Abstract

Background: The healthcare sector is very well-known for its very high-stress environment, with professionals experiencing and facing elevated rates of mental health issues such as anxiety, depression, and burnout. Approximately 40% of healthcare workers in the UK report symptoms of burnout, often due to workplace stressors and inadequate safety measures. Safety-specific leadership and safety consciousness are demonstrated and shown to very positively impact and influence well-being, reduce stress, and improve job satisfaction, highlighting the urgent need and requirement for combined approaches to enhance and improve healthcare professionals’ mental health outcomes.

Aim: This systematic review aims to explore the combined influence of safety consciousness and safety-specific leadership on the psychological well-being of healthcare professionals.

Methodology: The methodology of this systematic literature review (SLR) focuses on exploring the impact of safety consciousness and safety-specific leadership on healthcare professionals’ psychological well-being. It utilises and employs secondary data collection from peer-reviewed sources, utilising Boolean operators and key search terms. The process includes rigorous inclusion and exclusion criteria, thematic analysis for data synthesis, and ethical considerations ensuring much more transparency and accuracy in findings, along with quality assessment using the PRISMA checklist.

Findings: The presence of safety consciousness and safety-specific leadership can help in managing the psychological health status of all healthcare professionals in healthcare organisations. Moreover, the significant presence of much more supportive leadership approaches can help in decreasing burnout rates along with stress levels while improving job satisfaction among individuals.

Conclusion: This SLR emphasises the vital role and part of leadership, safety culture, and communication in enhancing healthcare professionals’ psychological well-being, offering actionable strategies for sustainable mental health support.

Chapter 1: Introduction, Research Question and Background Review​

1.1. Introduction

In recent years, the psychological well-being of healthcare professionals has become a very significant type of concern, especially considering the high-stress nature of healthcare environments. According to the World Health Organization (WHO) (2019), healthcare professionals significantly experience much higher rates of mental health issues, including anxiety, depression, and burnout, than those in other professions, largely due to intense kinds of job demands and the high-stakes environment they significantly work and operate. For instance, a 2020 study by Ferry et al.reported that approximately 40% of healthcare workers in the UK experienced and encountered symptoms of burnout, primarily connected and linked to workplace stressors and insufficient safety measures. Moreover, studies demonstrate and show that safety-specific leadership, leaders’ potential ability to emphasise and enact safety protocols, correlates positively with important employee well-being, with reports indicating that very strong safety leadership can reduce employee stress by up to 30% (Firestone, 2024). Additionally, safety consciousness, or an individual’s proactive awareness and adherence to safety practices, has been demonstrated and shown to reduce and minimise error rates and improve overall job satisfaction (Saleem and Malik, 2022). Despite these kinds of findings, a particular gap persists in understanding and knowing the combined influence and impact of safety-specific leadership and individual safety consciousness on psychological well-being. This SLR significantly intends and seeks to bridge and fill this gap, offering much more useful information and insights that can inform organisational policies to enhance and improve healthcare professionals’ mental health outcomes and reduce burnout levels.

1.2. Background

The healthcare sector is very well-known for its high-pressure environment, where healthcare professionals often face and experience long hours, high patient loads, and emotionally taxing situations (Gibson, 2022). This demanding sector and environment have substantial amounts of implications for their mental health. According to NHS Providers (2024), in the UK, in the past 12 months, 41.7% of employees reported feeling unwell as an outcome and result of work-related stress (down from 44.8% in 2022, but still higher than 2019 levels). Research effectively demonstrates and shows that key contributors to these kinds of psychological issues are workplace safety and leadership practices, which play crucial roles and parts in shaping employees’ experiences and well-being (Ahmed et al., 2020).

