Team Functioning Research Articles

"It's Usually Not Dementia That's the Focus": Barriers and Facilitators of Dementia Care in Primary Care.

Primary care provides most dementia care, yet providing high-quality dementia care within this setting remains a challenge. Medicare and health system initiatives create opportunities to improve quality of dementia care. To evaluate barriers and facilitators of high-quality dementia care in primary care with a secondary focus on interdisciplinary team-based primary care and health information technology. Qualitative study using semi-structured interviews from July 2021 to January 2023. Fifteen persons living with dementia (PLWD) and/or their 13 family caregivers, five primary care providers (PCPs), and 23 interdisciplinary primary care staff (nurses, medical assistants, care managers, social workers, pharmacists, practice administrators) across practices in a single health system. We used qualitative content analysis to identify barriers and facilitators to dementia care within a framework of factors affecting whether clinicians follow clinical practice guidelines and how interdisciplinary teams and technology may support dementia care. Across all participants, there was limited knowledge of care practices and domains that constitute high-quality dementia care. Though PCP, staff, and caregiver attitudes were affected by their own prioritization of other medical conditions in primary care, all groups appreciated the importance of dementia care, and PCPs and staff were already addressing many relevant care domains. Barriers driving behavior were numerous and included time constraints, staffing challenges, and resource limitations in addition to patient or family-level factors. Interdisciplinary team-based care, telehealth, and patient portals can facilitate dementia care from PCP, staff, PLWD, and caregiver perspectives but interdisciplinary teams in particular are not yet used optimally. PCPs, interdisciplinary staff, PLWD, and caregivers identify numerous barriers to high-quality dementia care. Implementing dementia care and primary care initiatives, optimizing interdisciplinary team functioning, patient portal and telehealth use for dementia care, PCP/staff dementia training, and addressing well-known primary care challenges could improve dementia care in select settings.

Implementation of hospital antimicrobial stewardship programmes in low- and middle-income countries: a qualitative study from a multi-professional perspective in the Global-PPS network

BackgroundHospitals in low- and middle-income countries (LMIC) face context-specific challenges in implementing antimicrobial stewardship (AMS) programmes. The Global Point Prevalence Survey (Global-PPS) project has established a network of hospitals across 90 countries, using point prevalence surveys to monitor antimicrobial use and guide AMS activities. However, little is known about AMS implementation in these hospitals. Using qualitative research, we aim to explore the implementation process in LMIC hospitals within the Global-PPS network and the factors influencing it, identify potential implementation strategies, and evaluate the role of Global-PPS in this process.MethodsA qualitative study was conducted using semi-structured online interviews with healthcare workers (HCWs) involved in AMS in LMIC hospitals within the Global-PPS network. Participants were selected using a combination of convenience and purposive sampling and included clinicians, microbiologists, pharmacists, and nurses. Interviews followed a topic guide based on the integrated checklist of determinants of practice (TICD Checklist). Transcripts were analysed using a combination of inductive and deductive thematic analyses.FindingsTwenty-two HCWs from 16 countries were interviewed. Hospitals were in different stages of the AMS implementation process at the time of the study, from pre-implementation to institutionalisation of AMS as part of the continuous quality improvement process. While the Global-PPS provided a valuable tool for education and implementation, contextual barriers often hindered the translation of findings into targeted interventions. Four themes influenced AMS implementation, “institutional support and resource allocation”, “AMS team functioning, roles, and expertise”, “adoption and integration of AMS recommendations”, and “data-driven decision-making” as a cross-cutting theme. Key determinants included AMS team competencies, multidisciplinary teams, sustainable funding and leadership support, diagnostic capacity, and reliable data to inform interventions. We also identified various strategies employed by local AMS teams to enhance implementation.ConclusionsThis study examines AMS implementation in LMIC hospitals in the Global-PPS network and identifies key determinants. AMS teams address challenges through task shifting, local engagement and ownership. While empirical evidence on the effectiveness of these strategies is limited, these insights can guide future AMS interventions and studies within LMIC hospitals. Strengthening AMS requires bridging the gap between measurement and action and expanding research on behaviour change.

