Examining the impact of psychosocial safety climate on working conditions, well-being and safety of healthcare providers: a scoping review

Abstract

Background

In contemporary healthcare systems, the well-being and safety of healthcare providers are pivotal for sustaining a resilient healthcare system. The concept of Psychosocial Safety Climate (PSC) emerges as a crucial framework influencing job design and employee perceptions in organisational settings, although its application within healthcare settings remains relatively underexplored. The aim of this review was to explore the buffering effect of PSC and its impact on working conditions, well-being and performance.

Method

This scoping review followed Arksey and O’Malley’s recommendations and PRISMA-ScR reporting checklist. Databases, including PubMed, Scopus, Central, JSTOR, and additional online sources such as Google Scholar were searched. Only peer-reviewed studies published in English that have measured PSC using PSC-12 or PSC-4 were included in this study.

Findings

High PSC environments correlated with enriched job resources, fostering resilience, positive job performance, and reduced job demands. Conversely, low PSC settings were linked to increased job demands, compromised well-being, and adverse job performance outcomes. Notably, PSC acted as a buffer, mitigating the negative impacts of high job demands on well-being and reinforcing positive associations between job resources, support, and performance facets among healthcare professionals.

Conclusion

This review highlights the pivotal role of PSC in shaping the work environment, well-being, and performance of healthcare providers. Prioritising PSC within healthcare settings is crucial to safeguarding the well-being of healthcare providers and improving patient outcomes. Future research should further explore the relationships between PSC, burnout, and other influencing factors, employing diverse methodologies to capture its comprehensive impact within healthcare settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-12254-2.

Introduction

In modern healthcare systems, the well-being and safety of healthcare providers are pivotal not only for the quality of patient care but also for sustaining a resilient healthcare system [1]. The healthcare environment, characterised by high demands [2], complex patient needs [3], and often limited resources [2, 4], poses significant challenges to the psychological health and safety of its workforce. The experience during the COVID-19 pandemic profoundly magnified these challenges, leaving a significant imprint on health systems worldwide and underscoring the substantial impact on the mental well-being of frontline healthcare workers actively involved in pandemic response initiatives [5]. Hence, prioritising the psychological well-being and safety of healthcare providers is an urgent public health priority [6].

The concept of Psychosocial Safety Climate (PSC), as explained by Dollard and Bakker [7] emerges as a crucial framework. PSC refers to the employees’ shared perceptions within an organisation regarding the managerial priorities and actions placed on workers’ psychological health and safety, shaping the overall work environment [7–9]. PSC significantly influences job design by influencing the perception of job demands and resources among employees. It is noteworthy that PSC is dynamically shaped and negotiated within organisations through various workplace practices, organisational policies, power dynamics, communication channels, resource allocation, and job demands, involving active participation from both management and workers. Thus, a high PSC work climate provides workers with resources and pays proper attention to their well-being. A positive PSC fosters an environment where job demands are perceived as manageable, resources are more accessible, and there is a heightened sense of support [10]. Thus, a high PSC work environment improves working conditions. This helps to tailor job designs that align with employee capabilities and needs, thus improving workers’ well-being and promoting better job satisfaction and performance. Moreover, PSC acts as a buffer, mitigating the negative impact of high job demands by providing a supportive framework and job resources that help employees navigate stressors, thereby reducing the adverse effects on their psychological health and well-being. Despite its potential significance, the application of PSC theory within healthcare settings remains relatively underexplored [10].

The concept of well-being encompasses various elements such as physical health, mental and emotional states, social connections, satisfaction with life, and a sense of purpose or fulfilment [11]. Well-being is often subjective and can be influenced by various factors, including personal experiences, relationships, health, environment, and cultural context. Enhancing the well-being and safety of healthcare providers is imperative not just for the healthcare providers themselves but also for the effectiveness and sustainability of healthcare delivery [12, 13]. The essence of improving these facets lies in fostering an environment that not only acknowledges but actively promotes psychological health, safety, and well-being as integral components of a supportive workplace [14–16]. The challenges faced by healthcare providers, ranging from burnout [17] and stress [18] to concerns about safety protocols and organisational support [12], necessitate a comprehensive understanding of how the organisational climate, particularly the PSC, influences their work conditions and mental health [19].

