Presentation of selected extracts from the articles supporting each theme related to RQ1: Why is psychological safety important for QM practice?
| Themes 1–7 | Extracts from reviewed articles |
|---|---|
| 1 Enabling Learning and Innovation | “The results show that psychological safety and intrinsic motivation both have direct as well as a positive synergetic influence on innovation” (Arumugam et al., 2024, p. 1521) |
| “Creating a climate of psychological safety, therefore, is of central importance for fostering open dialogues, thereby fueling both individual and team learning and development.” (Bindels et al., 2018, p. 8) | |
| “We conclude that psychological safety and structured methods are crucial to fostering individual creativity and improving Six Sigma outcomes” (Kim et al., 2024, p. 1621) | |
| “As leaders, setting the tone for a psychologically safe environment and modeling behaviors have the potential to foster growth, critical thinking, and innovation for nurses” (Hessler et al., 2025, p. 47) | |
| 2 Enhancing team collaboration and interdisciplinary work | “When PS* is present, so is team effectiveness and improved performance in clinical settings across professions.” (Hessler et al., 2025, p. 47) |
| “PS* is a key outcome that can directly contribute to the development of an engaged team.” (Hessler et al., 2025, p. 51) | |
| “An environment of greater psychological safety improved collaborative behavior, and in some cases, it replaced working in silos with working as a team.” (Sirimsi et al., 2022, p. 4) | |
| “Psychological safety as a promoter of teamwork.” (Passariello and Tarrant, 2024, p. 6) | |
| 3 Supporting participation in continuous improvements | “These findings underscore the relevance of PS* and its relationship to continuous improvement in patient care.” (Adair et al., 2022, p. 518) |
| “Organizational culture and psychological safety matter in primary care quality improvement.” (Wang et al., 2024, p. 826) | |
| “The results provide strong support for hypothesis 1, showing that learning behavior mediates a positive relationship between psychological safety and QI implementation in newly developed QI teams working in low-income countries.” (Albritton et al., 2019, p. 10) | |
| “Higher psychological safety increases the willingness of individuals to engage in error reporting and improvement behaviors, even though such efforts are inherently risky and can have negative personal and career consequences.” (Mazur et al., 2012, p. 634) | |
| 4 Fostering resilience to challenges and change | “The benefit of teams with a high psychological safety and established reflective practices is twofold: such teams will 1) be better equipped to adapt to emerging challenges and 2) will be better equipped to learn or draw lessons from adapting to these challenges to further improve” (Weenink et al., 2023, p. 2) |
| “Psychological safety is crucial in teams operating in highly uncertain and changeable environments and where the job depends on collaboration and member input” (Passariello and Tarrant, 2024, p. 1) | |
| “Psychological safety is crucial during times of change and innovation, it is a second-order attribute and not foundational because necessary conditions must be established from which it can emerge and be maintained” (Crabtree et al., 2020, p. 435) | |
| 5 Supporting development of trusting relationships | “Trust building is an important part of a psychologically safe environment where there is inclusion and a move toward mission critical goals.” (Hessler et al., 2025, p. 47) |
| “Additionally, psychological safety proved to be associated with strong interpersonal relationships and an effective culture that includes collaboration, trust and innovation, which ensure patient safety.” (Ito et al., 2022, p. 471) | |
| 6 Boosting employee well-being, job satisfaction and retention | “Our results show that psychological safety and job satisfaction are strongly linked in a good way. Creating an open and transparent atmosphere should be a top priority for businesses.” (Kennedyd et al., 2024, p. 9) |
| “Work settings with higher PS* report better local leadership, safety climate, teamwork climate, and work-life climate as well as lower personal burnout and burnout climate.” (Adair et al., 2022, p. 518) | |
| “Psychological safety as a facilitator for well-being and safe performance in the operating room.” (Vikan et al., 2024, p. 5) | |
| “This study provides valuable findings that complement turnover intention literature. Its findings show that being able to do (i.e. job self-efficacy) and wanting to learn (i.e. learning motivations) influence turnover intention indirectly through psychological safety” (Lin et al., 2022, p. 1518) | |
| 7 Improving leadership effectiveness | “Consistent with other research, this study also demonstrates that leaders play a critical role in establishing a climate of psychologically safety that supports effective teamwork and learning behavior.” (Albritton et al., 2019, p. 11) |
| “Inclusive leadership was found in this study to serve as a supportive mechanism that relieves employees’ psychological depletion and fear, resulting in increased psychological safety” (Lin et al., 2022, p. 1519) | |
| “Specific leadership behaviors found in this review, including leadership inclusiveness, trustworthiness, change-oriented leaders, and ethical leadership, can foster a psychologically safe environment.” (Aranzamendez et al., 2015, p. 171) | |
