A STUDY ON LEADERSHIP INFLUENCES ON THE PROMOTION OF PSYCHOLOGICAL SAFETY AMONG HEALTHCARE PROFESSIONALS IN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study It is widely recognized that cultivating psychological safety within organizations heavily depends on effective leadership. Research indicates that leaders who exhibit empathy, encourage honest communication, and genuinely care for their team members are more successful in creating workplaces where psychological safety thrives (Frazier et al., 2017). In healthcare, leaders play a critical role in shaping a culture of psychological safety. By nurturing an environment where healthcare professionals feel comfortable sharing concerns and ideas without fear, leaders can significantly reduce workplace stress, burnout, and staff turnover (Goh et al., 2022). Leadership approaches such as transformational and servant leadership are particularly effective in enhancing psychological safety because they emphasize mutual respect, tolerance, and support among team members (Schein, 2017). Studies have also shown that psychological safety—defined as the collective belief that team members can take interpersonal risks and seek help without fear of negative consequences—substantially influences workplace attitudes such as job satisfaction (Edmondson, 1999; Newman, Donohue, and Eva, 2017; Winarto, 2018). There is also a clear link between psychological safety, employee job satisfaction, and patient experiences with healthcare workers. Leadership styles that foster openness to feedback and the ability to admit mistakes contribute to greater psychological safety (Frazier, Fainshmidt, Klinger, Pezeshkan, and Vracheva, 2017). The term “psychological safety” was popularized by Edmondson (1999), describing a person’s confidence that they can freely express themselves in the workplace without facing adverse consequences. This concept has recently gained significant traction, especially in high-risk sectors like healthcare where patient outcomes rely heavily on trust, collaboration, and communication. Psychological safety in healthcare allows employees to raise concerns, admit errors, and collaborate without fear of blame, thereby improving patient safety and service quality (Edmondson, 2019; Newman et al., 2017). Like many healthcare systems in developing countries, Nigeria faces major challenges such as inadequate funding, overwhelming patient loads, and insufficient resources (Akinwale & George, 2022). These difficulties create intense pressure on healthcare workers, who often must perform under stressful conditions without adequate leadership support, threatening their psychological safety. Research reveals that Nigerian healthcare professionals frequently feel overburdened and undervalued, which decreases their job satisfaction and increases turnover rates (Ogunleye et al., 2020). To enhance healthcare outcomes, boost job satisfaction, and reduce stress and burnout in such a demanding environment, strong and supportive leadership that actively promotes psychological safety is vital (Okoye et al., 2023). Moreover, psychological safety is closely connected to patient safety and quality of care. In healthcare settings where psychological safety is high, employees are more likely to report adverse events, disclose mistakes, and engage in problem-solving activities, all of which contribute to improved patient outcomes (Kahn et al., 2021). For instance, a study by Nembhard and Edmondson (2016) found that staff were more willing to report errors in hospitals where leaders cultivated a culture of psychological safety, enabling teams to learn from these errors and implement safety improvements. Therefore, fostering psychological safety through effective leadership is critical for the overall success of Nigeria’s healthcare system, especially given the limited resources and frequently low morale among healthcare workers. Despite the acknowledged importance of leadership in promoting psychological safety, there remains a lack of comprehensive understanding about how Nigerian healthcare leaders influence their employees' psychological safety and which specific leadership behaviors are most effective in creating such an environment. Consequently, this study seeks to explore the role of leadership in enhancing psychological safety among healthcare workers in Nigeria. 1.2 Statement of the Problem There is increasing awareness that a supportive work environment—where healthcare professionals feel safe to voice concerns, ask questions, and communicate openly without fear of retaliation—is essential to psychological safety (Edmondson, 2019). However, healthcare settings in Nigeria are often characterized by rigid hierarchical structures and intense workloads, which can undermine psychological safety and negatively affect team dynamics, job satisfaction, and patient care outcomes (Okoye et al., 2023). Leadership plays a pivotal role in establishing a psychologically safe workplace by fostering open communication, building trust, and providing employee support, thereby enabling healthcare workers to share ideas and vulnerabilities without fear of criticism or punishment (Goh et al., 2022). Nevertheless, there remains a significant knowledge gap regarding the impact of different leadership styles on psychological safety within Nigerian healthcare contexts. This study therefore aims to investigate how leadership influences psychological safety among healthcare professionals in Nigeria. 