Leadership and trust in virtual teams

Background Advances in technology and the COVID-19 pandemic have led to increased use of remote work arrangements. Yet, research studies have examined the role of trust between leaders and employees in remote working conditions, despite the general relevance of trust to collaboration. Objective Here, we aim to investigate the specifics of remote working arrangements with a focus on the concept of leadership and trust in remote settings as opposed to classical teams. Methods For this purpose, expert interviews were conducted with representatives from the automobile, pharmaceutical, and financial services industries which have been contacted for that purpose. Results The expert interviews have clearly shown that differences exist between presence and remote conditions, while there is a realm of determinants which can influence remote team performance. Leadership plays an important role in the functioning of remote teams, including creating conditions that can help build trust. Conclusions Due to the increased importance of remote working, leadership must take necessary steps to provide optimal conditions so that organizations and employees can benefit from remote working. That requires a careful approach which does consider the specific determinants and the environments that characterize the organization.

The influence of cultural diversity on organizational citizenship behaviors in professional sport teams: The moderating role of intercultural competence

Professional sports teams provide a relevant setting for the study of multicultural work groups. Engaging in additional tasks or voluntary efforts—broadly referred to as organizational citizenship behaviors (OCBs)—is key to the effective functioning of such teams. Unfortunately, cultural diversity has been shown to decrease team cohesion and could therefore be detrimental to OCBs. However, intercultural competence (IC) should help team members understand and adapt to the cultural diversity in their teams. Because these aspects remain poorly understood, this study examines the influence of cultural diversity on OCB (i.e., sportspersonship, civic virtue, helping behavior), and the moderating role of IC. A vignette survey study was conducted with 219 professional athletes from different sports (i.e., football, basketball, and volleyball), each exposed to one of three scenarios representing different levels of cultural diversity. Data were analyzed using hierarchical linear modeling. Results suggest an inverted curvilinear relationship between cultural diversity and OCB, with OCBs being significantly lower in the moderate cultural diversity condition compared to the low and high conditions. In addition, the results suggest that athletes’ level of IC acted as a positive moderator between the level of cultural diversity and perceptions of OCB. These findings are discussed in relation to the literature on cultural diversity and (sport) team dynamics.

Optimizing Cyber Protection Team (CPT) Operations: An Analysis of Task Synchronization and Process Agility in Defensive Cyber Operations

The operations process for Cyber Protection Teams (CPTs) outlined in the U.S. Cyber Command’s (USCYBERCOM) Cyber Warfare Publication (CWP) 3-33.4, Cyber Protection Team Organization, Functions, And Employment, is currently hindered by inefficiencies stemming from a lack of synchronization between task assignment and execution. This disjointed approach results in a rigid, linear project lifecycle that fails to adapt to the dynamic tempo and increasing sophistication of adversarial cyber operations. Consequently, critical dependencies are missed, milestones are misaligned, and delays in the execution of defensive cyber operations (DCO) occur, ultimately impeding the CPT's ability to meet the strategic intent of USCYBERCOM, which emphasizes agility, creativity, and rapid deployment. This study critically examines the existing CPT operations process with the goal of identifying the optimal timeline for executing DCO missions while highlighting key inefficiencies that hinder operational effectiveness. By deconstructing the process into discrete work packages and analyzing task dependencies through Gantt chart modeling, the critical path is identified, and a best-case scenario is simulated. Even under ideal conditions, however, the process remains excessively rigid, resulting in prolonged timelines that undermine mission success. To address these shortcomings, this research advocates for the integration of agile project management methodologies into the CPT operations framework. By promoting flexibility, real-time feedback loops, and dynamic task sequencing, this approach would enhance the synchronization between planning and execution phases, enabling timelier and more effective DCO. The findings offer a pathway toward aligning the CPT operations process with USCYBERCOM’s vision of a more adaptive and responsive force capable of meeting the demands of the modern cyber threat landscape.

