Toward a research agenda on why and how psychological safety can unlock quality

Psychological safety has become a central concept for understanding how individuals and teams engage in learning, collaboration, innovation and improvement-oriented work. The concept has been studied extensively within organizational behavior, leadership, innovation and team research. It has also gained increasing attention as organizations face growing complexity and uncertainty, as psychological safety has been shown to support greater adaptability and resilience in times of change (Lee and Edmondson, 2017; Edmondson, 2018). Psychological safety is commonly defined as a shared belief that the team is safe for interpersonal risk-taking (Edmondson, 1999) and has been associated with behaviors such as knowledge sharing, speaking up, asking questions, reporting errors, sharing ideas, employee engagement and engaging in constructive disagreement (Kahn, 1990; Edmondson and Lei, 2014; Newman et al., 2017; Edmondson, 2018; Edmondson and Kerrissey, 2025). Interestingly, many of these same behaviors also underpin quality management (QM), where continuous improvement, teamwork, leadership engagement, employee participation and shared responsibility for quality constitute core QM principles (Dean and Bowen, 1994; Brown, 2013; Chen et al., 2021).

Despite this relevance, the relationship between psychological safety and QM practice remains relatively unexplored in QM research. Existing reviews from adjacent fields provide valuable understanding of the concept itself (Edmondson and Lei, 2014; Newman et al., 2017). However, they offer limited insight into how psychological safety has emerged within QM research, how it relates to QM principles and practices, or how it may inform future empirical research on quality development. At the same time, QM-oriented research has long emphasized the human dimension, including Deming’s (1986) principle of “driving out fear,” emphasizing the need to understand human psychology in quality work, the people dimension as the primary enabler of quality development (Dahlgaard-Park and Dahlgaard, 2010) and the role of trust and fear in total quality management (Bugdol, 2013, 2020). However, this literature has not articulated psychological safety as a conceptual lens for understanding how core QM behaviors may be enabled in practice. Together, these observations point to a gap in the current QM literature, suggesting that the relationship between psychological safety and QM practice remains relatively unexplored.

Consequently, developing a clearer understanding of the role of psychological safety within QM may represent a potentially important next step for the field. In this sense, the present study represents a deliberate step toward understanding a possible emerging area of QM research. As an initial step, this study synthesizes how current QM research discusses psychological safety, why it is considered relevant for QM practice and how it is described as being intentionally integrated and further outlining areas that can guide future empirical research. In this sense, the present study complements existing reviews of psychological safety by conducting a discipline-focused QM review.

The need for such a synthesis is further reinforced by changes in how quality work is organized. Contemporary QM is increasingly practiced in contexts characterized by complexity, uncertainty, digitalization and adaptive forms of organizing (Lee and Edmondson, 2017; Van Kemenade, 2021; Thomas and Suresh, 2023; Malikah et al., 2025). Reflecting these developments, Van Kemenade and Hardjono (2019) argue that QM is moving toward an emergence paradigm in which quality is created less through control and predefined solutions and more through interaction, dialog, learning and continuous adaptation. Such conditions place greater emphasis on organizational capabilities such as collaboration, adaptability, resilience and continuous learning. Recent QM research points in a similar direction by emphasizing people-oriented leadership (Els and Meyer, 2025), participatory approaches such as design thinking (Snyder et al., 2018) and psychological safety as a condition supporting the practical application of the Shingo model (Majerus and Abraham, 2025). Yet, despite these developments, current QM research remains fragmented regarding why psychological safety is important for QM and how it can be intentionally integrated into QM practice.

In this study, QM practice refers to the systematic and collective set of principles, behaviors and methods through which organizations ensure and improve the quality of their products, services and processes. It encompasses customer focus, continuous improvement, teamwork, leadership engagement, employee participation and shared responsibility for quality across the organization (Dean and Bowen, 1994; Brown, 2013; Chen et al., 2021). From this practice-oriented perspective, QM provides a relevant context for examining psychological safety because many quality-related behaviors involve interpersonal risk-taking, open communication, collective reflection and learning from problems and errors.