The imperative for this scoping review stems from the critical necessity to comprehensively explore PSC within healthcare settings. Given the pivotal role healthcare providers play in ensuring patient care and well-being [17, 18], exploring how PSC, based on Dollard and Bakker's [7] framework, impacts working conditions, the mental well-being of healthcare professionals, and the overall safety milieu is paramount [20]. While several measurement tools for PSC have been published, this review focuses exclusively on articles that have utilised the Dollard and Bakker framework and associated PSC measurement tools (PSC-12 and PSC-4) due to their widespread validation and specific relevance in capturing the comprehensive aspects of PSC within organisational settings. This focus, however, introduces a limitation in the scope of our review, which we acknowledge.

By bridging gaps in knowledge, this review aims to offer a comprehensive synthesis of existing literature, shedding light on the influence PSC has on working conditions and its impact on the well-being and safety of healthcare providers in the healthcare environment. Further, this review aims to understand the buffering effect of PSC in healthcare settings. Understanding these dynamics is pivotal to fostering a supportive, safe, and conducive workplace essential for both healthcare providers' welfare and the delivery of high-quality care to patients. A scoping review was chosen to explore this topic because its expansive nature allows for a broad exploration of existing literature, enabling the identification of key concepts, gaps, and emerging trends in this domain.

The benefits derived from this scoping review are manifold. Firstly, it provides a comprehensive understanding of the existing knowledge landscape concerning PSC within healthcare settings, identifying gaps and areas necessitating further research. Moreover, by explaining the relationship between PSC, working conditions, well-being, and safety, this review offers insights into fostering a supportive work climate conducive to healthcare providers' mental health. Finally, aligning with the Sustainable Development Goals (SDGs), particularly those concerning decent work and health (SDG 8.5 and 8.8), this review contributes to the global agenda of creating safe, supportive, and healthy workplaces.

Methods

This scoping review followed the recommendations by Arksey and O’Malley [21] and the reporting checklist as stipulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) [22]. The PRISMA-ScR checklist is presented in supplementary file (PRISMA-ScR checklist). This checklist enhances the transparency and completeness of reporting in scoping reviews, thereby improving the quality and reliability of the review process. Arksey and O'Malley proposed a scoping review methodology involving six iterative stages: identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarising, and reporting results, and an optional consultation exercise.

Research questions

This review was guided by two research questions: (1) what is the impact of PSC on working conditions, well-being and safety of healthcare providers in healthcare settings? and (2) What is the buffering effect of PSC on the effect of high job demand and low job resources on health and performance outcomes?

Identifying relevant studies

To identify relevant studies for this review, a search was conducted in four main databases (PubMed, Scopus, Central, and JSTOR). An additional search was conducted in Dimensions AI, Google Scholar, and Google. The databases were selected based on their readily accessible relevant publications and coverage within the health, biomedical and multidisciplinary fields. The initial search was conducted in PubMed using Medical Subject Headings (MeSH) terms and a combination of keywords and controlled vocabularies to comprehensively retrieve relevant articles. These MeSH terms are variations used in indexing and searching within the PubMed, PubMed Central and MEDLINE databases to encompass related concepts. Table 1 presents the search strategy that was conducted in PubMed. This strategy was adapted and modified for use in other databases to ensure a broad exploration of the literature across various disciplines and domains. The data search started on August 4, 2023, and ended on December 12, 2023.

Table 1.

Search strategy in PubMed

#1: Search to identify PSC	Psychosocial safety climate* [MeSH Terms] OR PSC* OR psychological safety climate* OR and psychosocial safety culture* OR safety climate*
#2: Search to identify healthcare providers	“Healthcare workers” [MeSH Terms] OR “Healthcare providers” OR "Health Personnel" OR "Physicians" OR "Nurses" OR "Dentists" OR “Frontline healthcare” OR "Pharmacists" OR "Allied Health Personnel" OR "Emergency Medical Technicians" OR "Laboratory Personnel" OR "Midwives" OR "Physician Assistants" OR "Health Educators" OR "Chiropractors" OR "Occupational Therapists" OR "Physical Therapists" OR "Dietitians" OR "Optometrists" OR "Podiatrists" OR "Social Workers" OR "Health Facility Administrators" OR "Community Health Workers" OR "Medical Staff" OR "Health Manpower" OR “Public health workers”
Overall search strategy	#1 AND #2 Not animal*
Filters activated	English language and date starting from 01/01/2010

Study selection

Eligibility criteria were used as the basis for screening studies for inclusion. The eligibility criteria is presented in Table 2. Search results were transferred to the Mendeley software, and duplicates were removed. Then, 13 trained graduate students were supervised to screen titles and abstracts for full-text eligible records using the eligibility criteria and supervised by authors. This was done to ensure an efficient and systematic screening of a large volume of titles and abstracts. Supervision by authors provided oversight and quality control, ensuring consistency and accuracy in selecting records that met the predetermined eligibility criteria. The reference lists of the eligible records were searched to identify additional eligible full-text records. Searching the reference lists of eligible records helps uncover additional relevant studies that might not have been captured in the initial search, ensuring a comprehensive inclusion of pertinent literature for the review. Finally, Dorcas Frempomaa Agyare (DFA) and Patience Fakornam Doe (PFD) independently screened the full-text eligible records against the eligibility criteria to determine inclusion. This was reviewed by Mustapha Amoadu (MA) and Susanna Aba Abraham (SAA). This was done to ensure consistency and accuracy in the study selection process, minimising the potential for bias and ensuring that only relevant studies meeting the eligibility criteria were included in the review.