INSTITUTIONAL CAPACITY FOR THE DEVELOPMENT OF TEAM MANAGEMENT IN THE CIVIL SERVICE MANAGEMENT SYSTEM IN UKRAINE UNDER MARTIAL LAW

The transformation processes taking place in Ukraine today under martial law require new approaches to the institutionalisation of the public administration system. One such approach is the principle of team building (team building) in the organisation of managerial and professional activities of civil servants. According to the author, there is a need to introduce a team-building approach to the functioning of competitive management teams in public authorities. This is due to the complexity of the tasks faced by civil servants under martial law in Ukraine and the prospects for transformational changes in public administration in the post-war period, as well as in the context of Ukraine's integration processes into the European community. Such challenges in the organisation of management activities of civil servants require a combination of intellectual and volitional efforts of the authorities to dynamically solve various management tasks, which cannot be implemented without the creation of target (project) groups and high competition between different authorities. This requires managers to provide client-oriented administrative services, increase the competitiveness of civil servants and the authorities themselves. The purpose of the article is to reveal, based on the theoretical analysis of scientific literature, the possibilities of institutionalising the development of team management in the public administration system in Ukraine under martial law, which will contribute to improving the professional activities of civil servants on the basis of team building and integrity. To solve the tasks set, theoretical and empirical methods were used: analysis of the problem on the basis of scientific literature and literary sources; test results, surveys of civil servants, content analysis; method of mathematical statistics; GET TEST methodology – to determine the characteristics of the competitiveness of the management team of civil servants in government. Recommendations for the authorities to ensure the institutionalisation of team management in the public administration system on the basis of team building and integrity are substantiated.

Facilitating Multidisciplinary Team Functioning in Child and Youth Advocacy Centres Using Shared Mental Models

Facilitating Multidisciplinary Team Functioning in Child and Youth Advocacy Centres Using Shared Mental Models

Satisfaction With Multidisciplinary Team Structure and Function in a Pediatric Outpatient Clinic.

Satisfaction With Multidisciplinary Team Structure and Function in a Pediatric Outpatient Clinic.

Implementing Australia's new guidelines for appropriate psychotropic medication use in residential aged care: Applying the Consolidated Framework For Implementation Research.

Accumulating evidence about psychotropic medication-related adverse events has had minimal apparent impact on overall rates of psychotropic medication use across Australian residential aged care facilities (RACFs). Australia's new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care were released in April 2023. This study aimed to identify contextual factors to inform strategies to implement the new Guidelines in Australian RACFs. A qualitative study using semi-structured interviews was conducted with the participants representing four Australian residential aged care organisations. The interviews were recorded, transcribed verbatim, coded and thematically analysed. Factors were deductively coded using the Consolidated Framework for Implementation Research (CFIR) into three domains: outer setting, inner setting and individuals, which subsequently informed the fourth CFIR domain-implementation process. Participants (n = 33) were aged care residents and their family members, occupational therapists, nurses, nurse practitioners, general practitioners, geriatricians and pharmacists. The outer setting factors included regulatory changes, increased workload and increased workforce demand. The inner setting factors were health digitalisation, governance and compliance culture. Individual factors included mindset towards psychotropics and staff capabilities. The implementation process domain comprised four key strategies-recognising workforce pressures, leveraging recent efforts, supporting local use of data and supporting team functioning. These outer setting, inner setting and individual factors represent an interconnected framework of potentially modifiable factors to guide the targeted implementation of Australia's new Guidelines. These four key strategies provide new approaches to support the translation of the Guidelines.