1.3 Objectives of the Study The primary objective of this research is to investigate the role of leadership in fostering psychological safety among healthcare workers in Nigeria. The specific objectives are as follows: i. To examine the impact of leadership styles on psychological safety among healthcare workers in Nigerian hospitals. ii. To identify leadership behaviors that contribute to creating a psychologically safe work environment for healthcare professionals. iii. To explore the barriers that hinder psychological safety in Nigerian healthcare settings. iv. To offer recommendations for leadership practices that can enhance psychological safety among healthcare workers in Nigeria. 1.4 Research Questions This study is guided by the following research questions: i. How do leadership styles influence psychological safety among healthcare workers in Nigerian hospitals? ii. What leadership behaviors foster a psychologically safe work environment for healthcare professionals? iii. What are the barriers to psychological safety in Nigerian healthcare settings? iv. What leadership strategies can be recommended to improve psychological safety among healthcare workers in Nigeria? 1.5 Significance of the Study The findings from this research will be valuable for healthcare leaders and policymakers in Nigeria as they design leadership development programs that emphasize psychological safety. By promoting open communication, empathy, and supportive leadership behaviors, healthcare leaders can reduce burnout, staff turnover, and stress-related absences. Additionally, the study’s insights will support the creation of policies that encourage feedback mechanisms and transparency within healthcare teams, thereby nurturing a culture of learning and continuous improvement across healthcare institutions in Nigeria. Furthermore, the study will contribute to the academic community by enriching the existing literature, expanding available library resources, and providing a reference point for future researchers. 1.6 Scope of the Study This study focuses on the role of leadership in enhancing psychological safety among healthcare workers in Nigeria. Empirically, the research will analyze the influence of leadership styles on psychological safety within Nigerian hospitals, identify leadership behaviors conducive to a psychologically safe work environment, investigate the obstacles to psychological safety, and propose leadership recommendations to improve it. Geographically, the study will be limited to the Federal Medical Center in Umuahia, Abia State. 1.7 Limitations of the Study As with any research endeavor, this study faced certain limitations: Time Constraints: The researcher had to balance this study alongside other academic commitments, such as attending lectures and participating in other educational activities, which limited the time available for the research. Financial Constraints: Costs associated with typesetting, printing, sourcing relevant materials and literature, and data collection increased the financial burden on the researcher. Availability of Materials: Difficulty in sourcing sufficient literature relevant to the study topic, owing to the niche nature of psychological safety discourse in Nigerian healthcare, posed a challenge. 1.8 Definition of Terms Psychological Safety: A workplace environment where individuals feel secure to express themselves openly without fear of negative consequences, promoting trust, open communication, and collaboration among team members. Leadership: The behaviors and attitudes of individuals in authoritative roles who influence, guide, and motivate others within an organization. In this study, leadership specifically refers to how healthcare leaders foster and support psychological safety among healthcare workers. Healthcare Workers: Professionals employed in healthcare settings, including doctors, nurses, administrative personnel, and allied health professionals who provide patient care and related services. Leadership Style: The methods and approaches leaders use to engage, motivate, and guide their teams. Common styles include transformational, transactional, and servant leadership, each impacting psychological safety differently. Job Satisfaction: The degree to which healthcare workers feel content, valued, and fulfilled in their roles, environment, and leadership support. Psychological safety is linked to greater job satisfaction. Teamwork: The cooperative efforts among healthcare workers aimed at achieving shared goals in patient care, which depend heavily on psychological safety for open communication and mutual support. Trust: A core element of psychological safety, referring to healthcare workers’ confidence in their leaders’ integrity, competence, and commitment to their welfare, thereby creating a secure and open environment