Table 2.

Eligibility criteria

Inclusion criteria:
1. The paper is written or published in the English language; 2. Only full-text peer-reviewed articles; 3. The study should explore the psychosocial safety climate among healthcare providers; 4. The study adopted or adapted the PSC-12, PSC-8 or PSC-4 to measure psychosocial safety climate or interview participants; 5. The study was conducted in any part of the world; 6. The study was published online in the year 2010 or later (because PSC-12 was published online by Hall et al. in 2010)
Exclusion criteria:
1. The paper was written or published in any other language other than English; 2. The paper is a conference paper, a letter to the editor, pre-print, grey literature, and commentaries; 3. The paper did not explore PSC but related constructs such as physical safety climate, safety culture, etc.; 4. The paper did not adopt or adapt PSC-12, PSC-8 or PSC-4 in measuring psychosocial safety climate;

Data charting/extraction

Data extraction forms were designed and piloted by DFA and PFD using three studies. This was done to refine the extraction form and ensure the reliability and consistency of the extraction process before applying it to the entire dataset. The data extraction form collected data on authors, year of publication, country and purpose of study, study design, population, sample size, PSC measure, and outcome variables (working conditions, health and safety and performance). DFA and PFD independently extracted the data which was then reviewed by MA and SAA with the aim of ensuring the accuracy, reliability, and consistency in the extracted data before further analysis and synthesis. Inconsistencies were resolved during weekly meetings.

Collating, summarising and reporting results

Collating involved organising the extracted data into coherent structures based on identified themes and grouping together related information for comprehensive understanding. This process allowed for the creation of a structured overview, enabling authors to discern patterns and trends within the collected data. Summarising the findings involved distilling this organised data into concise and meaningful insights, highlighting key themes, recurring patterns, and notable observations. This step aimed to condense the information without losing its significance, ensuring a clear representation of the review's core outcomes. Reporting the results involved a process of presenting the findings in a comprehensive manner, employing various formats such as narratives, tables, and figures to effectively communicate the identified trends. The aim was to offer a detailed yet accessible portrayal of the reviewed literature, capturing essential information and its relevance to the study's objectives. Throughout these stages, a rigorous approach was maintained, adhering to established protocols to guarantee accuracy and consistency in the presentation of results.

Consultations

A chartered librarian at the Sam Jonah Library, University of Cape Coast, was consulted to support authors in searching for relevant studies. Furthermore, healthcare providers and medical superintendents, hospital administrators and nurse managers were consulted for this review. Consulting healthcare providers, medical superintendents, hospital administrators, and nurse managers added a practical perspective to the review. Their insights and expertise provided real-world context, enriching the understanding of healthcare dynamics, system intricacies, and operational challenges. Their input offered invaluable insights into the practical implications of the findings, ensuring that the review outcomes were relevant, feasible, and aligned with the practical realities faced within healthcare settings.

Search results

The search across four primary databases yielded 6,005 records, while an additional search in other online sources contributed 52 more, totalling 6,057 records. The Mendeley software aided in removing 1,092 duplicate entries. Among the 4,965 titles and abstracts screened, 87 full-text eligible records were obtained, excluding 4,878 titles and abstracts due to their lack of relevance to the review. An examination of the reference lists accompanying the 87 full-text records unveiled 11 additional eligible records. Thus, 98 full-text eligible records were further screened to determine inclusion. Ultimately, 38 records met the inclusion criteria for this review. The excluded full-text records either fell outside the scope of the variables of interest or failed to report on those specific variables. Figure 1 presents the PRISMA flow diagram showing the search results and the screening process and screening results.

Fig. 1.

PRISMA flow diagram showing search results and screening processes

Characteristics of included studies

Most of the included studies were conducted in Australia (14), Iran (4), Netherlands (3), China (3), Italy (3) and Canada (3). See Fig. 2 for a detailed diagram showing countries where studies are conducted. Most (26) of the included studies were cross-sectional surveys followed by longitudinal studies (10) (see details in Fig. 3). Also, most reviewed studies were published online in 2022 (9) (5) and 2018 (6). The details of year of publication of included studies is presented in Fig. 4. See supplementary file (Table S1) for details on extracted data.

