AN INVESTIGATION INTO THE BARRIERS TO PSYCHOLOGICAL SAFETY IN NIGERIAN HEALTHCARE SETTINGS: A STUDY OF UNIVERSITY OF MEDICAL SCIENCE HOSPITAL, AKURE ONDO STATE

CHAPTER ONE

INTRODUCTION

1. Background of the study

The idea of psychological safety is when people feel free to express concerns, ask questions, or own up to mistakes without worrying about unfavourable reactions from their colleagues [Agbede & Ibe, 2020]. Since psychological safety may affect patient safety and treatment quality, this idea has been investigated in a variety of settings, including healthcare teams. Psychological safety fosters an atmosphere of trust and transparency for medical personnel, allowing them to voice concerns and make mistakes [Agbede & Ibe, 2020]. This makes it possible to concentrate on delivering high-quality treatment rather than controlling the expectations around the expression of disagreement and dissent. Additionally, it has been demonstrated that psychological safety fosters creativity, lowers burnout, and raises physician involvement. Psychological safety has been linked to a number of advantageous outcomes in the global healthcare system, such as increased patient safety, greater collaboration, and higher employee morale (Newman et al., 2017). Notwithstanding these advantages, hierarchical systems, fear of punishment, and a lack of supporting leadership are some of the major obstacles that healthcare professionals in many nations confront when it comes to psychological safety (Baer & Frese, 2015). Training, legislative changes, and leadership programs that promote candid communication and error reporting have all been used to try to create a culture of psychological safety in industrialised nations. However, there are still obstacles to overcome, especially in low- and middle-income nations where creating psychologically safe workplaces is made more difficult by institutional and cultural issues (Agbede & Ibe, 2020). The healthcare industry in Nigeria has particular difficulties in promoting psychological safety. Healthcare personnel are always under strain in this system because of its low-resourced facilities, high patient-to-staff ratios, and frequent shortages of necessary supplies (Efe & Ayinde, 2021; Bello et al., 2023). Furthermore, seniority frequently determines communication styles and decision-making procedures in Nigeria's highly hierarchical healthcare system. Junior employees may be less inclined to voice mistakes or complaints due to this hierarchy, fearing reprisals or career losses (Olajide et al., 2022). Such inflexible frameworks have been linked in studies to high employee turnover, job discontent, and a reluctance on the part of medical staff to disclose problems that may affect the standard of patient care (Omotayo & Oni, 2021). In hospital settings, leadership philosophies have a big impact on psychological safety. Authoritarian or transactional leadership styles tend to stifle psychological safety, whereas transformational leadership, which prioritises empathy, inclusion, and support, is positively connected with better levels of psychological safety (Edmondson, 2018). However, hierarchical and authoritarian leadership styles are common in Nigerian healthcare settings, which might make healthcare workers reluctant to raise issues or disclose mistakes, especially if they fear unfavourable consequences (Efe & Ayinde, 2021). These problems are exacerbated by the absence of leadership development programs designed to promote psychological safety, which can leave employees feeling alone and abandoned (Adebayo & Aremu, 2020). Furthermore, cultural influences also come into play. Admitting errors is frequently stigmatised in Nigeria, especially in professional contexts. This cultural component limits potential for organisational learning and mistake avoidance by discouraging healthcare personnel from reporting errors. This barrier has a major impact since research indicates that psychological safety is essential for both error reporting and ongoing healthcare improvement (O'Donovan & McAuliffe, 2020; Bello et al., 2023). It is difficult to create an atmosphere where medical practitioners feel comfortable asking for help and admitting their mistakes if these cultural factors are not addressed.
The psychological safety issues in Nigerian healthcare are made worse by a lack of resources. Many healthcare institutions struggle with understaffing, antiquated equipment, and limited supplies, which makes patients more stressed and hinders their capacity to provide the best treatment possible. According to Agbede and Ibe (2020), these factors frequently result in irritation and exhaustion, which lower psychological safety and make it more difficult for healthcare professionals to interact freely and cooperatively with their teams. Healthcare professionals are less likely to feel safe in their positions and be less inclined to voice issues when they feel undersupported by the resources at their disposal (Adebayo & Aremu, 2020). Despite the necessity of psychologically safe settings, there is little research on psychological safety in Nigerian healthcare, which leaves administrators of healthcare facilities with no direction on how to successfully overcome these obstacles. Therefore, the researcher sought to investigate the barriers to psychological safety in Nigerian Healthcare Settings: A Study of University of medical science hospital, Akure Ondo State.

