Creating a safe space: Psychological safety of healthcare workers

By Markirit Armutlu

The Canadian Patient Safety Institute has created a comprehensive guide and toolkit that provides Canadian healthcare organizations with the resources they need to develop and sustain a peer-to-peer support program (PSP). Creating a Safe Space: Strategies to Address the Psychological Safety of Healthcare Workers provides a broad overview of what peer support is available in Canada and internationally.

The guide outlines best practices, tools, and resources. These help policy makers, accreditation bodies, regulators, and healthcare leaders assess what healthcare workers need in terms of support, and to create PSPs to preserve their emotional well-being.  The result enables healthcare organizations to provide the best and safest care to their patients.


Some healthcare organizations are unable to provide the support needed to their staff and managers to maintain a healthy and resilient workforce. Albert Wu coined the term “second victim” to describe a healthcare worker after a patient safety incident. The “second victim phenomenon” describes healthcare providers who are psychologically traumatized by events during the provision of care, resulting in anxiety and depression, decreased performance, high turnover rates, and increased patient safety incidents. Various studies estimate that the prevalence of the second victim phenomenon ranges from 10.4 per cent up to 43.3 per cent.

Healthcare is a high stress environment. Healthcare providers are expected to work efficiently and safely in often difficult and pressured settings. Over the past decade, research has identified the clear link between a provider’s mental health and healthcare outcomes, including patient safety, with the probability of contributing to a preventable incident increased when the provider is suffering from psychological distress. For example, a healthcare professional may feel emotionally traumatized after a sudden or unexpected bad outcome, a patient safety incident, the loss of a patient with whom they feel close, workplace conflict, or dealing with multiple trauma cases.

“While patients and families will always be the first priority in healthcare, workers also need to be supported as a result of what they experience in their profession,” says Markirit Armutlu. “Peer-to-peer support programs, where health professionals can discuss their emotional distress in a nonjudgmental environment with colleagues who can relate to what they are going through, are now seen as an effective approach to helping health professionals cope and provide a safe space where they can get extra support.”

Creating a Safe Space is divided into four sections: Section 1 provides the results of a pan-Canadian survey of healthcare workers to determine what support they needed and identified gaps in that support. Section 2 includes knowledge from international literature so that we can learn from those who have established or studied healthcare PSPs. Section 3 addresses confidentiality and legal privilege for peer support programs. It provides clear explanations about what is and is not privileged information and how best to strengthen confidentiality. Section 4 provides a step-by-step approach to help healthcare organizations succeed in creating a PSP. It includes recommendations on how to recruit and train peer supporters and how to ensure spread and sustainability of the program. A webinar series has also been created to learn from others who have implemented PSP programs.

In partnership with the Mental Health Commission of Canada, the Canadian Patient Safety Institute has compiled the Creating a Safe Space Toolkit with input from experts and contributing organizations. “The Toolkit is an excellent source of information for healthcare workers, leaders, regulators, and policy makers that includes templates, examples, and recommendations for anyone who is embarking on creating a PSP,” says Armutlu. “The searchable database provides links to documents and examples from existing peer support programs for healthcare providers.”

Markirit Armutlu is a Senior Program Manager with the Canadian Patient Safety Institute.