Against this background, the purpose of this study is to examine how psychological safety is discussed in current QM research as a possible enabler for QM practice and to outline areas that point toward a future research agenda on how psychological safety can unlock quality practice. Therefore, this review is guided by the following research questions:

Together, these research questions move beyond identifying the presence of psychological safety within QM research by synthesizing how the literature explains its relevance for QM practice and how it is described as being intentionally fostered. In doing so, the study provides a structured understanding of an emerging body of research and identifies directions for the continued development of QM research and practice.

Edmondson’s (1999) early research on quality and medical errors in health care during the 1990s played a central role in establishing the concept of psychological safety. In her study, she initially hypothesized that successful teams would make fewer mistakes. Surprisingly, the findings revealed the opposite: the most effective teams reported more errors, not because they made more mistakes, but because they felt safe to acknowledge and discuss them openly, thereby enhancing learning. Edmondson defined this climate as “a shared belief held by members of a team that the team is safe for interpersonal risk-taking” (Edmondson, 1999, p. 350) and argued that this shared belief encourages voice, learning and error-reporting behaviors in teams.

Psychological safety has also been described by Kahn (1990) as an experience of feeling able to show and employ oneself without fear of negative consequences to self-image, career or status. Kahn’s work suggests that psychologically safe environments foster personal engagement and are directly shaped by interpersonal relationships, leadership behaviors and organizational norms. Psychological safety has also been described as a core component of the mindful infrastructure that gives people the confidence and serves as a catalyst of creativity and experimental learning (Oeij et al., 2018). The concept is, though sometimes misunderstood as being synonymous with niceness or agreeableness, whereas it actually refers to candor and openness to constructive conflict where disagreement and friction are not perceived as threats but as opportunities for dialog and learning, grounded in trust (Edmondson and Kerrissey, 2025). Research has also conceptualized psychological safety as a shared climate rather than an individual trait, demonstrating its role as a precursor to employee engagement, health and sustainable work environments (Dollard and Bakker, 2010). This conceptualization is further supported by Ziębacz and Moraru (2017), who show that these effects also hold during times of organizational change.

Psychological safety is thus not a new concept but has received increased scholarly attention (Edmondson and Lei, 2014) and is now well established in the broader organizational literature (Bahadurzada et al., 2024). The growing attention has likely been reinforced by Google’s Project Aristotle, which identified psychological safety as the most important factor distinguishing high-performing teams from less effective ones (Edmondson, 2018). These findings are further supported by Choi (2004) showing the mediating role of psychological safety related to individual and team performance outcomes and creativity.

Collectively, this body of research positions psychological safety as an important psychological and relational condition for enabling learning, collaboration and adaptation in organizations. This provides the theoretical basis for examining psychological safety within QM, where quality work similarly depends on voice, learning, collaboration and the willingness to address problems openly.

An integrative literature review was conducted in January 2025. Given the interpretive nature of the research questions, the review was positioned as integrative (Snyder, 2019). This methodological approach was considered appropriate because the study moves beyond a descriptive mapping of the literature by synthesizing findings into conceptual themes that inform a future research agenda. It required an interpretive analysis of the content of the literature rather than a bibliometric mapping of patterns or a systematic review of intervention effects, consistent with the distinctions described by Grant and Booth (2009). Compared to a scoping review, the integrative approach also allows for a deeper interpretation of how psychological safety is conceptualized and related to core QM principles, thereby supporting conceptual development (Torraco, 2005).

To ensure rigor, the aim was to follow systematic and transparent procedures for literature identification, selection and analysis in line with guidance on integrative literature review (Callahan, 2010; Snyder, 2019). The review was further guided by established frameworks including PRISMA and Population, Exposure and Outcome (PEO) to support transparency and replicability of the review process (Gough et al., 2017), with some adaptations related to the characteristics of the research questions and design. Figure 1 provides an overview of the review process.

