Psychological Safety and Patient Safety: a systematic and narrative review

Importance: Various psychological concepts have been proposed over time as potential solutions to improving patient safety and quality of care. Psychological safety has been identified as a crucial mechanism of learning and development, and one that can facilitate optimal patient safety in healthcare.Objective: We investigated the quantitative evidence on the relationship between psychological safety and objective patient safety outcomes.Evidence review: We searched 8 databases and conducted manual scoping to identify peer reviewed quantitative studies published up to November 2023. Objective patient safety outcomes of any type were eligible. The findings were analysed descriptively and discussed in a narrative synthesis.Findings: Nine papers were selected for inclusion which reported on heterogeneous patient safety outcomes. Five studies showed a significant relationship between psychological safety and patient safety. The majority of studies reported on the experiences of nurses working in healthcare from the USA. Conclusion: No clear conclusions can be extracted regarding the relationship between psychological safety and patient safety. Patient safety may be contradictory to elements of psychological safety and a more nuanced approach is needed. Systematic review registration This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD4202347829).