Interdisciplinary strategies for establishing a trusting relation as a pre-requisite for existential conversations in palliative care: a grounded theory study

BackgroundCommunication is central to implementing palliative care (PC) and effective interdisciplinary team functioning. Communication about existential issues is often urgent in PC, yet interdisciplinary teams frequently lack the time and education to meet these communication needs. Thus, more knowledge of existential conversations in different PC contexts is required.AimThis study aimed to gain an in-depth understanding of healthcare professionals’ (HCPs) experiences of existential conversations with patients with PC needs and their next-of-kin by generating a theoretical model.MethodSeven focus-group interviews that included 26 HCPs who worked with PC patients in different care settings were carried out in 2020 and 2022. The grounded theory method was used to analyse and compare data from the interview transcripts.ResultsThe HCPs’ primary concern in daily work was establishing a trusting relationship, a prerequisite for enabling existential conversations with a person with PC needs and/or their next-of-kin. The main concern was characterised by the core category maintaining presence and four categories describing interdisciplinary strategies that the HCPs used to achieve a trusting relationship and enable existential conversations in the late phase of life. Several potential barriers also hindered existential conversations. The theoretical model ‘meaningful existential conversations in PC’ was constructed.ConclusionsThe interdisciplinary strategies used to establish existential conversations, the potential barriers to these conversations and the model we present can be used as a basis for reflection in professional collaborative learning in PC, as a tool for teachers in educational PC programmes and as a guide for HCPs in PC.

Composition and Priorities of Multidisciplinary Pediatric Thyroid Programs: A Consensus Statement.

Background: The incidence of pediatric thyroid cancer has been increasing, and care varies due to socioeconomic disparities or differing practice patterns. Clinical guidelines call for care in multidisciplinary teams to minimize variance and provide protocols. Based on expert opinion, we hope to describe the form and function of such multidisciplinary teams for pediatric thyroid programs. Methods: A modified Delphi method to reach consensus statements over two rounds. Twenty-one experts with varying backgrounds responded to each statement on a 9-point Likert scale. Upon completion of the survey, the panel reviewed and shared the results and comments from participants and modified the statements accordingly. This process was repeated such that statements reached consensus, were deemed no consensus, or had no change in the mean. Results: There was an 88% and 83% completion rate for Rounds 1 and 2, respectively. A consensus was observed that there is a distinct definable model of care for pediatric thyroid patients. No consensus was reached for the age range of patients, but programs should care for children with medullary thyroid cancer, differentiated thyroid cancer, and patients with genetic predisposition syndromes. A comprehensive team includes, but is not limited to, a thyroid surgeon, a pediatric endocrinologist, a high-volume fine-needle aspiration (FNA) proceduralist, an oncologist, a nuclear medicine physician, a pediatric pathologist, a pediatric radiologist, and a nurse coordinator. Necessary support services involve care coordination, access to a multidisciplinary tumor board, ability to perform ultrasound-guided FNA, and access to molecular testing. The panel emphasized cross-institutional collaborative research prioritizing guidelines development, disease-specific outcomes, treatment toxicity, and the molecular landscape of thyroid cancer. Conclusions: These consensus statements can be beneficial in improving multidisciplinary care, by describing which elements of pediatric thyroid programs should be consistent across institutions. Overall, the panel agreed that pediatric thyroid centers should provide integrated care with defined team members, services, resources, and research priorities. This model has the potential to standardize various aspects of clinical care and enhance our ability to study patient outcomes, improve health care delivery, and increase scholarly collaboration.

An intervention in the paediatric cardiac ICU to standardise pre-family meeting huddles is feasible, acceptable, and improves clinician teamwork.