1.2 Statement of the problem
In healthcare settings, psychological safety—which is the belief that one may voice thoughts, worries, and errors without fear of repercussions—is essential because it promotes collaboration, communication, and the reporting of errors, all of which improve the quality of patient care (Edmondson, 2018). However, a number of structural and cultural obstacles frequently jeopardise psychological safety in Nigerian healthcare institutions. Research suggests that a lack of psychological safety among Nigerian healthcare professionals is caused by hierarchical systems, a lack of support from leaders, fear of reprisals, and a lack of opportunity for candid communication (Efe & Ayinde, 2021; Olajide et al., 2022). By impeding the exchange of vital information and impeding teamwork in healthcare delivery, these obstacles not only lower the wellbeing of medical personnel but also have a detrimental effect on patient outcomes. High psychological safety settings are associated with lower mistake rates, more worker satisfaction, and better patient care, according to research conducted in industrialised nations (Edmondson, 2018). However, Nigeria's healthcare system has particular difficulties that make psychological safety a bigger problem. The creation of psychologically secure workplaces is further hampered by elements including inadequately equipped facilities, high patient-to-staff ratios, cultural stigmas associated with disclosing errors, and a lack of interpersonal communication training (Agbede & Ibe, 2020; Bello et al., 2023). Hence, the study investigate the barriers to psychological safety in Nigerian Healthcare Settings: A Study of University of medical science hospital, Akure Ondo State.

1.3 Objective of the study

The broad objective of the study is to investigate the barriers to psychological safety in Nigerian Healthcare Settings: A Study of University of medical science hospital, Akure Ondo State. The specific objectives is as follows

1. To identify the organizational barriers to psychological safety in Nigerian healthcare settings.

2. To assess how resource limitations exacerbate the barriers to psychological safety in Nigerian healthcare

3. To examine how fear of retribution affects healthcare workers' willingness to report errors or concerns.

4. To identify strategies that can enhance psychological safety in Nigerian healthcare settings for better teamwork and patient outcomes.

1.4 Research questions

The following questions have been prepared to guide the study

1. What are the organizational barriers to psychological safety in Nigerian healthcare settings?

2. How does resource limitations exacerbate the barriers to psychological safety in Nigerian healthcare?

3. How does fear of retribution affects healthcare workers' willingness to report errors or concerns?

4. What are the strategies that can enhance psychological safety in Nigerian healthcare settings for better teamwork and patient outcomes?

1.5 Significance of the study

Findings from this study can guide policymakers in creating supportive policies that prioritize psychological safety in healthcare settings. These policies may include guidelines for handling error reporting without retribution, promoting non-hierarchical communication structures, and providing resources for employee mental well-being.

The study’s findings can further serve as a baseline for healthcare institutions to continuously monitor and improve psychological safety practices. Regular assessments and improvements in psychological safety can support ongoing quality assurance in healthcare settings, benefiting both employees and patients.

Findings of the study will also be significant to the academic community as it will contribute to existing literature, add to library resources and serve as a guide to future researchers.

1.6 Scope of the study

The study focus on the barriers to psychological safety in Nigerian Healthcare Settings: A Study of University of medical science hospital, Akure Ondo State. Empirically, the study will identify the organizational barriers to psychological safety in Nigerian healthcare settings, assess how resource limitations exacerbate the barriers to psychological safety in Nigerian healthcare, examine how fear of retribution affects healthcare workers' willingness to report errors or concerns and identify strategies that can enhance psychological safety in Nigerian healthcare settings for better teamwork and patient outcomes.

Geographically, the study is delimited to University of medical science hospital, Akure Ondo State.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint are:

Time: The researcher encountered time constraint as the researcher had to carry out this research along side other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study.

1.8 Definition of terms

Psychological Safety: A shared belief within a team or organization that members feel safe to take risks, voice concerns, ask questions, and admit mistakes without fear of punishment or humiliation.

Healthcare Settings: Environments where healthcare services are provided, such as hospitals, clinics, and healthcare centers, which include various levels of care, administrative structures, and professional hierarchies.

Hierarchy: The structured levels of authority within an organization. In healthcare, hierarchy often influences communication and decision-making, impacting the ability of lower-level staff to voice concerns openly.

Leadership Style: The approach that managers and supervisors use to direct, motivate, and support healthcare workers. Leadership styles, such as transformational or authoritarian, can significantly affect the psychological safety of a healthcare team.

Error Reporting: The process through which healthcare professionals communicate or document mistakes, incidents, or near misses in healthcare practice, critical for learning and improving patient safety.

Job Satisfaction: The level of contentment or fulfillment healthcare workers feel regarding their roles, responsibilities, and work environment. Higher psychological safety often correlates with improved job satisfaction.

Workplace Culture: The values, beliefs, behaviors, and practices that characterize an organization. A supportive workplace culture promotes psychological safety by encouraging open communication and respect among employees.

Patient Care Outcomes: The results of healthcare provided to patients, including patient recovery, safety, and satisfaction. Psychological safety among healthcare workers positively influences these outcomes by fostering better teamwork and communication.

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