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Safety consciousness, defined as an individual’s awareness commitment and dedication to maintaining and holding safe work practices, is much more essential in reducing and minimising workplace accidents and stress (Irshad et al., 2021). A study by Sillaet al. (2017) indicates that a safety-conscious work environment (SCWE) may aid in preventing catastrophic incidents in high-reliability organisations (HROs), which can have grave repercussions for people, the economy, and the environment, directly impacting the mental health and job satisfaction of healthcare professionals. In addition, safety-specific leadership, where leaders model and enforce safety protocols, has been demonstrated and shown to alleviate stress.

However, in many healthcare settings, a very comprehensive type of approach combining both individual safety consciousness and strong safety-specific leadership is particularly lacking, which contributes to very high turnover rates and increased healthcare costs. According to the American Psychological Association (APA) (2024), institutions that prioritise both these kinds of factors see improved well-being and retention rates among employees. This background highlights the need and requirement to investigate how combining safety consciousness and safety-specific leadership can foster better psychological outcomes for healthcare professionals, potentially influencing policies for safer and healthier workplaces.

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1.3. Research Aim, Objectives and Question

1.3.1. Aim

This systematic review aims to explore the combined influence of safety consciousness and safety-specific leadership on the psychological well-being of healthcare professionals.

1.3.2. Research Objectives

• To assess how safety-specific leadership affects the psychological well-being of healthcare professionals.
• To explore the relationship between safety consciousness among healthcare professionals and their well-being.
• To investigate the effect of the combination of both factors in providing better psychological health outcomes compared to specific leadership or consciousness.

1.3.3. Research Question

What is the combined effect of safety consciousness and safety-specific leadership on the psychological well-being of healthcare professionals?

1.4. Problem Statement

Hospitals, clinics and other healthcare settings are high-risk environments and it is noticed that healthcare professionals face huge stress due to the high-risk environment. Continuous working within a stressful environment resulted in negative impacts on the well-being of employees (Huhtala et al., 2021). This is also noticed within the healthcare setting which resulted in high psychological issues among the healthcare professionals. This resulted in a high rate of employee burnout and impacted the overall performance of healthcare professionals. This discussion highlighted a contemporary problem associated with the current environment in healthcare settings.  

1.5. Research Rationale

Investigation into this topic has been associated with several reasons such as effectively overcoming the health issues that are faced by healthcare professionals while working within healthcare settings. Healthcare organisations care about the health and well-being of the public but analysing the current landscape of healthcare, it is noticed that healthcare professionals are experiencing a lack of healthcare and safety at their workplace. The psychological health issue is highly noticed (Robles et al., 2020). To effectively find out the core reason for psychological health issues among healthcare professionals is the key reason for the investigation into this topic. In addition, identifying and addressing how safety-specific leadership affects and impacts the psychological well-being of healthcare professionals is another reason for the investigation into this topic (Hassan et al., 2023). This helps very effectively provide evidence for overcoming the issue.  To effectively find out the relationship and connection between safety consciousness among healthcare professionals and their well-being is the other reason for the investigation into this topic. As the existing research is lacking in providing and offering a very comprehensive understanding and knowledge of the topic, an investigation on this topic is conducted. 

1.6. Research Significance

Improving the overall health outcome of the healthcare professionals is one of the significances of this investigation. Moreover, the findings of this investigation are also going to provide valuable insight to government agencies and motivate them to take necessary steps for considering the psychological well-being of healthcare professionals. The findings can contribute to an improvement in existing healthcare policy or create a new healthcare policy. 

1.7. Dissertation Structure

Chapter 1 Introduction, Research Question and Background Review​	Introduction Background Research Aim, Objectives and Question Problem Statement  Research Rationale  Research Significance  Dissertation Structure
Chapter 2: Methodology	Research Design Search Strategy Inclusion and Exclusion Criteria PRISMA Flow Chart Quality Assessment Ethical Considerations
Chapter 3: Presenting the Data	Data Extraction Table Summary of the Articles
Chapter 4: Critical Analysis and Discussion	Thematic Analysis Overall Interpretation of Research Findings Implication of the Findings Relation to the Research Objectives Strengths and limitations
Chapter 5: Conclusion and Recommendations	Summary/Reflection on the ResearchImportance of the Topic to Management of HealthCare OrganisationsRecommendations

