Patient Psychological Safety: A Qualitative Study of Patient Experiences

There is growing interest in understanding patients’ experiences with psychological safety during healthcare encounters. Recent studies reveal that patients describe needing patient psychological safety (PPS) to form connections with their care providers, which are associated with better health outcomes. Therefore, it is critical to examine indicators of PPS. Using a phenomenological interpretive approach, this study utilized a patient narrative survey methodology to qualitatively explore how and why patients experience a lack of PPS during their healthcare encounters. We surveyed patients from across the U.S. and analyzed responses among a sub-sample of respondents to an open-ended question whose responses indicated they were concerned with PPS in past healthcare encounters (n = 724). Our inductive analysis aimed to identify common themes that emerged for patients with PPS concerns. Four key themes emerged as indicators of lack of PPS: violations of patient dignity, provider distrust of patient stories, disregard of patient input to their care, and inadequate information provided to patients or emotional support of them. Patients who lacked PPS described feeling unseen, unbelieved, uninvolved, and unsupported in their care experiences. These experiences often resulted in emotional distress, frustration, diminished confidence in providers, and reluctance to engage in care, all of which are likely associated with lack of PPS. This study contributes new understanding of patient experiences by conceptualizing them in the context of psychological safety during healthcare encounters. The study offers new patient experience insights, highlighting how providers’ words, non-verbal signals, and other actions—even if inadvertent—might interfere with patients’ perceptions of PPS.