The Impact of Psychological Safety Congruence on Safety Citizenship in Healthcare Organizations

Abstract

Patients continue to experience significant morbidity and mortality from preventable harm in healthcare organizations despite considerable investment, oversight and increased attention to patient safety. This paper explores the impact of psychological safety congruence between supervisors and workers on safety citizenship behaviours as a potential explanation for the stall in healthcare’s safety progress. High reliability organizations are defined and discussed as exemplars of safe and reliable operations. Psychological safety, safety climate and safety citizenship behaviours are explored as important components of safety cultures. A conceptual model which uses Festinger’s cognitive dissonance theory to augment Ajzen’s theory of planned behaviour is outlined and used to illustrate how psychological safety incongruence can affect the performance of safety citizenship behaviours at a unit level. Finally, the theoretical and practical implications of this model and psychological safety congruence are discussed in order to provide directions for future work aimed at developing new mechanisms through which healthcare safety culture can be understood and ultimately, enhanced.