Fig. 2.

Countries where studies were conducted

Fig. 3.

Study designs of included studies

Fig. 4.

Years included studies were published online

Findings

The findings are presented according to the research questions.

The impact of PSC on working condition in healthcare settings

In the context of healthcare settings, the examination of PSC as a predictive factor reveals its statistically significant positive association with job resources, as substantiated by multiple studies [23, 24]. Thus, in a high PSC healthcare setting, job resources encompassing elements such as job control [24], decision autonomy [23], supervisor support [8, 24], co-worker support [25], skill discretion [23], organisational support [26], organisational rewards [8], and psychological capital [27] are high. These findings emphasise the pivotal role of PSC in fostering an environment rich in resources, potentially bolstering healthcare professionals' resilience and well-being. In healthcare settings, the findings show that PSC has a statistically significant negative association with various job demands. For instance, in a high PSC healthcare environment, psychological demands [8, 23, 28], emotional demands [8, 24], workplace intensification [29], conflicting demands [30], workload pressures [24], high job insecurity [25], and work-family conflicts [25, 31, 32] are low. Additionally, in a low PSC healthcare setting, healthcare providers are more likely to report more workplace abuse, like working compulsively [33] and violence [34]. See Table 3 for a summary of the impact of PSC on the working conditions of healthcare providers.

Table 3.

PSC impact on working conditions among healthcare workers

Main theme	Specific factor	Author
Job demands	Job demands	[27]
	Psychological demands	[8, 22, 27]
	Emotional demands	[8, 23]
	Workplace intensification	[28]
	Conflicting demands	[29]
	Workload	[23]
	High job insecurity	[24]
	Work family conflict	[24, 30, 31]
Workplace abuse and violence	Working Compulsively	[32]
	Workplace violence	[33]
Job resources	Job resources	[22]
	Job control	[23]
	Decision authority	[22]
	Supervisor support	[8, 23]
	Co-worker support	[24]
	Skill discretion	[22]
	Organisational support	[25]
	Organisational rewards	[8]
	Psychological capital	[26]

PSC impact on well-being and safety in healthcare settings

In high PSC healthcare work environments, healthcare providers often report elevated levels of perceived psychological well-being [28], personal hope, and resilience [35]. Conversely, those operating within low PSC settings commonly experience psychological distress [8, 24, 36–39], stress [37, 40], emotional exhaustion [8, 23, 39, 41, 42] and workplace bullying [43, 44]. Healthcare workers who frequently report higher levels of musculoskeletal pain [45], physical fatigue [41] and poor self-rated health [34] may also perceive lower levels of PSC in their work environment. It worth noting that a study reported no statistically significant association between burnout [46–48] and PSC among healthcare workers in the United Arab Emirates. Furthermore, perceptions of low PSC align with reports of more workplace injuries [42] and accidents [9] among healthcare providers. For detailed insights into the findings concerning PSC and its association with well-being and safety, refer to Table 4.

Table 4.

PSC impact on well-being and safety among healthcare workers

Main theme	Specific factor	Authors
Psychological Wellbeing	Psychological well-being	[27]
	Stress	[36, 39]
	Personal hope and resilience	[34]
	Emotional exhaustion	[8, 22, 38, 40, 41]
	Psychological distress	[8, 27, 35–38]
	Bullying	[42, 43]
Physical well-being	Physical fatigue	[40]
	Poor self-rated health	[33]
	Burnout	[45–47]
	Musculoskeletal pain	[44]
Safety	Accidents	[9]
	Injuries	[41]

PSC impact on performance of healthcare workers

In healthcare settings marked by a high PSC, healthcare workers frequently report positive outcomes in job performance [8, 23, 33, 46]. Studies have reported that in a high PSC work environments, there is a notable elevation in work engagement and a heightened sense of commitment among healthcare providers [8, 23, 33, 46, 49, 50]. Moreover, McLinton et al. [9] reported that a positive PSC significantly contributes to enhancing the quality of patient care and ensuring patient safety. These positive associations between a high PSC and job performance are further evidenced by observed safety behaviors [25], increased morale [36], sustained profitability, reciprocal behaviors, workarounds for challenges [41], innovative behavior [27], engagement in organizational citizenship behavior [26], individual and team crafting [51], increased peer support [48], perceived appreciation [49] and improved leadership [52] at the healthcare setting. In healthcare environments characterised by a low PSC negative outcome in job performance are prevalent. Studies consistently associate low PSC with increased absenteeism [36, 53, 54], presenteeism [9, 29, 53, 54], turnover intention [31, 39] and increased compensation claims [36] among healthcare workers. Table 5 presents a summary table on the impact of PSC on job performance of healthcare workers.