Given the integrative nature of the review, the PEO framework was applied as a guiding and transparency structure rather than a strict evaluative tool. As interpreted by the authors, the Population refers to QM-related practices and contexts, while Exposure refers to the presence and discussion of psychological safety within QM research. The Outcome is understood as the argument the research makes about why psychological safety is considered important for QM practice and how it is described as being intentionally integrated into QM practice. The PEO framework guided both the development and application of the search strategy, as well as the inclusion and exclusion criteria (see Table 1), which were applied consistently throughout the screening process.

The following search terms were subsequently used: “psychological safety” and “quality management” or “TQM” or “quality improvement” or “lean” or “six sigma” or “business excellence.” Guided by the PEO framework, psychological safety was included as an exact search term to capture the Exposure dimension, defined as the presence and discussion of psychological safety within QM research. Related constructs, such as trust, were therefore not used as search terms to ensure conceptual consistency. The selection of multiple quality-related search terms aimed to encompass a broad range of QM practices and to cover perspectives from different areas and sectors in line with the Population dimension in the PEO framework. Four academic databases were selected because of their broad and complementary coverage of peer-reviewed journals. They also index QM well and provide broad multidisciplinary coverage, particularly in fields relevant to the study, such as organizational behavior, leadership, innovation and team research (see Figure 2).

The first round of screening involved automated filtering in the databases for research articles and reviews in English with no time frame applied, resulting in the identification of 220 articles. When articles without full-text access and duplicates were removed, the selection narrowed to 108 articles. The manual screening of titles and abstracts for relevance and quality was based on the inclusion and exclusion criteria. A total of six articles were excluded because they did not align with the study’s scope, leaving 102 articles for in-depth analysis. After the full-text review, another five articles were not considered relevant because they addressed psychological safety without a connection to QM practices. The screening process yielded the 97 articles included in the review, shown in Supplementary Material A. The full selection process is outlined in the PRISMA flow diagram shown in Figure 2.

No formal study-level critical appraisal was conducted. This decision reflects the purpose of the review, which was to synthesize how psychological safety is framed and discussed within QM research rather than to evaluate intervention effectiveness or establish evidence hierarchies. In line with recommendations emphasizing that review methods should be aligned with the review purpose (Gough et al., 2017; Tompa et al., 2006), the aim was to capture the breadth of the discourse across diverse study designs, contexts and methodological traditions rather than rank studies according to methodological strength. Instead, full-text screening was conducted by three researchers who assessed methodological transparency, clarity of purpose and relevance to the research questions. The findings should therefore be interpreted as a conceptual synthesis of the current discourse rather than as evidence-ranked conclusions.

The data extraction process involved descriptive and open coding to categorize and analyze the collected data in relation to the two research questions. The three steps of identifying, piloting and testing the codes were used as quality control (Gough et al., 2017). This method provides a structured way to extract key information from each article, ensuring that the main aspects of each study are captured and can be compared across the data set (Booth et al., 2016). Three researchers coded the 97 articles.

Descriptive coding was used to capture the contextual characteristics of the literature, specifically, the year of publication, journal, country, sector and titles containing the term psychological safety. The descriptive coding was limited intentionally, as the review was not designed as an extensive bibliometric or methodological mapping.

The open coding process involved accessing the full text of all included articles and searching systematically for the term “psychological safety” using the search function within the PDF documents. Surrounding text segments were then read to assess their relevance. Meaningful textual extracts from the articles were identified using the PEO framework, with the Outcome dimension understood as the arguments made in the reviewed literature about why psychological safety is considered important for QM practice and how it is described as being intentionally integrated. The extracts were then transferred to an Excel spreadsheet and documented together with the corresponding article identification code and page number to ensure transparency and traceability throughout the analysis.

The material extracted from the open coding process was analyzed using a thematic analysis with an inductive approach conducted by two of the researchers who performed the coding. The analysis was conducted in two main phases, each aligned with one of the research questions. In the first phase, the extracted data were analyzed through the lens of the first research question. In the second phase, the same data were revisited with a renewed analytical focus on the second research question. Structuring the analysis in this way allowed a comprehensive exploration of the data, with the intention being to approach the material with fresh eyes for both research questions, recognizing the importance of analytical neutrality.

