (2007) meta-synthesis was used to identify the drivers of a safe organization.
· In the quantitative phase, interpretive structural modeling (ISM)—Warfield’s (1973) eight-step method—was applied.
The research population is structured as follows:
1. Qualitative Phase:
Books, and scientific articles from reliable domestic and international databases and journals in management and organizational sciences (focusing on concepts such as safe organizations, fearless organizations, psychological safety, safety leadership, etc.) published over the past 40 years (1980–2023 / 1360–1403 SH) were reviewed.
2. Quantitative Phase:
The extracted drivers from the qualitative phase were evaluated by 12 senior and experienced healthcare experts (executives from Social Security Hospitals in Tehran).
Results
In this study, 146 final sources were selected based on prior research. The data from these sources were analyzed using thematic analysis, with specific indicators assigned to all extracted information, thereby identifying the key drivers of a fearless organization. The researcher categorized these drivers into five main dimensions: Managerial Behavior, Employee Behavior, Organizational Culture, Infrastructure, and Processes.
Using interpretive structural modeling (ISM), the drivers were hierarchically leveled, revealing that "Managerial Behavior" has the strongest influence among all drivers. "Managerial Behavior" and "Infrastructure" are classified as fundamental (independent) components. "Employee Behavior" and "Organizational Culture" fall under dependent components. "Processes" hold an intermediary (linkage) role.
Conclusion
This study aimed to develop an interpretive-structural model (ISM) of the drivers of a fearless organization in Social Security Hospitals. The findings revealed that "managerial behavior" is one of the most critical determinants of a fearless organization. Leaders, through their actions, communication, and decision-making, shape the organizational culture. When managers demonstrate openness, honesty, and supportiveness, employees experience psychological safety, enabling them to voice opinions and ideas without fear of reprimand or ridicule. "Employee behavior" refers to actions that cultivate a secure, supportive, and positive work environment, fostering goodwill among colleagues. As dynamic and vital elements of an organization, employee behaviors play a fundamental role in establishing and sustaining a supportive and safe culture. "Organizational culture" encompasses the necessary cultural shifts to transform an organization into one that is supportive and exhibits positive organizational behavior. "Infrastructure" represents the foundational and contextual factors within an organization that facilitate the development of a fearless organization. Both physical and organizational infrastructures underpin workplace activities and directly influence the development of a secure and supportive culture.
Finally, "processes" denote the required modifications to organizational procedures and workflows that expedite the creation of a fearless organization. As the operational backbone of an organization, processes have a decisive impact on fostering a secure culture. Key contributions are: ·
Hierarchical Influence: The ISM analysis highlighted that managerial behavior and infrastructure serve as fundamental drivers, while employee behavior and organizational culture function as dependent factors. Processes act as linking elements that bridge these components. ·
Practical Implications: The study provides actionable insights for healthcare administrators to cultivate psychological safety by focusing on leadership development, infrastructure investment, and process optimization. ·
Theoretical Advancement: This research addresses a gap in the literature by proposing a structured model for safe organizations in Iran’s healthcare sector, aligning with global discourse on psychological safety (e.g., Amy Edmondson’s "fearless organization" framework). Limitations and Future Research suggestions are: ·
Context-Specific: Findings are based on Social Security Hospitals in Tehran; broader validation is needed. ·
Dynamic Factors: Longitudinal studies could assess how these drivers evolve over time. In conclusion, creating a safe organization requires a systemic approach that integrates leadership, culture, infrastructure, and processes. This model offers a roadmap for healthcare institutions seeking to enhance employee well-being and organizational resilience.
Practical Implications of the Research
1. Raising awareness among hospital managers and staff about the main factors that influence the establishment of a fearless organization.
2. Enhancing psychological safety for hospital staff to ultimately improve the quality of services provided to patients and help preserve their health and lives.
3. Boosting employee engagement and commitment to work-related tasks to reduce medical errors and enhance patient safety.