Presentation of selected extracts from the articles supporting each theme related to RQ2: How can psychological safety be more intentionally integrated into QM practice?
| Theme 1–6 | Extracts from reviewed articles |
|---|---|
| 1 Train leader to foster psychological safety | “A manager should learn and use appreciative communication to express his/her gratefulness about employees’ learning attempts and efforts so as to boost their psychological safety.” (Lin et al., 2022, p. 1519) |
| “Leadership development programs must be designed to cultivate the ability of a leader to identify when to implement a specific leadership domain, being sensitive to the individual needs and context, to develop and sustain a psychologically safe environment.” (Aranzamendez et al., 2015, p. 176) | |
| “The IDN course consisted of leadership topics designed to enhance PS. Course topics included emotional intelligence, PS*, trust, generous listening, and powerful questions.” (Hessler et al., 2025, p. 51) | |
| “She had noticed that psychological safety was facilitated when the practice leaders were also willing be honest and vulnerable with the staff” (Crabtree et al., 2020, p. 430) | |
| “Assertive leadership and affirmative communication increased the team members’ psychological safety, involvement, and performance quality.” (Vikan et al., 2024, p. 7) | |
| 2 Shape norms that support a culture of psychological safety | “Developing a psychologically safe culture is an iterative process that requires clear commitment from all levels of leadership. One way leaders demonstrate commitment is by investing in PS* initiatives.” (Adair et al., 2022, p. 518) |
| “When people are culturally inclined not to speak up, then it becomes the role of the leadership to promote psychological safety to counter the effect of this cultural attitude” (Alami and Andkrancher, 2022, p. 164) | |
| “The concept of psychological safety is a multilevel phenomenon related to a unit culture that facilitates interpersonal risk behaviour.” (Ito et al., 2022, p. 471) | |
| “To empower nurses to voice their concerns about patient safety, we introduced graded assertiveness frameworks and aimed to foster a culture of psychological safety.” (Sweeney et al., 2024, p. 3) | |
| “PS* is something that does not occur organically and must be fostered” (Hessler et al., 2025, p. 47) | |
| 3 Facilitate team collaboration through everyone’s participation | “Our research results point to team psychological safety as an antecedent that fosters the development of shared leadership and, more importantly, these effects are stronger when the tasks are more complex and more interdependent” (Wu et al., 2024, p. 568) |
| “Hierarchies can obstruct interprofessional teamwork and collaboration leading to a hostile work environment that impacts individual and team psychological safety” (McElroy et al., 2024) | |
| “…peer support and inclusiveness were enablers of psychological safety.” (Passariello and Tarrant, 2024, p. 6) | |
| “Psychological safety emerges in groups where participation is balanced and students work to ensure everyone understands the topics of discussion.” (Kochis et al., 2021, p. 1782) | |
| “This analysis also revealed the importance of shifting from individual to team ownership of serious illness communication, which relied on interprofessional empowerment and psychological safety…” (Paladino et al., 2023, p. 8) | |
| 4 Enable open communication and feedback | “Team communication: designs should promote teamwork, including ‘psychological safety’ and struct structured communication opportunities within the care team.” (Aggarwal et al., 2021, p. 537) |
| “To achieve improvement in daily practice, honest and open dialogues were perceived as necessary. These dialogues were regarded as the result of an interplay between an ‘internal dialogue’ or private conversation with oneself, and an ‘external dialogue’ or the act of sharing experiences with others. The internal dialogue required sensitivity and courage of the individual; the external dialogue required psychological safety and encouragement of the environment.” (Bindels et al., 2018, p. 1) | |
| “The results of this study emphasized the importance of informal role models in creating communication openness and learning, especially in prestigious cultures.” (Vikan et al., 2024, p. 9) | |
| “Some practical steps could be to set up such as regular feedback loops and encourage team retrospectives where workers can talk about their wins and mistakes without worrying about getting in trouble.” (Kennedyd et al., 2024, p. 9) | |
| 5 Design structure for group reflection where everyone is heard | “Psychological safety can be an important aspect when considering a reflective practice and should not easily be neglected.” (Weenink et al., 2023, p. 10) |
| “The pre-briefing script was also crafted to build psychological safety to enhance learning.” (Chan et al., 2021, p. 201) | |
| “In the high-risk environment in which the team operates, the clearly defined process and functions and the structured opportunities that provide legitimate moments to reflect together influence how psychological safety is experienced.” (Passariello and Tarrant, 2024, p. 1) | |
| “To set up an effective debriefing program, it is essential to create a psychologically safe working environment where individuals can be open and confident in group situations without fear of retribution” (McElroy et al., 2024, p. 572) | |
| “Psychological safety is both a prerequisite for and a product of debriefing.” (McElroy et al., 2024, p. 567) | |
| 6 Systematically structure learning environments for experimentation | “There is a parallel between psychologically safe, learning environments and safe clinical practice; when learners gain comfort with processing mistakes, they can carry those abilities into practice. Therefore, an investment in safe learning supports safe patient care.” (Ingalsbe et al., 2024, p. 551) |
