# A concept analysis of psychological safety: Further understanding for application to health care

*Ito et al. · Origins, Safety & Error, Power & Equity · Nursing Open · 2022 · Open access*

A concept analysis of psychological safety in health care, framed by Ito and colleagues as the first theoretical framework for using it to improve workplace relationships and patient care, on the argument that a concept taken from another field should be critically examined in its new one. Using Rodgers' evolutionary method, they searched PubMed, CINAHL, PsycINFO and the Japanese database Ichushi-Web in April 2020 and analysed 88 empirical healthcare studies. They identify five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, a group-level phenomenon, a work environment safe for interpersonal risk-taking, and a non-punitive culture. Antecedents are structural (policy, fairness, organisational support), interpersonal (trust, communication, leader inclusiveness and behavioural integrity) and individual (demographics, status, skills); consequences run to patient safety and quality of care, collaboration and learning, job satisfaction and engagement, and speaking up, error reporting and implementing new practices.

Among what they take to be specific to health care are status differences, which work within a discipline (residents and physicians) and between disciplines (in neonatal intensive care, physicians felt more psychologically safe than nurses, and nurses more than respiratory therapists), so both gaps need narrowing; and a group-level dimension alongside the individual one, which they read as complementary, with individual feelings of safety a precondition for a team culture of it. The review also counts how much the studies draw on Edmondson, which they read as a sign of her work's influence: 51 of the 88 cited her 1999 definition, and 35 of the 58 that measured psychological safety used her scale, which they note is single-factor and built for a general context; hence their call for a healthcare-specific measure. Only eight of the studies came from Asia, and few from Eastern cultures, so they also call for research on national culture. The stated limits are the search, which covered only abstracts using the exact phrase and excluded grey literature and languages other than English and Japanese. Separately, a concept analysis organises what studies report rather than testing those claims.

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- **View the source paper:** https://doi.org/10.1002/nop2.1086
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## Neighbours (12)

- [Psychological Conditions of Personal Engagement and Disengagement at Work](https://explore.psychsafety.com/n/kahn-1990.md) (paper)
- [Psychological Safety and Learning Behavior in Work Teams](https://explore.psychsafety.com/n/edmondson-1999.md) (paper)
- [What is PS?](https://explore.psychsafety.com/n/about-psychological-safety.md)
- [Disrupted Routines: Team Learning and New Technology Implementation in Hospitals](https://explore.psychsafety.com/n/edmondson-bohmer-pisano-2001.md) (paper)
- [Psychological Safety: A Systematic Review of the Literature](https://explore.psychsafety.com/n/newman-donohue-eva-2017.md) (paper)
- [Just Culture](https://explore.psychsafety.com/n/just-culture.md)
- [Linking Leader Inclusiveness to Work Unit Performance: The Importance of Psychological Safety and Learning from Failures](https://explore.psychsafety.com/n/hirak-et-al-2012.md) (paper)
- [Making it Safe: The Effects of Leader Inclusiveness and Professional Status on Psychological Safety and Improvement Efforts in Health Care Teams](https://explore.psychsafety.com/n/nembhard-edmondson-2006.md) (paper)
- [Psychological Safety in Healthcare](https://explore.psychsafety.com/n/psychological-safety-in-healthcare.md)
- [Reducing Power Gradients](https://explore.psychsafety.com/n/reducing-power-gradients.md)
- [Leadership in Healthcare (CRM)](https://explore.psychsafety.com/n/the-evolution-of-leadership-and-management-in-healthcare-lessons-from-aviation-and-crew-resource-management.md)
- [Measuring PS](https://explore.psychsafety.com/n/measure-psychological-safety.md)