Table 1: Dissertation Structure

(Source: Self-Made)

Chapter 2: Methodology

2.1. Introduction

This particular chapter outlines the methodological framework guiding the systematic literature review on the combined influence and impact of safety consciousness and safety-specific leadership on the psychological well-being of healthcare professionals. It details the chosen and selected research design, strategy, data collection methods, and data analysis approach, ensuring a systematic and reliable approach to address and identify the research objectives. Ethical considerations and quality assessment processes are also significantly discussed to ensure rigour in evaluating and assessing the collected literature.

2.2. Research Design

Research design is the general plan to express the process and procedure of the research. It explains the overall methods and approaches of data collection and data analysis followed in research. The researcher has adopted a secondary research design to complete this study. A systematic literature review or SLR has been selected to complete the study. In this research design, the research gets a scope to select concurrent literature focusing on the research question, aim and objectives (Banijamali et al., 2020). Therefore, the key research question is answered based on the findings from the literature. This research design involves several techniques and practices to achieve the best possible outcome, satisfying the research question.

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2.3. Research Strategy

Considering the systematic literature review, the researcher has decided to collect secondary information from existing literature on the combined influence of safety consciousness and safety-specific leadership on the psychological well-being of healthcare professionals. To collect relevant papers, the researcher developed some keywords and utilised those while searching through the databases. The application of Boolean operators has also been done to signify the overall search process in terms of efficiency (Gusenbauer and Haddaway, 2020). Furthermore, to keep the focus of this research intact, the research has prepared a set of inclusion and exclusion criteria. It helped throughout the literature search process.

2.4. Data Collection Method

The data collection method is one of the most essential tasks of research as it delivers the crucial information to be relied on for providing a strong conclusive statement. There are generally two types of data collection methods such as primary data collection method and secondary data collection method. In primary data collection, the researcher needs to rely on information that has never existed, leading to the arrangements for surveys, focus groups and interviews. This method of data collection is time-consuming and requires more resources when compared to the secondary data collection method (Taherdoost, 2021). In secondary data collection, the information can be sourced from existing literature, published newspaper articles, government websites, books, and online portals. Therefore, the struggle to conduct surveys and sample participants can be eliminated in the secondary data collection method. The research in this study has followed the secondary data collection method. Relevant literature has been collected from Google Scholar, PubMed, Scopus, PsycINFO, Research Gate, MDPI and Science Direct.

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2.5. Search Strategy

2.5.1. Boolean Operators

Boolean operators, including AND, OR, and NOT, were used to refine the search process and increase search accuracy. For instance, using “safety consciousness AND psychological well-being” helped identify studies where both concepts were relevant, while “NOT patient safety” excluded studies focused on patient outcomes, ensuring relevance to healthcare professionals’ well-being.

2.5.2. Key Terms

 Key terms were carefully selected to maximize relevant search results, including “safety consciousness,” “safety-specific leadership,” “psychological well-being,” and “healthcare professionals.” Synonyms and related terms, like “mental health” and “occupational safety,” were also included to capture studies covering a broader scope of the research question.

Search Terms	Boolean Operators	Example Search String
“safety consciousness”	AND	“safety consciousness” AND “psychological well-being”
“safety-specific leadership”	OR	“safety-specific leadership” OR “safety leadership”
“psychological well-being”	AND	“psychological well-being” AND “healthcare professionals”
“healthcare professionals”	AND	“healthcare professionals” AND “mental health”
“occupational safety”	NOT	“safety consciousness” AND “occupational safety” NOT “patient safety”
“mental health”	OR	“psychological well-being” OR “mental health”
“safety culture”	AND	“safety culture” AND “psychological well-being” AND “healthcare”
“leadership influence”	AND	“leadership influence” AND “safety consciousness” AND “healthcare professionals”
“workplace well-being”	AND	“workplace well-being” AND “safety leadership” AND “healthcare professionals”
“employee burnout”	AND	“employee burnout” AND “psychological health” AND “safety consciousness”