| “We found that a lack of interprofessional trust, different understandings of RRS protocol, and signs of low psychological safety in the wards disrupted collaboration. To help remedy identified challenges, healthcare professionals requested shared arenas for learning…” (Olsen et al., 2022, p. 722) | |
| “This study highlighted the need for interprofessional arenas where the surgical team could work on a shared understanding of patient and psychological safety and learn from adverse events.” (Vikan et al., 2024, p. 1) | |
| “Employee training sessions as a forum for building a positive, nonpunitive culture for speaking up” (Robbins and McAlearney, 2016, p. 1228) |
| Theme 1–6 | Extracts from reviewed articles |
|---|---|
| 1 Train leader to foster psychological safety | “A manager should learn and use appreciative communication to express his/her gratefulness about employees’ learning attempts and efforts so as to boost their psychological safety.” ( |
| “Leadership development programs must be designed to cultivate the ability of a leader to identify when to implement a specific leadership domain, being sensitive to the individual needs and context, to develop and sustain a psychologically safe environment.” ( | |
| “The | |
| “She had noticed that psychological safety was facilitated when the practice leaders were also willing be honest and vulnerable with the staff” (Crabtree | |
| “Assertive leadership and affirmative communication increased the team members’ psychological safety, involvement, and performance quality.” ( | |
| 2 Shape norms that support a culture of psychological safety | “Developing a psychologically safe culture is an iterative process that requires clear commitment from all levels of leadership. One way leaders demonstrate commitment is by investing in PS* initiatives.” ( |
| “When people are culturally inclined not to speak up, then it becomes the role of the leadership to promote psychological safety to counter the effect of this cultural attitude” ( | |
| “The concept of psychological safety is a multilevel phenomenon related to a unit culture that facilitates interpersonal risk behaviour.” ( | |
| “To empower nurses to voice their concerns about patient safety, we introduced graded assertiveness frameworks and aimed to foster a culture of psychological safety.” ( | |
| “PS* is something that does not occur organically and must be fostered” ( | |
| 3 Facilitate team collaboration through everyone’s participation | “Our research results point to team psychological safety as an antecedent that fosters the development of shared leadership and, more importantly, these effects are stronger when the tasks are more complex and more interdependent” ( |
| “Hierarchies can obstruct interprofessional teamwork and collaboration leading to a hostile work environment that impacts individual and team psychological safety” ( | |
| “…peer support and inclusiveness were enablers of psychological safety.” (Passariello and | |
| “Psychological safety emerges in groups where participation is balanced and students work to ensure everyone understands the topics of discussion.” ( | |
| “This analysis also revealed the importance of shifting from individual to team ownership of serious illness communication, which relied on interprofessional empowerment and psychological safety…” ( | |
| 4 Enable open communication and feedback | “Team communication: designs should promote teamwork, including ‘psychological safety’ and struct structured communication opportunities within the care team.” ( |
| “To achieve improvement in daily practice, honest and open dialogues were perceived as necessary. These dialogues were regarded as the result of an interplay between an ‘internal dialogue’ or private conversation with oneself, and an ‘external dialogue’ or the act of sharing experiences with others. The internal dialogue required sensitivity and courage of the individual; the external dialogue required psychological safety and encouragement of the environment.” ( | |
| “The results of this study emphasized the importance of informal role models in creating communication openness and learning, especially in prestigious cultures.” ( | |
| “Some practical steps could be to set up such as regular feedback loops and encourage team retrospectives where workers can talk about their wins and mistakes without worrying about getting in trouble.” ( | |
| 5 Design structure for group reflection where everyone is heard | “Psychological safety can be an important aspect when considering a reflective practice and should not easily be neglected.” ( |
| “The pre-briefing script was also crafted to build psychological safety to enhance learning.” ( | |
| “In the high-risk environment in which the team operates, the clearly defined process and functions and the structured opportunities that provide legitimate moments to reflect together influence how psychological safety is experienced.” (Passariello and | |
| “To set up an effective debriefing program, it is essential to create a psychologically safe working environment where individuals can be open and confident in group situations without fear of retribution” ( | |
| “Psychological safety is both a prerequisite for and a product of debriefing.” ( | |
| 6 Systematically structure learning environments for experimentation | “There is a parallel between psychologically safe, learning environments and safe clinical practice; when learners gain comfort with processing mistakes, they can carry those abilities into practice. Therefore, an investment in safe learning supports safe patient care.” ( |
| “We found that a lack of interprofessional trust, different understandings of | |
| “This study highlighted the need for interprofessional arenas where the surgical team could work on a shared understanding of patient and psychological safety and learn from adverse events.” ( | |
| “Employee training sessions as a forum for building a positive, nonpunitive culture for speaking up” ( |
PS* = psychological safety
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