Editor’s Note: This article by the World Federation of Chiropractic Research Committee’s Global Patient Safety Initiative (GPSI), chaired by Katherine Pohlman, DC, PhD, is reprinted with permission from the WFC Quarterly World Report (April 2025). It has been edited only to conform with Dynamic Chiropractic’s editorial style guide.
Patient safety is a fundamental pillar of health care, ensuring care delivery minimizes risk and optimizes outcomes. While much attention in patient safety is given to adverse event (AE) reporting, clinical protocols and system-based interventions, an often-overlooked component of patient safety is psychological safety – the ability for health care providers to openly discuss concerns, admit mistakes and seek guidance without fear of judgment or retaliation. For chiropractors, who often work in independent or small-practice settings, fostering psychological safety is particularly crucial, as it directly impacts our ability to engage in transparent communication, continuous learning and patient-centered care.
Psychological safety, a concept popularized by Harvard researcher Amy Edmondson, refers to an environment where individuals feel safe to speak up, ask questions and acknowledge errors without fear of embarrassment or punishment. In health care, psychological safety is essential for openly reporting patient safety concerns, collaborative problem-solving and reducing preventable errors. Research consistently shows that psychologically safe environments encourage peer discussions, shared learning and system-wide improvements, all of which are vital for enhancing patient safety in chiropractic care.
Despite its importance, several factors make fostering psychological safety in chiropractic care challenging:
- Fear of Professional Repercussions – Chiropractors, similar to other healthcare professions, may be reluctant to report adverse events or patient safety concerns due to fear of legal consequences, damage to their professional reputation, or disciplinary action.
- Lack of Institutional Support – Without formalized peer-review processes or mentorship programs, many chiropractors lack a structured system for discussing and learning from safety incidents, such as the opportunity available through CPiRLS (https://rcc-uk.org/cpirls/).
- Competitive and Independent Practice Models – The nature of private practice can discourage collaboration, making it less likely for practitioners to seek peer input or admit clinical challenges.
- Limited Access to Interdisciplinary Networks – Chiropractors often lack access to safety teams available in some hospital settings, reducing opportunities for collaborative learning, error prevention and continuous improvement.
To enhance patient safety, chiropractic organizations, regulatory bodies and professional associations must prioritize psychological safety by creating a culture that encourages open dialogue, learning from errors and continuous improvement. Key strategies include:
- Establishing Non-Punitive AE Reporting Systems – Encouraging chiropractors to report adverse events and near misses without fear of retribution can enhance transparency and allow system-wide learning.
- Developing Peer Support Networks – Creating mentorship programs, clinical discussion forums and case review groups can help chiropractors share insights and gain confidence in discussing safety concerns.
- Training in Communication and Patient Safety Culture – Incorporating patient safety and psychological safety training into chiropractic education and continuing professional development can reinforce the importance of open dialogue and shared learning.
- Encouraging Interdisciplinary Collaboration – Partnering with other health care providers can provide diverse safety strategies and promote a broader, more comprehensive approach to patient safety.
Psychological safety is an essential yet often overlooked component of patient safety in health care, including chiropractic care. Without a supportive environment that fosters open discussion, self-reflection and peer collaboration, addressing adverse events and clinical uncertainties remains a challenge – ultimately impacting patient outcomes.
The WFC’s Global Patient Safety Initiative (GPSI) champions the advancement of psychological safety within the profession, encouraging chiropractors to adopt structured reporting systems, peer support networks and ongoing education. By embracing these strategies, we can strengthen our commitment to patient-centered, evidence-based care, ensuring that safety and learning remain at the heart of chiropractic practice.
Investing in a culture of safety and openness not only supports practitioners, but also enhances the quality, credibility and global trust in chiropractic care.
