Published June 2026
Psychological safety is a shared belief that it is safe to take interpersonal risks at work without fear of embarrassment, rejection, or punishment. These risks include speaking up, asking questions, admitting mistakes, offering ideas, and engaging in discussions involving differing opinions. Distinct from interpersonal trust, which reflects one individual’s perception of another, psychological safety represents a collective belief embedded within team norms and culture. In healthcare, where work is complex, high stakes, and emotionally demanding, psychological safety is essential to patient safety, optimal outcomes, and workforce resilience. It is associated with improved team learning, creativity, innovation, open communication, feedback-seeking, and overall performance.
Research has identified multiple interrelated factors that enable psychological safety in healthcare settings. Central to this is a strong culture of safety in which patient wellbeing is consistently prioritized and leaders demonstrate behavioral integrity by aligning their actions with their stated values. Leaders set the tone through everyday interactions, particularly in moments of vulnerability or uncertainty.
Example: An attending physician openly acknowledges an omission identified by a learner and expresses appreciation for the learner’s vigilance. The message conveyed is powerful: speaking up is valued, hierarchy does not supersede safety, and every team member has a meaningful role in protecting patients. These moments reinforce that mistakes and near misses are opportunities for learning rather than blame.
Similarly, principles of just culture strengthen psychological safety by fostering confidence that raising concerns will lead to constructive dialogue, accountability, and meaningful improvement rather than humiliation or punishment.
Example: A surgical scrub technician who alerts the attending surgeon to glove contamination. The physician responds respectfully and acknowledges the technician’s contribution to maintaining patient safety. This reinforces a shared expectation that all voices matter, regardless of role or status. Such interactions normalize speaking up and empower individuals who may otherwise feel hesitant to challenge authority in high-pressure clinical settings.
The relationship between psychological safety and safety culture is inherently bidirectional: psychologically safe teams are more likely to communicate openly, identify risks early, and engage in continuous learning, which in turn further strengthens organizational safety culture. Environments that support continuous improvement and change-oriented leadership also promote psychological safety by encouraging curiosity, thoughtful risk-taking, transparent discussion of errors, and innovation. Further, organizations that value staff wellbeing and contributions, leaders who are accessible, and peers who model respect and collaboration all contribute to creating conditions where individuals feel safe to participate fully.
Additional Resources
- Hallam KT, Popovic N, Karimi L. Identifying the key elements of psychologically safe workplaces in healthcare settings. Brain Sci. 2023;13(10):1450. doi:10.3390/brainsci13101450.
- Newman A, Donohue R, Eva N. Psychological safety: A systematic review of literature. Hum Resour Manage Rev. 2017;27(3):521-535. doi: 10.1016/j.hrmr.2017.01.001.
- O’Donovan R, McAuliffe E. A systematic review of factors that enable psychological safety in healthcare teams. Int J Qual Health Care. 2020;32(4):240-250. doi:10.1093/intqhc/mzaa025.