Table 5.

PSC impact on job performance among healthcare workers

Main theme	Specific factor	Authors
Positive outcomes	Work engagement	[8, 22, 32, 45, 48, 49]
	Job satisfaction	[38, 46]
	Quality of patient care	[9]
	Patient safety	[9]
	Safety behaviours	[24, 54]
	High morale	[35]
	Sustained profit	[35]
	Reciprocal behaviour	[35]
	Workaround	[40]
	Innovative behaviour	[26]
	Organisation citizenship behaviour	[25]
	Team and individual crafting	[50]
	Perceived appreciation	[48]
	Peer support	[47]
	Improved leadership	[51]
Negative outcomes	Compensation Claims	[35]
	Absenteeism	[35, 52, 53]
	Presenteeism	[28, 52, 53]
	Turnover intention	[30, 38]
	Absence	[9]

The buffering effect of PSC in the healthcare setting

In healthcare settings characterised by a high PSC, several observed phenomena underscore the buffering effect of PSC. Reviewed studies highlight the reinforcing nature of PSC in a positive work environment, strengthening associations between various factors. For instance, in such settings, the positive association between job control and everyday mindfulness [55], job resources and safety behaviors [25], social support and work engagement [46], as well as supportive leadership and personal hope [35] among healthcare providers is notably strengthened. Furthermore, high PSC healthcare setting strengthens the direct impact of adaptive leadership on readiness to change [56]. On the other hand, within more challenging healthcare work environments, the direct impact of high job demands on psychological well-being [57] and burnout [46] is markedly reduced due to the presence of a perceived high PSC. Similarly, the negative impact of work-family conflict and job insecurity on the safety behaviors of healthcare workers is reduced in settings characterised by a high PSC [25, 53]. These insights collectively highlight the pivotal role of PSC in buffering against adverse impacts on various aspects of healthcare professionals' well-being and work performance within challenging work environments.

Discussion

Summary of findings

The mapping of evidence on PSC in healthcare settings reveals its significant impact on working conditions, presenting a positive association with heightened job resources and a simultaneous reduction in various job demands. High PSC environments correlate with abundant job resources, including job control, decision authority, support systems, and organisational rewards, fostering resilience among healthcare providers. Conversely, low PSC settings link to increased job demands and adverse outcomes, such as psychological distress, stress, and decreased well-being among workers. Notably, high PSC environments bolster positive job performance outcomes, evidenced by enhanced engagement, patient care quality, safety behaviors, and organisational commitment. On the other hand, low PSC settings associate with negative job performance outcomes, such as increased absenteeism, presenteeism, and turnover intentions, adversely affecting productivity and stability within healthcare environments. Moreover, PSC acts as a buffering mechanism in high-stress healthcare settings, attenuating the negative impacts of job demands on well-being and safety while reinforcing positive associations between resources, support, and various job performance facets among healthcare professionals.

PSC impact on working conditions of healthcare providers

The findings in this review underscore the significant impact of PSC on healthcare settings, particularly its implications for healthcare workers and patient outcomes. High PSC environments, abundant in job resources such as autonomy, support, and rewards, emerge as pivotal protective elements for healthcare professionals [27, 34]. These elevated job resources associated with high PSC play a critical role in fostering resilience among healthcare workers, potentially mitigating burnout and supporting their overall well-being [46]. This becomes especially crucial given the demanding nature of healthcare work, where factors like job control, support, and organisational backing can significantly buffer stressors, bolstering the resilience of healthcare professionals [24].

Low PSC settings reveal concerning associations with increased job demands, including heightened psychological and emotional pressures, work intensification, and conflicts, contributing to a precarious work environment [30, 33]. Within such settings, healthcare providers become more susceptible to experiencing workplace abuse, encompassing compulsive work habits and incidents of violence [34]. These adverse conditions not only jeopardise the mental and physical health of healthcare workers but also potentially compromise patient care due to stressed and strained professionals [30].

The implications of these findings resonate deeply with Sustainable Development Goals (SDGs). The correlation between high PSC and enriched job resources aligns with the imperative of safeguarding the mental health and well-being of all individuals (SDG 3.6). Moreover, it emphasises the significance of creating conducive work environments (SDG 8.5), where the correlation between high PSC and enhanced job resources becomes pivotal. Additionally, the role of PSC in contributing to safer working conditions, reflected in reduced workplace conflicts and violence (SDG 8.8), signifies the critical importance of fostering positive PSC in healthcare settings.