Interprofessional teams in the pediatric cardiac ICU consolidate their management plans in pre-family meeting huddles, a process that affects the course of family meetings but often lacks optimal communication and teamwork. Cardiac ICU clinicians participated in an interprofessional intervention to improve how they prepared for and conducted family meetings. We conducted a pretest-posttest study with clinicians participating in huddles before family meetings. We assessed feasibility of clinician enrollment, assessed clinician perception of acceptability of the intervention via questionnaire and semi-structured interviews, and impact on team performance using a validated tool. Wilcoxon rank sum test assessed intervention impact on team performance at meeting level comparing pre- and post-intervention data. Totally, 24 clinicians enrolled in the intervention (92% retention) with 100% completion of training. All participants recommend cardiac ICU Teams and Loved ones Communicating to others and 96% believe it improved their participation in family meetings. We exceeded an acceptable level of protocol fidelity (>75%). Team performance was significantly (p < 0.001) higher in post-intervention huddles (n = 30) than in pre-intervention (n = 28) in all domains. Median comparisons: Team structure [2 vs. 5], Leadership [3 vs. 5], Situation Monitoring [3 vs. 5], Mutual Support [ 3 vs. 5], and Communication [3 vs. 5]. Implementing an interprofessional team intervention to improve team performance in pre-family meeting huddles is feasible, acceptable, and improves team function. Future research should further assess impact on clinicians, patients, and families.

Factors Associated With Registered Nurses' Safety Nursing Activities in Nursing Homes.

Factors Associated With Registered Nurses' Safety Nursing Activities in Nursing Homes.

Being a Team Captain in Professional Soccer: Perceptions and Experiences from the Head Coach Perspective

In soccer, the team captain is the official on-field leader of the team, adding increased responsibilities to the captain and expectations from the coach. The relationship between the coach and captain must be strong to help the team function effectively. However, how the coach perceives the role of the captain has only had minimal investigation. Semi-structured interviews were conducted with 11 male professional soccer coaches. Thematic analysis created 11 higher-order themes, which combined to identify the advantages, disadvantages, and influencing factors of being a captain. Being team captain has the advantages to the individual of being more prominent than other players, and representing the club on and off the field, which can contribute to the transition to coaching after the retirement. Likewise, several negative aspects of being captain are incurred due to the increased pressure and challenges the role brings. These can be intensified when the club exhibits unprofessional approaches to management. The captain’s role can become undesirable, as it can be perceived as insignificant and worthless, and can impact their private life. On reflection, team captains are perceived as being in a disadvantaged position rather than by coaches. Training can be given to the captain through sports psychologists.

Understanding factors influencing safety and team functionality at operative vaginal birth through multidisciplinary perspectives: a mixed methods study

BackgroundOperative vaginal birth (OVB) relies on effective teamwork to optimise outcomes. This study aims to explore providers’ perspectives of factors influencing safety and team functionality at OVB.MethodsThis mixed methods study involved four maternity sites at Monash Health, Australia. Surveys sent to healthcare providers invited quantitative and qualitative appraisal of safety and team functionality at OVB. Semi-structured interviews further explored themes emerging from survey responses. Categorical survey data were compared between staff roles using Pearson’s chi-squared tests. Thematic analysis of free-text survey responses and interviews identified themes influencing safety and team functionality at OVB.FindingsWe received 100 survey responses from obstetric (n = 41), midwifery (n = 52) and paediatric (n = 7) staff, including senior (n = 49) and junior (n = 51) roles. Overall, 99% thought team communication should improve and 82% had witnessed practices outside protocol. Obstetric versus midwifery or paediatric staff were less likely to rate communication as low or very low quality (5% vs. 29%, p = 0.010). Reporting being extremely or very confident to escalate concerns was more likely in obstetric versus midwifery or paediatric staff (49% vs.12%, p = 0.003) and senior versus junior staff (44% vs. 10%, p = 0.008). Five overarching themes impacted on team functionality at OVB; (1) Quality of communication, (2) Preparation and risk assessment, (3) Leadership and interpersonal dynamics, (4) Transfer from Birth Unit to Operating Theatre, (5) Variation in clinical practice.DiscussionSome care providers perspectives of team functionality at OVB differed, with midwifery and paediatric staff more likely to report challenges with communication and were less empowered to escalate concerns. Training in factors impacting team functionality at OVB should be considered.

