The concept of psychological safety3 was first applied to healthcare by Edmonson more than 20 years ago. She defined it as “a shared belief that the team is safe for interpersonal risk taking” and a culture that encourages individuals “to express their ideas and concerns, to speak up with questions, and to admit mistakes—all without fear of negative consequences.”4 The concept is generally used in patient safety to encourage transparent and open discussion of hazards and errors and to foster innovation and learning.5-7
Psychological safety relies on two key principles: respect and trust.4 Respect presumes that individuals involved in healthcare, even in adverse events, have expertise, acted in good faith and with good intentions, and were motivated to perform well. It is important to understand the context for their decisions and actions. If decisions or actions were imperfect, the goal should be to understand why they made sense at the time and how care could be improved in the future.
The goal of reporting and analyzing errors should be to promote insight, create solutions, and enable the individual and team to advance understanding and solutions. Trust requires that the team supports the individual, acknowledges and appreciates them for their contribution to learning, and joins them in developing strategies to make care safer for all going forward.
Organizational culture refers to the collective attitudes, beliefs, and values of an organization; a safety culture fosters a shared commitment to identifying and mitigating risks, learning, and improving. Safety culture requires leadership commitment to safety, engagement of individuals, and training to support improvement.8
Psychological safety and an organizational culture of safety are ideas firmly embedded in patient safety, but evidence is limited around their role in addressing diagnostic errors. It is reasonable, however, to think that the principles that enable error reporting and guide process improvements can also enable improvements in diagnostic safety.