PSC impact on well-being and safety among healthcare workers

In high PSC healthcare settings, studies like Idris et al. [28] and Siami et al. [35] reveal that healthcare providers often report elevated levels of psychological well-being, personal hope, and resilience. These findings suggest that in environments where PSC is strong, healthcare workers experience better mental health, increased optimism, and greater adaptability in dealing with work challenges. Conversely, in low PSC healthcare settings, reports from studies consistently highlight higher levels of psychological distress, stress, and emotional exhaustion among healthcare professionals [8, 24, 58]. This indicates a troubling scenario where inadequate PSC might contribute to a wide range of mental health challenges faced by healthcare workers.

Moreover, observations linking physical fatigue [41] and poor self-rated health [34] with perceptions of lower PSC highlight the potential cyclical nature of these issues. When healthcare workers experience fatigue or poor health, their perception of the work environment's safety and supportiveness might diminish, creating a detrimental loop where individual well-being and work conditions influence each other. The absence of a direct statistical association between burnout and PSC, as observed in the study by Alshamsi et al. [46], does not diminish the broader role of PSC in shaping well-being among healthcare workers. It rather suggests that while PSC may not be the sole determinant of burnout, it interacts with numerous other factors in complex ways, impacting healthcare workers' mental states. It is noteworthy that the alignment between low PSC and increased workplace injuries and accidents [9, 42] underscores the criticality of PSC in ensuring workplace safety. A deficient PSC might contribute to an unsafe environment, raising concerns not only for healthcare workers' well-being but also for patient safety.

These findings bear significant implications for both healthcare workers and patients. Enhanced PSC can potentially uplift the mental resilience and well-being of healthcare providers, fostering a healthier workforce better equipped to deliver quality care. In healthcare work settings with low PSC, healthcare workers might face increased stress, exhaustion, and potentially hazardous conditions, affecting their ability to provide optimal care and jeopardising patient safety. Understanding these dynamics emphasises the importance of prioritising PSC enhancement strategies within healthcare settings. Strengthening PSC could lead to improved mental health for healthcare workers, safer working conditions, and potentially better outcomes for patients, aligning with the broader goals of ensuring a healthier workforce and providing higher-quality care [10, 19].

PSC impact on performance of healthcare workers

In healthcare settings marked by a high PSC, a consistent trend emerges in this review, indicating enhanced job performance. High PSC in the work environment of healthcare providers encompasses improved job performance, and better and more responsive healthcare delivery [30]. Collectively, these insights highlight the strong correlation between a nurturing PSC and the multifaceted improvement in job performance. Such a correlation emphasises the critical role of a supportive PSC in fostering commitment, ensuring safety, and elevating the overall quality of care within healthcare settings.

On the flip side, low PSC settings in healthcare lead to adverse job performance outcomes. Studies consistently associate low PSC with increased absenteeism, presenteeism, and turnover intentions among healthcare workers [9, 29]. Absenteeism refers to employees frequently being absent from work, while presenteeism indicates employees being present at work but not fully productive due to factors like health issues or dissatisfaction [59]. These findings imply that a deficient PSC negatively affects job performance, resulting in higher intentions to leave and increased absence from work. These outcomes can significantly impact workforce productivity and stability within healthcare settings.

The implications of these findings are significant. A supportive PSC not only enhances the work experience for healthcare professionals but also positively influences patient care quality and safety. It contributes to a more engaged, committed, and productive workforce [10]. A low PSC can lead to decreased workforce stability, affecting patient care due to increased absenteeism and turnover intentions among healthcare workers [10]. Therefore, these findings underscore the importance for healthcare institutions to foster supportive PSC environments to ensure the well-being of their staff and the delivery of high-quality care to patients.

Buffering effect of PSC in healthcare settings

In healthcare settings, the concept of Psychosocial Safety Climate (PSC) operates as a significant shield against the adverse effects of demanding work environments. As highlighted through numerous studies, PSC's influence is evident in reinforcing positive associations among various crucial factors [35, 55]. This signifies that a robust PSC not only fosters a positive work atmosphere but also strengthens the interconnectedness of essential components, elevating the overall professional experience for healthcare providers [57]. Within more challenging healthcare environments, the impact of high job demands on critical aspects like psychological well-being and burnout is notably reduced in the presence of a perceived high PSC [25]. These findings further imply that PSC acts as a buffer against the detrimental impacts of demanding work settings, effectively shielding healthcare professionals from the severe toll of stressors and conflicts inherent in in their daily work schedules.