Table 2: Search Terms and Boolean Operators

(Source: Self-Made)

2.6. Inclusion and Exclusion Criteria

Criteria	Inclusion	Exclusion
Publication Date	Studies published within the last 5 years to ensure relevance and recent data.	Studies published more than 5 years ago
Language	Articles published in English	Articles published in languages other than English
Population	Studies focusing on healthcare professionals (such as doctors, nurses, and allied health workers)	Studies focusing on non-healthcare professionals (such as patients, administrative staff)
Focus on Safety Factors	Studies examining safety consciousness and/or safety-specific leadership in healthcare settings	Studies not addressing safety consciousness or safety-specific leadership in healthcare
Psychological Well-Being	Studies that assess psychological well-being or mental health outcomes among healthcare professionals	Studies focusing on unrelated health outcomes (such as physical health, and patient safety)
Type of Study	Peer-reviewed journal articles	Non-peer-reviewed articles or grey literature
Setting	Studies conducted in healthcare environments (such as hospitals, and clinics)	Studies conducted in non-healthcare environments
Study Design	Empirical studies with quantitative or qualitative data	Articles without empirical evidence (such as opinion pieces, and editorials)

Table 3: Inclusion and Exclusion Criteria

(Source: Self-Made)

The inclusion and exclusion criteria are designed to ensure the relevance, reliability, and quality of the studies selected for the systematic literature review. By mainly focusing on studies published within the last five years, the review captures the most up-to-date research on the combined influence of safety consciousness and safety-specific leadership on healthcare professionals’ psychological well-being. The criteria significantly prioritise peer-reviewed articles to ensure academic rigour and exclude non-healthcare settings and studies without empirical evidence to maintain focus on the specific research topic. Additionally, the exclusion of non-English publications ensures consistency in language and accessibility for thorough analysis.

2.7. PRISMA Flow Chart

2.8. Quality Assessment

Assessing the quality of each literature included in the study is necessary to avoid the risk of bias, academic requirement breach, and poor quality of research outcomes. The researcher has sincerely followed the PRISMA Checklist 2020 to avoid the risks of facing complex quality inquiry (Knight, 2024). The structured questions within the checklist helped the researcher to understand if the studies were eligible to be considered in this research. The purpose, objectives, methods, analysis, evaluation, critical discussion, and clarity in conclusion of all these areas can be assessed for quality assurance by this checklist.

2.9. Data Extraction

The systematic literature review has focused on considering the data extraction process, which has included structured and regular support to collect all the important information from different studies focusing on the respective influence of safety consciousness and safety-specific leadership for the psychological well-being of healthcare professionals. It has focused on identifying various databases from the past 5 years and considering various inclusion and exclusion criteria the studies have significantly identified important information considering a proper data extraction table, which is mentioned below:

Author and year	Title	Method of the study	Findings	Outcomes

Table 3: Data Extraction Table Sample

(Source: Self-Made)

2.10. Data Analysis

The extracted data is analysed with the help of thematic analysis, which is suited for this research activity. The thematic analysis involves various kinds of stages that include familiarising with the data and also going through various extraction processes including codes that focus on understanding the pattern (Ali et al., 2021). With the help of thematic analysis some of the codes are generated we have seen a grouping of the large themes that are related to safety-specific leadership, self-consciousness, and the respective impact on the healthcare workers’ psychological well-being. Each of the themes has explored the respective depth for understanding more about the nuances associated with healthcare leadership and the safety consciousness that interact to influence the overall mental health of healthcare professionals. It has initiated validity and reliability for the analysis process, which has involved multiple reviews of the data as per the research topic and refining of the team providing a comprehensive understanding of different evidence.