In the initial step of each phase, the researchers independently read through the collected data and identified key concepts and themes without predetermined categories. The next step was collaborative sorting, during which the researchers compared their interpretations and discussed coding consistency before grouping the extracts into broader themes. This iterative process supported thematic validation, as themes were refined and merged until they were coherent and well supported by the material in relation to the research questions (Grant and Booth, 2009). Thematic saturation was considered to have been reached when no substantially new themes or conceptual insights emerged. The digital tool Mural provided a structured workspace and was used for visualizing and organizing the data and mapping connections between extracts. The second phase followed the same steps as the first phase. The involvement of multiple researchers and the use of piloting in both coding and thematic development were intended to enhance the credibility and robustness of the analysis.

The findings from the descriptive coding highlight an increasing academic interest in psychological safety in relation to QM; this interest is reflected in the increased number of publications over time, as shown in Figure 3. A notable shift toward a steep upward trend occurred around 2017. This increase is likely related to the impact of the Google study (Edmondson, 2018). This trend continues, with 2024 demonstrating unprecedented growth. The geographical distribution of the reviewed studies is concentrated strongly in North America, with the USA accounting for more than 50% of the included articles.

Another notable finding is the predominance of articles related to the health-care sector, which accounted for 80% of the articles. This dominance may be related to health care’s high-risk context, in which mistakes can be life-threatening, making it essential for professionals to feel safe when raising concerns and risks. The hierarchical structure prevalent in health care may also reinforce the need for psychological safety, as fear of authority may hinder open communication (McElroy et al., 2024). The sector’s focus likely also reflects Edmondson’s early hospital-based studies in the 1990s.

The descriptive analysis of publication journals further reinforces the strong dominance of health care. The journals occurring most frequently include BMJ Quality and Safety, BMJ Open Quality and the Journal of Patient Safety, with 5 articles each. Examples of journals outside health care are the International Journal of Operations and Production Management, the Journal of Operations Management and Production Planning and Control. The articles are dispersed widely across journals, suggesting that the ongoing scholarly discussion is not concentrated within a dominant forum; rather, the discussion is distributed across multiple journals. The broad journal distribution may be explained by the interdisciplinary character of psychological safety as well as QM.

Title coding revealed 18 articles with psychological safety in the title. In several of the studies, psychological safety emerged as a result or analytic finding rather than as a planned design component.

The results of the thematic analysis are presented through a thematic synthesis of the existing QM research related to why psychological safety is important for QM and how it is described as being integrated into QM practice. The presentation of the thematic findings is organized around the two research questions. The themes are not ranked in importance but are interrelated and often overlap in practice. Finally, the two sets of themes are combined in an integrated model, providing a structured overview of the current research discourse on psychological safety within QM.

Seven themes emerged during the thematic analysis of the research discourse related to RQ1: What does QM research address about why psychological safety is considered important for QM practice? The synthesis of the WHY-themes is presented below, accompanied by references to selected extracts supporting each theme. Further extract examples supporting each theme are presented in Table 2:

1. Enabling learning and innovation.

Across the reviewed literature, psychological safety is addressed as an enabling condition for learning and innovation within QM practice. For example, Bindels et al. (2018) emphasize that creating a climate of psychological safety is of central importance for fostering open dialogue, which accelerates team and individual learning. Similarly, Arumugam et al. (2024) reported that psychological safety is directly and positively related to innovation and that its effect is strengthened further when it is combined with intrinsic motivation in QM contexts. Taken together, the research illustrates how psychological safety is discussed as a foundational condition for learning-oriented quality improvement and for supporting innovation.

1. Enhancing team collaboration and interdisciplinary work.

Multiple studies in the reviewed literature emphasize psychological safety as an enabler of effective team collaboration, shared responsibility and interdisciplinary work within QM practice. For example, Passariello and Tarrant (2024) describe psychological safety explicitly as a promoter of teamwork, highlighting its role in supporting coordinated work among team members. Furthermore, Sirimsi et al. (2022) report that environments characterized by higher levels of psychological safety can improve collaborative behavior and replace siloed ways of working with more integrated teamwork across roles. The research further emphasizes that psychological safety is associated with engaged teams, team effectiveness and improved performance across professional boundaries (Hessler et al., 2025).