The implications of these findings are profound for healthcare settings. A strong PSC not only reinforces positive associations among various work-related factors but also serves as a protective mechanism for healthcare professionals. PSC acts as a shield, mitigating the detrimental effects of demanding job aspects on their well-being and job performance. By lessening the negative impacts of stressors and conflicts, PSC contributes significantly to maintaining a healthier and more productive workforce in healthcare [46]. Additionally, these findings highlight the critical importance of nurturing a positive PSC within healthcare organisations as a means of strengthening the resilience and well-being of their workforce. Furthermore, the benefits of a highly perceived PSC among healthcare workers extend beyond the individual well-being of healthcare workers. A supportive PSC indirectly contributes to the enhancement of patient care and safety within healthcare settings [10]. As healthcare providers experience reduced burnout, higher engagement, and increased safety behaviours, the quality and reliability of patient care can potentially improve [34]. A positive work environment due to a high PSC can translate into better patient outcomes, underlining the interconnectedness between the well-being of healthcare professionals and the quality of care they provide.

Implication for managerial practice and policy

In healthcare management, cultivating a workplace that prioritises psychological safety and support emerges as a fundamental imperative. The role of managers is pivotal in nurturing an environment where healthcare workers feel secure, encouraged, and supported. This involves fostering a culture that values open communication, providing resources to navigate stress, and emphasising teamwork to collectively address challenges [9, 60]. Empowering the healthcare workforce through initiatives such as granting decision-making authority, promoting autonomy, and investing in skill development programs significantly contributes to enhancing PSC [10]. Equipping healthcare team members with the tools and confidence to make impactful decisions elevates their resilience and overall well-being [35]. Additionally, investing in leadership development is crucial. Training healthcare managers and administrators to provide supportive guidance, empathetic mentorship, and clear bottom-up communication fosters trust and solidarity among healthcare staff, fostering a positive PSC [10, 60]. To ensure continual progress, continuous monitoring of PSC through employee surveys and focus groups becomes essential. This data-driven approach allows for the identification of specific areas for improvement and the implementation of targeted interventions. Active cultivation of a culture of support, empowerment, and continuous enhancement not only shapes a positive work environment but also holds the promise of enhancing the well-being of healthcare professionals and, consequently, improving patient outcomes [9, 60].

Revisiting and reshaping existing policies are crucial to align them with the goal of fostering a positive PSC and prioritising the mental well-being of healthcare providers. This might involve policy revisions that emphasise the significance of mental health support, stress management resources, and well-being programs for healthcare workers. Introducing or enhancing policies that promote flexible work arrangements, such as flexible scheduling or remote work options where applicable, can contribute to a healthier work-life balance, thus positively influencing PSC. Moreover, policies should be designed to empower employees by providing decision-making autonomy within their roles, ensuring clear communication channels, and promoting a culture of respect and inclusion. This might entail policies aimed at training leaders on empathetic leadership practices and establishing support networks within the workplace. Instituting clear anti-harassment and anti-discrimination policies further reinforces a safe and respectful work environment.

Theoretical implications

The findings provide robust support for the foundational aspects of the PSC theory. Researchers have the opportunity to delve deeper into refining existing work-stress models, emphasising the pivotal role of PSC within healthcare settings. This reaffirms and strengthens the arguments surrounding PSC theory, grounding them in empirical evidence and highlighting their significance in shaping workplace environments [8]. Advancing PSC applications in healthcare settings requires a multidisciplinary approach. Collaborations across disciplines such as psychology, healthcare management, and occupational health can yield a more comprehensive understanding of PSC's multifaceted nature within healthcare [9, 10]. Integrating diverse perspectives allows for a richer exploration of the complexities inherent in PSC, offering nuanced insights into its mechanisms and impact.

Theoretical advancements should focus on longitudinal studies to trace the enduring effects of PSC interventions [39]. Tracking the sustained impact of a high PSC work environment over extended periods can provide invaluable insights into its long-term implications for healthcare workers and patient outcomes. This longitudinal approach contributes to a deeper understanding of how PSC influences well-being, performance, and overall organisational dynamics over time [10]. Theoretical applications should aim to develop practical intervention models aligned with PSC. Healthcare administrators should delineate specific strategies for fostering a positive PSC and mitigating negative impacts within healthcare organisations. By outlining actionable steps derived from the PSC framework, these intervention strategies can guide healthcare managers and policymakers in implementing targeted initiatives that promote a supportive and psychologically safe work environment for healthcare professionals.

