Psychological Safety as a Core Driver of Patient Safety Culture: A Narrative Review of Evidence in Hospital Settings

Abstract

ABSTRACT Patient safety culture is a fundamental component of healthcare quality in hospitals. Despite the implementation of safety policies and reporting systems, adverse events continue to occur, indicating that structural interventions alone may be insufficient. Psychological safety has increasingly been recognized as an important organizational condition that enables healthcare professionals to speak up, report errors, and participate in collective learning processes. This review aims to synthesize current evidence regarding the contribution of psychological safety to patient safety culture in hospital settings. This narrative review synthesized evidence from peer-reviewed literature on psychological safety and patient safety culture in hospitals. Relevant publications were identified through searches of PubMed, Scopus, ScienceDirect, and Google Scholar, focusing on studies published between 2015 and 2025. A total of 96 articles were screened for relevance, methodological quality, and thematic alignment. The findings were synthesized thematically to identify relationships among psychological safety, leadership, teamwork, communication, reporting behavior, and patient safety culture. The reviewed evidence demonstrated that psychological safety contributes to patient safety culture by facilitating speaking-up behavior, strengthening teamwork and communication, and encouraging error and near-miss reporting. Psychological safety also mediates the influence of leadership, organizational support, and working conditions on safety-related behaviors. Workforce factors such as workload, staffing adequacy, and burnout further influence safety performance. Psychological safety should be regarded as a central mechanism in strengthening patient safety culture. Supportive leadership, non-punitive reporting systems, effective communication, and organizational support may contribute to sustainable improvements in patient safety and healthcare quality. Keywords: Psychological Safety, Patient Safety Culture, Hospital, Teamwork, Leadership.