Structure and psychological safety as complementary elements in integrated healthcare leadership teams: an exploratory case study

Purpose This study aims to examine how leadership approaches balancing structure with psychological safety influence team effectiveness in integrated healthcare leadership teams that span organisational boundaries. The research focuses specifically on an integrated mental health crisis service leadership team. Design/methodology/approach A qualitative intrinsic case study design was conducted as part of MSc dissertation requirements. The study reanalysed interview data (n = 8) alongside reflective notes, and team effectiveness measures from an integrated mental health crisis service leadership team. Reflexive thematic analysis identified structure-psychological safety relationships. Findings Reanalysis revealed three interconnected themes: clear parameters and boundaries, psychological safety within structure and structured development opportunities. Structured leadership approaches created conditions for psychological safety and team development rather than constraining them. Team effectiveness measures showed improvements, including role clarity (3.6 / 5.0–4.4 / 5.0), inter-team working (3.5–4.1), team innovation (4.2–4.7) and team objectives (4.0–4.6), though multiple factors likely influenced these changes. Research limitations/implications The single case study design limits generalisability but suggests avenues for future research into how systematic approaches complement psychological safety in integrated healthcare settings. The exploratory data reanalysis provides preliminary insights requiring validation across diverse contexts. Practical implications Healthcare leaders might benefit from examining how clear parameters enable rather than constrain team development across organisational boundaries, supporting current integrated care system initiatives. Originality/value This study contributes to conversations about structure and psychological safety relationships in leadership practice. It challenges assumptions that structure necessarily constrains psychological safety, suggesting structured approaches can create enabling conditions for team development in complex healthcare environments.