1. Supporting participation in continuous improvement.

The research highlights psychological safety as an important condition for broad participation in continuous improvement work, emphasized by the following statement: “These findings underscore the relevance of PS and its relation to continuous improvement in patient care” (Adair et al., 2022, p. 518). Mazur et al. (2012) reported that psychologically safe environments support individuals’ willingness to engage in improvement activities, including reporting errors, suggesting changes and questioning existing routines, even when such actions involve personal or professional risk.

1. Fostering resilience to challenges and change.

The review highlights psychological safety as an important condition for teams’ capacity to respond adaptively rather than defensively in contexts of change and uncertainty. For example, Weenink et al. (2023) describe how teams with high levels of psychological safety and reflective practices are better equipped to adapt to emerging challenges and to draw lessons from these adaptations. Psychological safety is also highlighted as being particularly important in highly uncertain and changeable environments in which work depends on collaboration and member input (Passariello and Tarrant, 2024).

1. Supporting development of trusting relationships.

The research discourse also draws attention to the effect that a psychologically safe environment can have on the development of relationships. For example, Hessler et al. (2025) describe trust-building as a central aspect of psychologically safe environments characterized by inclusion and a shared focus on mission-critical goals. The research also indicates that psychological safety is associated with stronger interpersonal relationships and organizational cultures that emphasize trust and collaboration (Ito et al., 2022). Taken together, these studies suggest that psychological safety is treated as supporting the formation of trusting relationships, which strengthen relational connections and contribute to more stable team dynamics in quality-focused work.

1. Boosting employee well-being, job satisfaction and retention.

A recurring theme in the reviewed studies is the association between psychological safety and employee well-being, job satisfaction and retention in quality-related work. Adair et al. (2022) reported that psychologically safe environments are associated with work climates that are more positive and lower levels of stress and burnout. Kennedyd et al. (2024) promote prioritizing an open and transparent atmosphere because psychological safety and job satisfaction are linked strongly and positively. In the QM context, in which customer focus also encompasses internal customers/employees, these findings suggest that psychological safety supports the well-being and sustainable engagement of employees who are central to high-quality work.

1. Improving leadership effectiveness.

Leadership effectiveness is treated repeatedly in the reviewed studies as being closely intertwined with psychological safety in QM contexts. One study articulates that “Hierarchy and dictatorial leadership represented barriers to psychological safety” (Passariello and Tarrant, 2024, p. 6). Aranzamendez et al. (2015) describe how inclusive, trustworthy and empathic leadership behaviors are associated with higher levels of psychological safety. Albritton et al. (2019) further emphasize that leaders play a critical role in establishing climates of psychological safety that support effective teamwork, engagement and learning-related behaviors.

Six themes address RQ2: What does QM research address about how psychological safety can be intentionally integrated into QM practice? Below, each HOW-theme is outlined with reference to the supporting article extracts shown in Table 3:

1. Train leaders to foster psychological safety.

Across the reviewed studies, leadership is highlighted frequently as a key enabler of fostering psychological safety within QM practice. Rather than formal authority, the literature emphasizes the development of leaders’ relational and communicative capabilities to foster psychological safety. For example, leadership development programs are described as addressing topics such as emotional intelligence, trust, appreciative communication and attentive listening (Hessler et al., 2025; Lin et al., 2022). Aranzamendez et al. (2015) address the importance for leaders to be sensitive to individual needs and contexts to develop and sustain psychological safety.

1. Shape norms that support a culture of psychological safety.

The reviewed literature describes psychological safety as being fostered through shared cultural norms that are shaped and reinforced intentionally rather than emerging organically. For example, Adair et al. (2022) emphasize that developing a psychologically safe culture is an iterative process that requires explicit commitment and investment and that a psychologically safe organizational culture shapes individuals’ willingness to speak up and engage in interpersonal risk-taking (Ito et al., 2022). Furthermore, explicit frameworks, such as graded assertiveness, are introduced to foster norms that support psychological safety in quality-focused work (Sweeney et al., 2024).