The authors found evidence suggesting that PSC may indeed be influenced by broader cultural, national, or regional workplace contexts, as observed across studies conducted in different countries such as Australia, Iran, United Arab Emirates, the Netherlands, Egypt, New Zealand, and Canada. While PSC has been validated in various cultural settings, understanding its applicability in non-western contexts requires consideration of cultural understanding, legal frameworks, and regulatory environments governing workplace dynamics and job design [61].

Limitations in this review

Several limitations should be considered when interpreting the findings of this scoping review. Firstly, while efforts were made to conduct a comprehensive search across various databases and sources, the exclusion of studies not published in English or those preceding 2010 might have led to the omission of relevant data, potentially introducing language and publication bias. Additionally, the focus on peer-reviewed articles might have excluded valuable insights from grey literature or unpublished studies, limiting the scope of the review. Furthermore, despite rigorous screening and selection procedures, the subjective nature of study inclusion might have introduced selection bias. The reliance on specific measurement tools such as PSC-12 or PSC-4 for inclusion criteria might have restricted the inclusion of studies utilising different but relevant approaches to measure psychosocial safety climate. Lastly, while consultations with healthcare professionals added practical insights, the perspectives gathered might not fully encapsulate the diversity of experiences within various healthcare settings, potentially limiting the generalisability of the findings.

Recommendations for future studies

Exploring the nuanced interplay between PSC and burnout warrants further investigation, especially given the observed insignificant direct association in some studies. Adopting a more multifaceted approach to understand the complex relationships between PSC, burnout, and other contributing factors, such as job demands and resources, could provide deeper insights. Moreover, investigating the potential moderating or mediating variables that might influence the relationship between PSC and burnout could offer a more comprehensive understanding. Additionally, considering the diversity of healthcare settings and professionals, future studies should aim to conduct longitudinal research that tracks changes in PSC over time, correlating them with burnout trajectories to discern patterns and causal relationships. Expanding the scope beyond traditional measurement tools like PSC-12, PSC-8, or PSC-4 to encompass diverse methodologies and innovative metrics for assessing PSC may offer more comprehensive insights into its impact on overall well-being and safety among healthcare workers. Future research could explore how specific cultural factors influence PSC across different global contexts, enhancing understanding and application of PSC concepts in diverse workplace settings.

Future studies should also focus on exploring the underlying reasons why healthcare managers have not adequately responded to the mounting evidence that PSC is critical to the well-being of healthcare workers and the success of healthcare organisations. Research should also investigate the characteristics of institutions that successfully maintain a positive PSC, examining factors such as healthcare financing models, unionization, organisational size, and patient demographics. Additionally, studies should evaluate the effectiveness of various interventions uch as healthcare policies, compensation schemes, regulatory mandates, and unionization efforts that may drive healthcare organisations to prioritise and enhance their PSC. This research is essential for developing targeted strategies to improve the work environment in healthcare settings.

Conclusion

The comprehensive exploration of PSC in healthcare settings underscores its multifaceted impact on working conditions, well-being, safety, and performance among healthcare professionals. High PSC environments align with enriched job resources, fostering resilience and positive job performance outcomes, while low PSC settings are associated with increased job demands, compromised well-being, and adverse job performance. The buffering effect of PSC in attenuating negative job demands and reinforcing positive associations between resources and performance highlights its pivotal role in sustaining a supportive and psychologically safe work environment. These findings emphasise the criticality of prioritising PSC enhancement strategies within healthcare settings to safeguard the well-being of healthcare providers and improve patient outcomes. Nurturing a positive PSC not only contributes to a healthier workforce but also ensures higher-quality care, underlining the interconnectedness between healthcare professionals' well-being and patient safety. Moving forward, future research should delve deeper into understanding the nuanced relationships between PSC, burnout, and other influencing factors, adopting diverse methodologies to capture its comprehensive impact within healthcare settings. Future studies should give attention to the cross-cultural validation of PSC in non-Western world such Africa and South America where PSC has received less research attention.

Authors’ contributions

M.A and S.A.A conceptualised the review. M.A conducted search and analysis, thematic analysis, reported the findings and wrote the initial manuscript. M.A, D.F.A and S.A.A wrote th.e final manuscript. M.A and P.F.D independently extracted data for evidence synthesis, reviewed by M.A and S.A.A. The final draft of the manuscript was read and authorised for publication by all authors.

Funding

This work received no funding support.

Data availability

All data generated or analysed during this study are included in this article and its supplementary files (Table S1 and PRISMA-ScR checklist).

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.