In my previous leadership roles, and now as a Senior Lecturer in Cancer Care, the importance of psychological safety has become increasingly apparent. Oncology is becoming ever more complex in terms of patient pathways, treatment delivery and the management of treatment-related side effects.

With one in two people expected to develop cancer during their lifetime, more people are living longer with cancer and we are caring for an ageing population with multiple co-morbidities. Working in oncology is highly specialised and emotionally demanding. Oncology nurses require increasing levels of knowledge, skills and education to meet the complex needs of their patients, often within environments experiencing workforce shortages and limited resources. Despite these challenges, patient safety remains at the heart of our practice and must be maintained to ensure the delivery of high-quality care.

What is psychological safety?

Psychological safety exists when teams feel safe enough to raise concerns, feel valued, heard and included in finding solutions. Team members know they will not be ignored, criticised or blamed and instead work within an open and transparent culture focused on learning and improvement.

Psychological safety encourages constructive challenge and helps individuals feel secure enough to offer different perspectives, which can stimulate innovation, creativity and service improvement. It is important to recognise that psychological safety is not the same as psychological support. However, it can improve staff wellbeing, morale and motivation, while reducing burnout and helping teams cope with some of the wider pressures within the healthcare system that often feel beyond their control.

Why is it important?

Historically, the NHS was often characterised by a hierarchical, command-and-control style of leadership. In recent years, however, there has been a significant movement towards more compassionate approaches to leadership. This shift has been championed by professional bodies, national organisations such as The King's Fund, and leadership programmes including those offered by the Florence Nightingale Foundation.

The principles of psychological safety are closely aligned with compassionate leadership. Leaders who foster psychological safety and role model these behaviours create environments where teams can work collaboratively, building trust, respect and mutual understanding. When staff feel psychologically safe, reporting of safety concerns increases, innovation flourishes and staff wellbeing improves. Organisations also benefit from better staff retention, and ultimately patients receive safer, higher-quality care.

Yet the most recent NHS Staff Survey tells a different story. In 2025, only 60.3% of staff reported feeling safe to speak up about anything that concerned them, while just 47.6% felt confident that their organisation would address their concerns. These figures have gradually declined over recent years. Although there has been a significant focus on compassionate leadership and embedding psychological safety into practice, staff experiences suggest that there is still considerable work to do.

How can leaders build psychological safety?

Leadership behaviours have a direct impact on whether staff feel able to speak up. Leaders set the tone for team culture and influence what becomes accepted as the norm.

Leaders who are visible, approachable and present, who listen with empathy and seek to understand the experiences of their teams, are more likely to foster psychological safety. Creating solutions collaboratively demonstrates respect and trust, while role modelling vulnerability can help reduce hierarchical barriers. Being honest when uncertain, asking for help and openly sharing experiences of mistakes and learning can encourage openness within teams and strengthen relationships.

Moving away from blame cultures and instead approaching challenges with curiosity creates opportunities for learning and improvement. Aligning values, focusing on continuous improvement and placing patient care at the centre of decision-making can help teams feel united by a common purpose.

Leaders can also provide access to clinical supervision, introducing Schwartz Rounds for reflection to strengthen a culture where all voices are valued.

What next?

Throughout my career, both in clinical leadership and now in education, I have seen the difference psychological safety can make. As the demands of cancer care continue to grow, fostering psychological safety will become increasingly important. By creating environments where every voice matters, we can support our workforce, improve patient outcomes and build cultures that are resilient, compassionate and focused on continuous improvement. 

Psychological safety is not a leadership initiative or a standalone programme; it is a fundamental prerequisite for safe, compassionate and high-quality cancer care.