# The Presence and Potential Impact of Psychological Safety in the Healthcare Setting: An Evidence Synthesis

*Grailey, Murray, Reader & Brett · Safety & Error, Culture & Context, Measurement & Method · BMC Health Services Research · 2021 · Open access*

Grailey and colleagues synthesise the evidence on psychological safety among healthcare workers, pulling together 62 studies from 19 countries with three aims: to survey what the literature says about the presence of psychological safety, to catalogue how it is assessed, and to gather what is known about its consequences. The headline finding is reassuring on its face and awkward underneath. Reassuring, because psychological safety is consistently present, often at high levels, across the healthcare populations studied. Awkward, because the measurement is a patchwork: the included studies use such a wide range of tools, scales and definitions that the data cannot be pooled, so any confident overall statement about how psychologically safe healthcare actually is has to be hedged. Around this the authors map facilitators and barriers (culture, workload, infrastructure, teamwork and motivation) and sort them by the level at which they bite (individual, team, organisational), building a model of how situational context shapes whether people feel safe to speak. For the corpus the paper earns its place twice over: it is the systematic healthcare-domain evidence base behind the claim that psychological safety supports patient safety and error prevention, and, more in this map's register, it is an honest account of the measurement problem, a field measuring the same construct so many different ways that the findings will not add up, which is the measurement-critique argument arriving from inside the clinical literature rather than from its critics. Its limits are inherent to the method: a synthesis of heterogeneous studies inherits their heterogeneity, it describes the state of the field rather than resolving it, and the underlying search predates the end of 2018. (Text drawn from the 2021 BMC Health Services Research paper, 21(1), article 773.)

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