| “As leaders, setting the tone for a psychologically safe environment and modeling behaviors have the potential to foster growth, critical thinking, and innovation for nurses.” (Hessler et al., 2025, p. 47) | |
| “Hierarchy and dictatorial leadership represented barriers to psychological safety” (Passariello and Tarrant, 2024, 6) |
| Themes 1–7 | Extracts from reviewed articles |
|---|---|
| 1 Enabling Learning and Innovation | “The results show that psychological safety and intrinsic motivation both have direct as well as a positive synergetic influence on innovation” ( |
| “Creating a climate of psychological safety, therefore, is of central importance for fostering open dialogues, thereby fueling both individual and team learning and development.” ( | |
| “We conclude that psychological safety and structured methods are crucial to fostering individual creativity and improving Six Sigma outcomes” ( | |
| “As leaders, setting the tone for a psychologically safe environment and modeling behaviors have the potential to foster growth, critical thinking, and innovation for nurses” ( | |
| 2 Enhancing team collaboration and interdisciplinary work | “When PS* is present, so is team effectiveness and improved performance in clinical settings across professions.” ( |
| “PS* is a key outcome that can directly contribute to the development of an engaged team.” ( | |
| “An environment of greater psychological safety improved collaborative behavior, and in some cases, it replaced working in silos with working as a team.” ( | |
| “Psychological safety as a promoter of teamwork.” (Passariello and | |
| 3 Supporting participation in continuous improvements | “These findings underscore the relevance of PS* and its relationship to continuous improvement in patient care.” ( |
| “Organizational culture and psychological safety matter in primary care quality improvement.” ( | |
| “The results provide strong support for hypothesis 1, showing that learning behavior mediates a positive relationship between psychological safety and | |
| “Higher psychological safety increases the willingness of individuals to engage in error reporting and improvement behaviors, even though such efforts are inherently risky and can have negative personal and career consequences.” ( | |
| 4 Fostering resilience to challenges and change | “The benefit of teams with a high psychological safety and established reflective practices is twofold: such teams will 1) be better equipped to adapt to emerging challenges and 2) will be better equipped to learn or draw lessons from adapting to these challenges to further improve” ( |
| “Psychological safety is crucial in teams operating in highly uncertain and changeable environments and where the job depends on collaboration and member input” (Passariello and | |
| “Psychological safety is crucial during times of change and innovation, it is a second-order attribute and not foundational because necessary conditions must be established from which it can emerge and be maintained” ( | |
| 5 Supporting development of trusting relationships | “Trust building is an important part of a psychologically safe environment where there is inclusion and a move toward mission critical goals.” ( |
| “Additionally, psychological safety proved to be associated with strong interpersonal relationships and an effective culture that includes collaboration, trust and innovation, which ensure patient safety.” ( | |
| 6 Boosting employee well-being, job satisfaction and retention | “Our results show that psychological safety and job satisfaction are strongly linked in a good way. Creating an open and transparent atmosphere should be a top priority for businesses.” ( |
| “Work settings with higher PS* report better local leadership, safety climate, teamwork climate, and work-life climate as well as lower personal burnout and burnout climate.” ( | |
| “Psychological safety as a facilitator for well-being and safe performance in the operating room.” ( | |
| “This study provides valuable findings that complement turnover intention literature. Its findings show that being able to do (i.e. job self-efficacy) and wanting to learn (i.e. learning motivations) influence turnover intention indirectly through psychological safety” ( | |
| 7 Improving leadership effectiveness | “Consistent with other research, this study also demonstrates that leaders play a critical role in establishing a climate of psychologically safety that supports effective teamwork and learning behavior.” ( |
| “Inclusive leadership was found in this study to serve as a supportive mechanism that relieves employees’ psychological depletion and fear, resulting in increased psychological safety” ( | |
| “Specific leadership behaviors found in this review, including leadership inclusiveness, trustworthiness, change-oriented leaders, and ethical leadership, can foster a psychologically safe environment.” ( | |
| “As leaders, setting the tone for a psychologically safe environment and modeling behaviors have the potential to foster growth, critical thinking, and innovation for nurses.” ( | |
| “Hierarchy and dictatorial leadership represented barriers to psychological safety” (Passariello and |
PS* = psychological safety
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