Racial and ethnic differences in patient psychological safety: A qualitative patient narrative study

The existence of racial and ethnic disparities in health outcomes is well-established. In addition to discrimination and social determinants, disparities can result from lower-quality relationships that historically marginalized groups may experience with health care providers and systems. The extent to which patients can connect with and be known by care providers is thought to play a key role in their subsequent diagnoses, treatments, care plans, and health behaviors. Recent research has found that many patients express the need for patient psychological safety (PPS) in order to feel connected. Thus, we were interested in exploring whether there exist racial/ethnic differences in experiences of PPS, as a lack of safety could reduce patients’ opportunities to connect with providers. This study used a patient narrative approach, in which patients respond to open-ended questions in their own words, to examine what patients say related to PPS and the extent to which their characterizations may vary by race and/or ethnicity. Patient responses (n = 1766) were coded to fit into one of three conceptual PPS dimensions: belonging, learning, and participating. Analysis found that nearly all patients described some level of PPS as indicating to them they had a good connection with providers, with greater proportions of Black and Hispanic/Latino patients expressing belonging safety, that is, the need to feel welcomed and respected as a human being. In contrast, White patients were more likely to express participation safety, or the need to have influence on their care. This study contributes a new, nuanced understanding of patient experiences of connecting with care providers.