AN EXAMINATION OF OBSTACLES TO PSYCHOLOGICAL SAFETY IN NIGERIAN HEALTHCARE FACILITIES: A CASE STUDY OF UNIVERSITY OF MEDICAL SCIENCE HOSPITAL, AKURE, ONDO STATE

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Psychological safety refers to a team environment where individuals feel comfortable expressing concerns, asking questions, and admitting mistakes without fear of negative consequences from colleagues (Agbede & Ibe, 2020). This concept has gained attention in healthcare due to its influence on patient safety and treatment quality. Psychological safety fosters trust and openness among healthcare workers, enabling them to focus on delivering high-quality care rather than managing the risks of speaking up (Agbede & Ibe, 2020). Studies show it enhances creativity, reduces burnout, and increases physician engagement. Globally, psychological safety is associated with improved patient safety, collaboration, and employee morale (Newman et al., 2017). However, challenges such as hierarchical organizational structures, fear of punishment, and lack of supportive leadership hinder psychological safety in many healthcare systems (Baer & Frese, 2015). Developed countries have addressed these issues through training, policy reforms, and leadership development programs that encourage open communication and error reporting. Nonetheless, barriers persist, especially in low- and middle-income countries where institutional and cultural factors complicate the creation of psychologically safe workplaces (Agbede & Ibe, 2020). Nigeria’s healthcare sector faces unique difficulties in promoting psychological safety. Under-resourced facilities, high patient-to-staff ratios, and frequent shortages of essential supplies place healthcare workers under constant stress (Efe & Ayinde, 2021; Bello et al., 2023). Additionally, Nigeria’s strongly hierarchical healthcare system often limits open communication, as junior staff may hesitate to report errors or concerns due to fear of retaliation or career setbacks (Olajide et al., 2022). Such rigid systems contribute to high turnover, low job satisfaction, and reluctance to report issues that may compromise patient care (Omotayo & Oni, 2021). Leadership styles significantly impact psychological safety in hospitals. Authoritarian and transactional leadership often suppress open dialogue, whereas transformational leadership, which emphasizes empathy and support, fosters better psychological safety (Edmondson, 2018). Unfortunately, hierarchical and authoritarian leadership styles dominate Nigerian healthcare, discouraging staff from raising concerns, especially when fear of adverse consequences is high (Efe & Ayinde, 2021). The lack of leadership development programs that promote psychological safety leaves workers feeling unsupported (Adebayo & Aremu, 2020). Cultural factors also play a role. In Nigeria, admitting errors is often stigmatized professionally, limiting opportunities for organizational learning and error prevention (O'Donovan & McAuliffe, 2020; Bello et al., 2023). Without addressing these cultural barriers, creating environments where healthcare workers feel safe to ask for help and admit mistakes remains challenging. Resource scarcity further compounds the issue. Many Nigerian healthcare facilities suffer from understaffing, outdated equipment, and limited supplies, which heighten stress and reduce capacity to provide optimal care (Agbede & Ibe, 2020). These conditions contribute to frustration and burnout, diminishing psychological safety and hindering effective teamwork (Adebayo & Aremu, 2020). Despite the clear importance of psychological safety, research on this topic within Nigerian healthcare is limited, leaving hospital administrators without adequate guidance to overcome these challenges. This study, therefore, aims to investigate the barriers to psychological safety in Nigerian healthcare settings, focusing on the University of Medical Science Hospital in Akure, Ondo State. 1.2 Statement of the Problem Psychological safety—defined as the confidence to express ideas, concerns, and admit mistakes without fear—is crucial in healthcare for promoting teamwork, communication, and error reporting, which improve patient care quality (Edmondson, 2018). However, in Nigerian healthcare institutions, structural and cultural barriers such as hierarchical management, lack of leadership support, fear of punishment, and limited opportunities for open communication threaten psychological safety (Efe & Ayinde, 2021; Olajide et al., 2022). These barriers restrict information flow and teamwork, negatively impacting healthcare workers’ well-being and patient outcomes. Studies in developed countries link high psychological safety environments with reduced errors, increased job satisfaction, and improved patient care (Edmondson, 2018). Yet, Nigerian healthcare faces unique challenges including under-resourced facilities, high patient-to-staff ratios, cultural stigma around error disclosure, and insufficient communication training (Agbede & Ibe, 2020; Bello et al., 2023). This study thus investigates the barriers to psychological safety at University of Medical Science Hospital, Akure, Ondo State. 1.3 Objectives of the Study The broad objective is to investigate the barriers to psychological safety in Nigerian healthcare settings at the University of Medical Science Hospital, Akure. Specifically, the study aims to: i. Identify organizational barriers to psychological safety in Nigerian healthcare. ii. Assess how resource limitations worsen these barriers. iii. Examine the impact of fear of retribution on healthcare workers’ willingness to report errors or concerns. iv. Identify strategies to improve psychological safety for enhanced teamwork and patient outcomes. 1.4 Research Questions To guide the study, the following questions are posed: i. What are the organizational barriers to psychological safety in Nigerian healthcare settings? ii. How do resource limitations exacerbate these barriers? iii. How does fear of retribution affect healthcare workers’ willingness to report errors or concerns? iv. What strategies can enhance psychological safety for better teamwork and patient outcomes? 1.5 Significance of the Study This study’s findings can inform policymakers in designing supportive policies that prioritize psychological safety, including non-punitive error reporting, reducing hierarchical communication barriers, and improving mental health resources for healthcare workers. Healthcare institutions can also use the findings as a baseline for ongoing evaluation and improvement of psychological safety practices, ultimately benefiting employees and patients. Academically, the study will contribute to existing literature and guide future research. 1.6 Scope of the Study The study focuses on barriers to psychological safety within Nigerian healthcare, specifically at the University of Medical Science Hospital, Akure, Ondo State. It will empirically examine organizational barriers, resource limitations, fear of retribution, and strategies to enhance psychological safety and patient care outcomes within this hospital setting. 1.7 Limitations of the Study The researcher encountered the following limitations: Time constraints: Balancing research with academic obligations limited available time. Financial constraints: Costs related to printing, sourcing materials, and data collection were challenging. Availability of materials: Scarcity of literature on psychological safety in Nigerian healthcare limited resources for this study. 1.8 Definition of Terms Psychological Safety: A shared belief that team members can take interpersonal risks, voice concerns, and admit mistakes without fear of punishment or humiliation. Healthcare Settings: Places where health services are delivered, such as hospitals and clinics, encompassing various care levels and hierarchies. Hierarchy: The structured levels of authority that influence communication and decision-making in healthcare organizations. Leadership Style: The approach leaders use to guide and support staff, e.g., transformational or authoritarian, impacting psychological safety. Error Reporting: The act of communicating mistakes or near misses to improve patient safety. Job Satisfaction: The degree of contentment healthcare workers feel regarding their roles and work environment. Workplace Culture: The values, behaviors, and norms that define an organization’s environment, influencing openness and respect. Patient Care Outcomes: The results of healthcare interventions, including patient safety, recovery, and satisfaction.