1. Facilitate team collaboration through everyone’s participation.

Several studies describe psychological safety as being fostered through team practices that support participation, inclusiveness and shared responsibility. The research highlights that psychological safety emerges in teams in which participation is balanced and members work actively to include all voices in discussions (Kochis et al., 2021; Passariello and Tarrant, 2024). Wu et al. (2024) show that psychological safety supports the development of shared leadership, particularly in complex and interdependent tasks. In practice-oriented contexts, this shift from individual to collective responsibility is illustrated through efforts to move from individual ownership toward shared team ownership, enabled by psychological safety and interprofessional empowerment (Paladino et al., 2023). The following quote supports this concept: “peer support and inclusiveness were enablers of psychological safety” (Passariello and Tarrant, 2024, p. 8).

1. Enable open communication and feedback.

Several studies describe open communication as a central method through which psychological safety is fostered in everyday QM practice. Examples include designed communication opportunities, feedback loops and team retrospectives that help reduce the fear of speaking up and support regular sharing of experiences and mistakes (Aggarwal et al., 2021; Kennedyd et al., 2024). The research further highlights that psychological safety enables the transition from individual reflection to shared dialog (Bindels et al., 2018).

1. Design structure for group reflection where everyone is heard.

Structured reflection is identified frequently in the reviewed articles as a valuable practice for fostering psychological safety in teams and a standard in quality work. When debriefings or dedicated review sessions are systematically built into routines, such sessions are described as creating legitimate and predictable spaces in which diverse perspectives can be shared and learning can take place without fear of negative consequences (Passariello and Tarrant, 2024; McElroy et al., 2024). As one study notes, “psychological safety is both a prerequisite for and a product of debriefing” (McElroy et al., 2024, p. 567):

1. Systematically structure learning environments for experimentation.

In this review, the discourse highlights intentionally structured learning environments within improvement work as a way of fostering psychological safety. Studies describe how training sessions and interprofessional learning arenas are used as spaces in which dialog, shared problem solving and learning from adverse events are encouraged (Robbins and McAlearney, 2016; Vikan et al., 2024). These environments are described as supporting psychological safety by allowing individuals and teams to interact in protected settings.

The “Psychological Safety Enabler Model for QM” illustrated in Figure 4 represents a conceptual synthesis of how psychological safety is discussed within QM research. By integrating the themes related to why psychological safety is considered important and how it is described as being integrated into practice, the model provides a structured framework for understanding the role of psychological safety as an enabler within QM. The proposed model should be viewed as an agenda-setting conceptual synthesis that organizes current knowledge and identifies promising directions for future empirical testing. Although the two sets of themes represent interrelated dimensions of the emerging discourse, the model in its current form does not specify the relationships between them.

The aim of this review was to synthesize how psychological safety is currently discussed in QM research and to clarify its potential role in relation to QM practice. By structuring this research discourse, the review identifies conceptual and practical contributions as well as directions for future research.

This review makes a primarily integrative and conceptual contribution to QM research. Rather than theory generation or establishing causal relationships, its contribution lies in synthesizing a fragmented body of QM research into a structured conceptual understanding that can guide future empirical and theoretical development.

This review suggests that psychological safety provides a contemporary conceptual lens through which established QM principles may be enacted in everyday practice. QM research has long emphasized employee participation, teamwork, leadership commitment, learning and continuous improvement as fundamental principles of QM (Brown, 2013; Dean and Bowen, 1994). The findings suggest that these principles are not only structural or procedural but also depend on team-level psychological conditions that influence whether individuals choose to engage in the behaviors on which QM relies. In doing so, the review makes a conceptual contribution by positioning psychological safety as a potential enabler of QM practice.

