The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis

Abstract

Introduction Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. Methods We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. Results We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. Discussion This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual’s psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified.

Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study

“…The psychological safety of emergency nurses was lower than the results of a similar study in South Korea [ 2 ]. Psychological safety plays a special role in high-risk work areas such as health care [ 13 ]. When health care teams are psychologically safe, they are likely to improve the quality and teamwork initiatives [ 14 ].…”

“…Psychological safety is defined as the conditions under which team members feel safe to take risks, discover new ideas, and challenge the status quo [ 12 , 13 ]. In fact, the team is ensured that group members are not blamed for report errors.…”

“…The psychological safety of team members strengthens creativity and active participation in teamwork. Also, providing psychological safety to nurses increases patient safety and quality of care and lower levels of psychological safety led to increased psychological stress, absenteeism, endangering patient safety, and reducing job satisfaction in Nurses [ 13 , 14 ]. The results of the study Green et al showed that the psychological safety of health workers in the care environment influences teamwork, engagement in quality improvement work, learning from failures, reporting adverse events, and patient safety competency [ 14 ].…”

Patient-to-Patient Interactions During the Pain Management Programme: The Role of Humor and Venting in Building a Socially Supportive Community

“…The difference between our findings here and that of Ramírez-Maestre et al ( 39 ) may be explained by the “optimal matching hypothesis” ( 9 ). In the current study, all participants already had a mutual understanding of chronic pain and therefore the shared pain experience was a commonality between the group, allowing for psychological safety in approaching this difficult topic ( 44 ) removing the need to employ distancing. Therefore, patient-to-patient interactions in PMPs were evidencing an affiliative humor style , using humor to enhance one's relationship with others ( 45 ).…”

Healthcare professionals’ longitudinal perceptions of group phenomena as determinants of self-assessed learning in organizational communities of practice

“…Psychological safety is a person’s sense (i.e., appreciation, perception) that others “will not embarrass, reject, or punish someone for speaking up.” [ 46 ] Edmondson and Lei [ 47 ] explain that psychological safety “facilitates the willing contribution of ideas and actions to a shared enterprise.” Individuals who perceive their environment as psychologically safe are more likely to manifest behaviours such as speaking up to those who occupy positions of authority at work, offering ideas, admitting mistakes, asking for help and providing feedback [ 47 ]. High psychological safety is key to effective and safe healthcare delivery, as well as organisational learning [ 48 ]. Psychological safety also serves as a basis for individual learning.…”