Patient safety: Psychological safety in perspective

The patient is one of the most vulnera­ble persons in society. They are unable to express themselves without the support of family and friends. Indeed, sometimes their need for the basic necessities of life are not fully met due to factors such as inadequate funds, stigma and cultural beliefs. The rela­tionship between the patients and the clinical and non-clinical staff in some hospitals leaves much to be desired. Frankly, some of these patients are left on the hook struggling to fend for themselves and stifling to identify a trustworthy person to answer their most pressing questions, share suggestions on the outlook of their health and discuss issues pertaining to their health and livelihoods. But who would listen to them and do they feel comfortable to share them?

Personally, I have witnessed patients who voice their frus­trations on the quality of care received from heath care facili­ties and others who simply keep mute for reasons such as the doctor knows best, who am I to complain, ‘Fa ma Nyame’(Give it to God) amongst others. This is because they believe no one would welcome their grievances, opinions or questions. These patients witness some non-clini­cal personnel throw unprintable comments at them just to si­lence their voice as they attempt to ask a question or express their thoughts on their medical condition, administrative and operational concerns.

A report by Immaculate Sabe­lile Tenza, et al (2022) indicates that fear of reporting adverse events, the existence of a blame culture, inconsistent response to errors were among factors that constrained patient safety cul­ture in some hospitals in Ghana.

To what extent are medical facilities in Ghana willing to cooperate with patients to nav­igate the increasing demand for safe environment where both of them can enjoy the serenity needed for improved patient outcomes, now and the genera­tions after?

Patient safety in Ghana – Cur­rent situation

A study by Ashinyo M. E. et al (2022) revealed that in Ghana, the status of patient safety in the last 7 years has remained un­known. The researchers there­fore, sought to assess the patient safety status in selected hospitals in Ghana.

They assessed the safety status of 27 hospitals in Gha­na. The results of their study indicate that the average national patient safety score was high (85 per cent). However, there were variations in the perfor­mance of the hospitals across the World Health Organisation (WHO) patient safety action areas. Knowledge and learning in patient safety (97 per cent) was the highest-rated patient safety action area. Patient safety surveillance, patient safety funding, patient safety partner­ships and national patient safety policy had mean scores lower than the national average score (85 per cent). Less than half (42per cent) of the hospitals had a dedicated budget for patient safety activities. The means of continuous education for health professionals include clinical sessions, and in-service training, while the system of clinical au­dits in the hospitals were mater­nal mortality, perinatal mortality, stillbirth and general mortality audits. In their conclusion, the researchers noted that the current patient safety status in the hospitals was generally good, with the highest score in the knowledge and learning in the patient safety domain. Patient safety surveillance was identified as the weakest action area.

What is psychological safety?

Psychological safety is one of the dimensions of safety in any given community, the health care community is no exception.

Amy Gallo (2023) defined psychological safety as shared belief held by members of a team that it’s fine to take risks, to express their ideas and concerns, to speak up with questions, and to admit mistakes — all without fear of negative consequences.

In a related definition, the Centre for Creative Leadership described psychological safety as the confidence “that you won’t be punished or humiliated for speaking up with ideas, ques­tions, concerns, or mistakes. At work, it’s a shared expectation held by members of a team that teammates will not embar­rass, reject, or punish them for sharing ideas, taking risks, or soliciting feedback.

Within a hospital setting, psychological safety is the willingness and courage of staff, patients and the community members to voice their opinion on matters affecting the prog­ress of the facility or themselves without fear of intimidation, re­prisal, shame, blame or making a mistake. Specifically, reporting errors, suggesting ideas, bringing up concerns, asking questions, asking for help and sharing knowledge are identified as pos­itive outcomes of psychological safety in health care (Ayano Ito, et al 2021)

The psychological safety of patients – Who cares?

The need for patient safety in hospitals cannot be underesti­mated as there has been growing concern on the quality of care for patients in hospitals in Gha­na over the past years.

To what extent are patients willing to voice their frustra­tions on the care they received, to what extent is management willing to receive and work on the concerns of the patients, how many patients have died for fear of undermining the knowledge of the doctor as such were unwilling to voice out medical conditions unknown to the doctor and have been issued with wrong medication. How many doctors are willing to listen to the ideas of patients on the most appropriate treatment option. Do the management of medical facilities respect the voice of the patient? Such questions have led to the de­velopment of a new scale of measurement for the psycholog­ical safety of patients called the Neuroception of Psychological Safety Scale (NPSS). This scale is developed by the Universi­ty of Strathclyde and may be adopted by health care facilities across the globe to assess the state of psychological safety of patients.

Other strategies adopted by some health care facilities in Ghana include; Patient satisfac­tion surveys, the social welfare schemes and patient Safety Training programs

The significance of psycho­logical safety of patients.

Psychological safety is one of the growing disciplines across the global. It helps patients de­velop the confidence to question medications given to them and enquire about the features, se­verity and treatment options of their medical conditions. Again, it fosters collaboration between the patients and the medical practitioners as it unearths the potential ideas that may help re­solve any social or psychological issue the patient may be facing aside the medical condition.

Dr Liza Morton (2022), indicates that “The importance of feeling psychologically safe for health and wellbeing is being increasingly recognized. Feeling psychologically safe is essential for protecting us from stress, anxiety and low mood, while promoting post-traumatic growth following adversity.

Dr Nicola Cogan, a Senior Lecturer in Strathclyde’s School of Psychological Sciences & Health, adds that “Clients often seek therapy because they are struggling to feel safe, blighted by anxiety, stress and low mood. They often wish to feel safe again, or indeed yearn to for the first time.

Wrapping up

Are the patients in Ghana confident to report errors, suggest ideas, bring up concerns, ask questions, and ask for help without fear of intimidation?

In an era where holistic care encourages a complete treat­ment of patients, the psycholog­ical safety of the patient must not be neglected as it contrib­utes significantly in the drive for holistic care. The management of healthcare facilities in Ghana should urgently put interven­tions in place to nurture psycho­logically safe patients.

The writer is an Institutional Assessment Practitioner

BY HENRY ATTA NYAME