Understanding Psychological Safety in Health Care: A Qualitative Investigation and Practical Guidance

Psychological safety is a critical teamwork competency that promotes effective communication, teamwork, patient safety, and the well-being of health care professionals. However, previous research on barriers and facilitators to promotion of psychological safety has focused mainly on clinical staff, omitting other health care disciplines that contribute to patient safety and high-quality care.

The authors conducted a qualitative study in one health system to identify barriers and facilitators to psychological safety in the workplace. Participants in a quality improvement (QI) initiative were invited through automated e-mails sent via the Qualtrics platform to participate in this survey. Employees self-selected whether to respond, as participation was not required as part of the QI initiative engagement.

A total of 429 participants across 19 departments spanning administration, education, research, and clinical areas were invited. The average survey response rate across departments was 52.2%. Participants answered two open-ended questions: (1) "What are situations where it can be difficult to take an interpersonal risk and speak up [on this team]?" and (2) "What are the challenges to creating psychological safety within your current team?" Three psychological safety subject matter experts coded the data to extract factors and subthemes. Thematic factors at the individual, team, and organization level were uncovered. Sixteen subcategories of factors that affect psychological safety emerged, uncovering two implications.

Psychological safety as defined here includes not just team level but the individual and organization levels. Interventions must align with the factors at all three levels for a personalized and comprehensive approach.