Promoting Team Success Through Reflection on Communication Needs.

Graduate nursing students often face challenges in team-based projects due to diverse backgrounds and learning styles. Team charter development is helpful for making expectations clear, but it misses a critical step of self-reflection and shared understanding that can further improve team functioning. This innovation integrated a communication needs reflection exercise, based on the Birkman Method, into team charter meetings in a graduate-level course. Students reflect on their communication needs individually before sharing and discussing strategies for respectful engagement as a team. Incorporating reflection on communication needs into team charters was well received. The process can enhance self-awareness and respect for diversity of communication needs within teams. Implementation of a structured process for self-reflection and sharing in team charters is a low-effort teaching innovation with the potential for high results. Formalizing a process of self-reflection and sharing has the potential to increase student self-awareness and respect for diversity. [J Nurs Educ. 2025;64(X):XXX-XXX.].

Early Experience of Peer Advocate Program: Using Quality Improvement to Optimize Behavioral and Communication Disconnect in the Operating Room.

The operating room (OR) remains a challenging and hierarchical work environment within healthcare, where the attending surgeon functions as a team captain. Unprofessional behavior or disconnects in this environment can lead to breakdowns in teamwork and reports within the safety event reporting system (SERS). Interventions focused on remediating adverse behaviors and team interactions should optimize team function and potentially enhance patient outcomes. The aim of the present study focused on decreasing the SERS reports regarding behavior and communication disconnects from November 2019 to March 2023. A multidisciplinary team designed a novel reporting system to separate mechanical and procedural safety events from communication and behavior-related disconnects in the OR. The following plan-do-study-act cycles were performed by the multidisciplinary team: (1) developed the role of the peer advocate (PA) to mediate conversations among team members when behavior and communication disconnects occur, (2) redirect behavior and communication disconnects reported in the SERS to the PA program, and (3) develop and discuss interpersonal skills to prevent disconnects from occurring. Thirty-nine disconnects were reported through the PA program during the 2-year trial. The most common initiating team member were nurses, and the most common identifying team member were surgeons. The number of monthly SERS reports regarding behavior and communication disconnects decreased with the described interventions. The multidisciplinary task force developed and adapted a process to address communication and behavioral concerns in an efficient and supportive manner, with the objective of restoring relationships among team members in the perioperative environment and deweaponizing the SERS.

Relational coordination and team‐based care: Change initiative overload and other challenges in a learning health system

AbstractIntroductionMost change interventions to address quality of care and lower costs focus on technical aspects of the work through process improvements, which have not consistently delivered the anticipated impact for healthcare organizations. This study aims to (1) understand how relational interventions including shared huddles and cross‐role shadowing opportunities, impact team dynamics and functioning and (2) describe the challenges and opportunities associated with implementing relational interventions at an Academic Medical Center in a large metropolitan city in the United States.MethodsThis paper is a mixed method, pre–post‐intervention study in which data were collected using a validated survey, observations, interviews, and one focus group. Relational coordination survey data were analyzed within and across eight interdependent workgroups on three inpatient medical units at baseline and 16 months post‐intervention. Qualitative data were coded and analyzed for themes.ResultsWhile there were some improvements in overall relational coordination between baseline and post‐intervention measures, the findings were not statistically significant. Qualitative data reveal four themes, highlighting the strengths and barriers to the intervention: (1) incomplete fidelity to the relational coordination framework, (2) leadership, (3) meeting structure and participation, and (4) stakeholder engagement.ConclusionsWithin the healthcare context, this study contributes to our learning about implementing and measuring relational interventions. We offer insights for future research and practice on change initiative overload and operational constraints, socializing relational interventions, and balancing core and non‐core roles in the intervention strategy.

