How Psychological Safety Is Created or Damaged in Healthcare Teams : the Role of Leadership Traits and Self-Awareness

Abstract

Abstract: Psychological safety is increasingly recognized as a core condition for effective teamwork in healthcare, where communication, coordination, and rapid decision-making directly influence patient safety. This thesis explores how leadership behaviours and leaders’ self-awareness influence psychological safety in healthcare teams. To address this, a narrative literature review was conducted using peer-reviewed studies, book chapters, and reports published between 1995 and 2025. Searches were conducted in PubMed, Google Scholar, ScienceDirect, and other sources. After screening 55 records, 35 publications were included. A thematic analysis was used to identify recurring patterns in leadership behavior, self- awareness, emotional climate, and team functioning. The review shows that psychological safety shapes how healthcare teams communicate, collaborate, report errors, and learn. High psychological safety enables open dialogue, shared decision-making, and early risk identification, while low psychological safety contributes to silence, stress, and breakdowns in coordination. Leadership behavior emerged as a central determinant: leaders who demonstrate emotional regulation, openness, and reflective capacity strengthen psychological safety, whereas punishing, unpredictable, or controlling behaviors undermine it. Self- awareness was identified as a moderating factor that can soften or redirect even challenging leadership traits, including narcissism, psychopathy and Machiavellianism, transforming them from potential risks into strategic assets when managed responsibly. The findings highlight the practical value of fostering leadership development that integrates emotional intelligence, reflective practice, and awareness of interpersonal impact. Given the complexity of modern healthcare, psychological safety should be viewed not as an abstract ideal but as a measurable and essential component of high-quality care. Keywords: psychological safety, healthcare teams, leadership, team dynamics, self-awareness, emotional intelligence, Dark Triad traits, communication