Initial Development of a Scale to Measure Patient Psychological Safety

Psychological safety is the perception that it is safe to express oneself without fear of ridicule. Better patient outcomes are associated with health care teams that experience psychological safety. However, the psychological safety of the patient has largely been ignored, even though it may affect patient forthrightness and adherence. We developed an initial Patient Psychological Safety Scale (PPSS) to assess patients' experience of psychological safety.

Thirteen items modified from team-focused measures of psychological safety comprised the initial version of the PPSS. To explore criterion validity, 8 items pertaining to nondisclosure of important information were used. A convenience sample of 100 patients from 4 primary care settings completed a survey comprised of the PPSS and nondisclosure questions.

A confirmatory factor analysis (CFA) indicated that the 13-item PPSS did not measure 1 factor. A subsequent exploratory factor analysis (EFA) identified 2 factors. A second CFA was conducted on a modified 9-item PPSS representing the 2 factors and retaining items with a factor loading of 0.40 or higher, and the results indicated a good fit. Internal reliability and validity for factors 1 (relationship comfort) (α = 0.95) and 2 (belonging) (α = 0.88) were strong. Although few respondents endorsed nondisclosure, there was a significant association between lower relationship comfort and nondisclosure of disagreement with clinician recommendation (median difference = 5.0, P = .001).

Patients' experience of psychological safety may affect clinical outcomes. The PPSS provides a starting point for further study of this potentially important variable.