ORIGINAL RESEARCH
Paul J. Hershberger, PhD; Timothy N. Crawford, PhD, MPH; Angie Castle, MA; Sarah K. Hiett, BS; Roselle Bea P. Almazan, BS; Khadijah C. Collins, MS; Jared M. Burkert, BS; David G. Fields, BA, BS; Sarah G. Yu, BA; Katharine Conway, MD, MPH
Corresponding Author: Paul J. Hershberger, PhD; Department of Family Medicine, Wright State University Boonshoft School of Medicine
Email: paul.hershberger@wright.edu
DOI: 10.3122/jabfm.2023.230465R1
Keywords: Behavioral Sciences, Factor Analysis, Patient Care Team, Patient Safety, Patient-Centered Care, Primary Health Care, Psychological Safety, Scales, Surveys and Questionnaires
Dates: Submitted: 12-12-2023; Revised: 02-29-2024; Accepted: 04-08-2024
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: Psychological safety is the perception that it is safe to express oneself without fear of ridicule. Better patient outcomes are associated with healthcare teams that experience psychological safety. However, the psychological safety of the patient has largely been ignored, even though it may affect patient forthrightness and adherence. We developed an initial Patient Psychological Safety Scale (PPSS) to assess patients’ experience of psychological safety.
METHODS: Thirteen items modified from team-focused measures of psychological safety comprised the initial version of the PPSS. To explore criterion validity, eight items pertaining to nondisclosure of important information were used. A convenience sample of 100 patients from four primary care settings completed a survey comprised of the PPSS and nondisclosure questions.
RESULTS: A confirmatory factor analysis (CFA) indicated that the 13-item PPSS did not measure one factor. A subsequent exploratory factor analysis (EFA) identified two factors. A second CFA was conducted on a modified 9-item PPSS representing the two factors and retaining items with a factor loading of 0.40 or higher, and the results indicated a good fit. Internal reliability and validity for factors one (relationship comfort) (α = 0.95) and two (belonging) (α = 0.88) were strong. Although few respondents endorsed nondisclosure, there was a significant association between relationship comfort and nondisclosure of intent to not follow clinician recommendations (median difference = 5.0, p = .001).
CONCLUSIONS: Patients’ experience of psychological safety may affect clinical outcomes. The Patient Psychological Safety Scale provides a starting point for further study of this potentially important variable.