A further contribution is the reframing of Deming’s (1986) principle of “driving out fear.” The findings suggest that psychological safety adds a complementary and more proactive dimension to this principle. While fear reduction emphasizes removing barriers to quality work, psychological safety directs attention to actively cultivating conditions that support interpersonal risk-taking, voice, experimentation and learning. This shift connects QM with contemporary research from organizational psychology and team research. This review also builds on earlier QM research emphasizing the human dimension of quality work and the importance of understanding human psychology (Deming, 1986; Dahlgaard-Park and Dahlgaard, 2010), suggesting that psychological safety extends this human dimension with a more explicit relational understanding of how participation, engagement, learning and continuous improvement may be enabled in practice.

At the same time, these contributions should be interpreted in light of the characteristics of the reviewed literature. Approximately 80% of the included studies were conducted within health care, which limits the transferability of the findings across the wider QM field. However, the core behaviors linked to psychological safety, such as speaking up, learning from errors, collaboration and participation in continuous improvement, are not unique to health care. Rather, the sectoral dominance primarily indicates where the relationship has been most explicitly articulated and researched. The findings therefore indicate likely relevance beyond health care, while positioning this relevance as a proposition for future research rather than as an established sector-general conclusion.

Across the reviewed literature, psychological safety is frequently discussed in relation to behaviors that involve interpersonal risk, such as asking questions, reporting errors, challenging routines, sharing improvement ideas and engaging in reflective dialog, which are central to QM practice. As summarized in Table 2, the thematic findings related to RQ1 suggest that psychological safety may reduce these perceived interpersonal risks, thereby creating conditions that make learning and innovation, colaboration, participation, in continuous improvement, trusting relationships and adaplability more likely. In this sense, psychological safety may be understood as a possible enabling mechanism through which established QM principles are translated into everyday quality practices. This understanding provides the basis for the proposed Psychological Safety Enabler Model for QM (Figure 4). The model should be understood as an agenda-setting conceptual synthesis that visually integrates the recurring patterns and themes in the literature across the two research questions and informs the future research agenda, rather than as a validated causal model or an evidence-ranked conclusion.

Although this review does not provide prescriptive tools or ready-made interventions, it offers practically relevant knowledge by clarifying how psychological safety may inform QM practice and indicating possible directions for organizational efforts. The practical contribution therefore lies less in introducing new quality methods than in informing how existing QM practices may be designed, facilitated and sustained.

As summarized in Table 3, the findings suggest that psychological safety can be intentionally supported through recurring organizational practices, including leadership training, buidling shared cultural norms, facilitating participatory team practices, enabling open communication and feedback, structuring group reflection and creating learning environments for experimentation. These themes indicate that psychological safety should be viewed as a potential design principle for how quality work is organized and led.

For managers and quality professionals, this implies that the critical question is not only whether an organization has improvement meetings, feedback systems, employee involvement practices, or problem-solving routines, but how these practices are enacted. Psychological safety may be strengthened when existing QM routines are facilitated in ways that make it safe to raise concerns, question assumptions, report errors, contribute ideas and learn from failure without fear of interpersonal consequences. This shifts attention from the presence of QM routines to the way they are facilitated in everyday work.

The findings further suggest a reciprocal relationship between psychological safety and QM practice. Psychological safety may enable participation in quality work by lowering the interpersonal risks. At the same time, QM practices that are genuinely inclusive, empowering and learning-oriented may themselves reinforce psychological safety over time. Psychological safety should therefore be understood as a dynamic condition that requires continuous attention rather than as a static cultural attribute or a checklist item. This is consistent with Edmondson’s (2018) view of psychological safety as a relational and dynamic condition shaped through everyday interactions.

The practical implication is therefore not that organizations should introduce psychological safety as a separate program. Rather, psychological safety should be considered when designing, facilitating and continuously improving the social conditions under which existing QM practices take place. By creating environments where employees feel able to contribute honestly, challenge assumptions, reflect on failures and experiment with improvements, organizations may strengthen the conditions that allow core QM principles to thrive in practice.