Supporting implementation of universal prevention initiatives in K-12 schools: impacts on fidelity through organizational readiness and team functioning in a cluster-randomized trial

BackgroundRural School Support Strategies (RS3) is a bundle of implementation supports (including training, technical assistance, and a virtual learning collaborative) designed for the scale-up of universal prevention initiatives. This study addresses mechanisms of action, exploring whether positive effects of RS3 on implementation fidelity are attributable to improvements in functioning of school implementation teams, and increases in organizational readiness.MethodsData are from a cluster-randomized hybrid Type 3 implementation-effectiveness trial of RS3 among rural Idaho schools implementing Positive Behavioral Interventions and Supports (PBIS). Forty public K-12 schools in Idaho, located in rural areas or townships, were recruited for the trial and were equally randomized to either the basic supports condition, including standard trainings, or to the RS3 condition. Condition was not masked. The mechanistic aims were hypothesized prior to the trial and tested with survey data from individuals on each school’s implementation team (n = 205). Surveys were collected in spring 2019 and 2020 regarding organizational readiness and team functioning. The outcome measure was PBIS implementation fidelity, measured by school teams during the summers of 2019 and 2020 using the Tiered Fidelity Inventory. School-level path models tested the effect of RS3 on implementation fidelity, controlling for baseline, school grade level, and school location. Multilevel (2–1-2) mediation models tested the degree to which individual team members’ perceptions of organizational readiness and team functioning mediated the relationship between school-level experimental condition and fidelity, controlling for the team members’ role.ResultsSchools receiving RS3 reported significantly greater implementation fidelity, although effects were slightly reduced (b = 8.40, p = .056, 95% CI [-0.22,17.01], β = 0.54) after inclusion of baseline and demographic controls. Models indicated a significant indirect effect of RS3 on fidelity through increased team productivity (b = 6.30, SE = 2.63, p = .017, MC 95% CI [0.83,13.86], β = 0.21), and effects through organizational readiness, change commitment, team culture, and team goal setting.ConclusionsExternal supports may improve implementation of universal prevention initiatives in rural schools through improvements in readiness and fostering teaming in organizations.Trial registrationThis research was prospectively registered on ClinicalTrials.gov (NCT03736395), on November 9, 2018.

Patient safety incidents within adult community-based mental health services in England: A mixed-methods examination of reported incidents, contributory factors, and proposed solutions.

Relatively little is known about mental healthcare-related harm, with patient safety incidents (PSIs) in community-based services particularly poorly understood. We aimed to characterize PSIs, contributory factors, and reporter-identified solutions within community-based mental health services for working-age adults. We obtained data on PSIs reported within English services from the National Reporting and Learning System. Of retrieved reports, we sampled all incidents reportedly involving 'Death', 'Severe harm', or 'Moderate harm', and random samples of a proportion of 'Low harm' or 'No harm' incidents. PSIs and contributory factors were classified through qualitative content analysis using existing frameworks. Frequencies and proportions of incident types were computed, and reporter-identified solutions were inductively categorized. Of 1825 sampled reports, 1443 were eligible and classified into nine categories. Harmful outcomes, wherein service influence was unclear, were widely observed, with self-harm the modal concern amongst 'No harm' (15.0%), 'Low harm' (62.8%), and 'Moderate harm' (37.6%) categories. Attempted suicides (51.7%) and suicides (52.1%) were the most frequently reported events under 'Severe harm' or 'Death' outcomes, respectively. Incidents common to most healthcare settings were identified (e.g. medication errors), alongside specialty-specific incidents (e.g. Mental Health Act administration errors). Contributory factors were wide-ranging, with situational failures (e.g. team function failures) and local working conditions (e.g. unmanageable workload) widely reported. Solution categories included service user-directed actions and policy introduction or reinforcement. Study findings provide novel insights into incidents, contributory factors, and reported solutions within community-based mental healthcare. Targets for safety improvement are outlined, aimed at strengthening system-based prevention of incidents.