Creating and sustaining such conditions is, however, closely related to how leadership is practiced. As summarized in Table 3, the theme “train leaders to foster psychological safety” emerged as a recurring theme for intentionally fostering psychological safety. The reviewed studies point to relational and communicative leadership, addressing emotional intelligence, appreciative communication, attentive listening and the importance of being sensitive to individual needs to develop psychological safety. These findings suggest that developing such leadership capabilities may be an important factor in cultivating psychological safety within QM practice.

Broad QM search terms were used to capture diverse practices, yet some perspectives may still have been lost. We also excluded “trust” as a search term deliberately, as the focus was on how the term “psychological safety” is used and conceptualized in the research, which may have narrowed the scope by excluding studies addressing similar conditions without explicitly using the term psychological safety. Furthermore, four QM-relevant databases with adjacent-field coverage (e.g. psychology) were searched. The high degree of cross-database duplication indicated adequate coverage of the discourse.

Additionally, we used a full-text PDF search to locate references to psychological safety across a large corpus of articles, enabling a broader scan than manual reading alone could permit. While this approach can miss nuance, it provides a reasonably solid basis to map the presence of psychological safety in QM research and to produce an overview.

The dominance of health care-related studies limits the sectoral diversity of the review and calls for caution when considering the transferability of the findings to other sectors.

A further limitation is that no formal study-level appraisal tool was used. Consistent with the integrative and discourse-oriented purpose of the review, the focus was on synthesizing how psychological safety is framed within QM research rather than evaluating the relative strength of evidence. Consequently, the review does not distinguish between findings originating from methodologically stronger or weaker studies. The identified themes should therefore be interpreted as recurring patterns in the literature rather than evidence-ranked conclusions.

The proposed “Psychological Safety Enabler Model for QM” (Figure 4) provides promising areas in which future research efforts are likely to be most valuable. The four broad future research directions outlined below are guided by the model while moving beyond its thematic structure to articulate broader avenues for future research.

One potential area for future research concerns how psychological safety is integrated into existing QM models and practices or whether and how such models and practices may need to evolve. This review treats psychological safety as a construct closely related to core QM principles. A suggestion for future research is to explore how psychological safety is currently embedded in QM models and practices and how a stronger human and relational focus might shape their development.

The review reveals a strong dominance of studies conducted within the health-care sector, which indicates a significant gap in other sectors. Future research could examine whether psychological safety plays a similarly enabling role in other sectors and how sector-specific conditions shape the role and relevance of psychological safety within QM practice.

QM is increasingly practiced in complex environments as a result of, among other things, digitalization and intelligent technology trends. This places new demands on how work is organized. These demands suggest forms of organizing that are less hierarchical and more team-based, including a greater reliance on self-managing teams. A suggestion for future research is to examine how such organizational forms influence leadership dynamics in QM practice, including the role of self-leadership, shared leadership and relational leadership in supporting psychological safety and quality work.

Another suggestion for future research is to deepen the understanding of the mechanisms that enable individuals and teams to engage in learning, collaboration and change in QM practice. Such work could include explorations of how the underlying psychological dimensions, such as cognitive, emotional and social processes, shape behaviors on which effective QM depends.

This review synthesizes an emerging and fragmented body of QM research. The proposed Psychological Safety Enabler Model for QM integrates what current QM research addresses about why psychological safety is considered important for QM practice and how it is described as being intentionally integrated, thereby providing an agenda-setting basis for future research.

The review positions psychological safety as a potential enabler of QM practice and as a meaningful and underexplored lens for understanding how established QM principles are translated into everyday quality practices. It also reframes Deming’s principle of “driving out fear” by shifting attention from fear reduction toward cultivation of psychologically safe conditions that support quality work. This perspective contributes to QM research by making the psychological and relational conditions of quality work more explicit.

Psychological safety should therefore not primarily be approached as a separate program or new foundational QM principle, but as a design principle that may inform how existing QM practices are organized, led and enacted. Given the dominance of health-care studies in the reviewed literature, these findings should be understood as a conceptual synthesis of an emerging discourse within QM and as a basis for future empirical research rather than as established causal evidence across QM contexts or sectors.

The supplementary material for this article can be found online.