2.11. Ethical Consideration

The SLR has focused on utilising the ethical guidelines for the respective conducting of the systematic literature review. The research has not involved direct interaction with the human participants or any kind of collecting new data therefore no ethical approval is required for this research. It is much more essential to consider the studies that are reviewed for the ethical integrity that ensures that the following of the ethical protocol is considered to deal with confidentiality and data handling. Ethical consideration is considered to be one of the important and critical elements within the research process for help in dealing with different activities within the research process (May and Perry, 2022). The review process has significantly emphasised transparency and has ensured that the synthesis of the data focuses on unbiased and representing of the findings in the original way the author has initiated.

2.12. Chapter Summary

The chapter has focused on considering important steps and strategies that are used to identify important information and aspects that are directly connected to the research topic. The SLR has highlighted a comprehensive understanding regarding important steps that are often considered for the case of systematic literature review to gather all the important information directly associated with the safety consciousness activities and leadership that are considered by healthcare professionals.  

Chapter 3: Presenting the Data

3.1. Data Extraction Table

Author and year	Title	Method of the study	Findings	Outcomes
Irshad et al., 2021	“The combined effect of safety specific transformational leadership and safety consciousness on psychological well-being of healthcare workers”	A mixed method is considered, which combines the quantitative survey with the qualitative interview. It has included the health care workers to understand more about the perception of safety leadership and safety consciousness.	The study has indicated that the safety of a specific transformational leadership, which is further combined with the safety consciousness, brings about improvement in the psychological well-being of the healthcare workers.	The study has significantly emphasized the importance of integrating the leadership style with the help of safety consciousness to further promote psychological well-being. It has highlighted other respective benefits of the Healthcare workers for both the supportive leadership and also for initiating a safety culture. It can be considered that the involvement of better leadership can be beneficial in dealing with different activities regularly with healthcare professionals.
Hassan et al., 2023	“Relationship among leadership styles, employee’s well-being and employee’s safety behavior: an empirical evidence of COVID-19 from the frontline healthcare workers”	The study has included a quantitative research design that has utilized surveys that are distributed to frontline healthcare workers. The data were further analyzed with the help of statistical methods to understand the respective relationship present between leadership styles and others will be and the safety of the employees.	The research has significantly demonstrated the safety focus leadership, which initiates the most impact on employee well-being and also the safety week behaviour specifically during the pandemic situation. Safety behaviour that includes adherence to all important protocols is further considered that is correlated with well-being.	The study has concluded that leadership that emphasizes safety and employee support helps in improving the overall psychological safety and the safety complaints observed among healthcare workers specifically during any high-stress situation. It indicates that the leadership emphasizes the overall understanding of the employees and focuses on initiating safety protocols to deal with the respective activities of the nurses.
Zaheer et al., 2021	“Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety–a mixed methods study”	A mixed method design is considered in the study, which has included qualitative interviews and a quantitative survey. The study has significantly focused on the acute care nurses’ perception related to leadership, teamwork, turnover, and the respective patient’s safety using thematic analysis and statistical analysis.	The study has significantly identified that the perception of the nurses regarding leadership and teamwork has impacted their overall psychological well-being and the intention to stay within the profession.	The findings have significantly suggested that stronger irrational and other involvement of effective teamwork are considered to be crucial for enhancing psychological well-being and helping in reducing the turnover rate among nurses. It ensures that the inclusion of better collaboration in the teamwork helps in dealing with different activities that initiate better job satisfaction reducing the turnover rate to a larger extent.
Capone et al.  (2022)	‘Mental well-being and job satisfaction of hospital physicians during COVID-19: Relationships with efficacy beliefs, organizational support, and organizational non-technical skills’	Reviewing this literature, it is noticed that primary research methodology has been applied by the researchers. 78 Italian physicians are the participants in this investigation	One of the key findings is that high organisational support impacts the mental well-being of healthcare professionals, maintains a high job satisfaction level and increases productivity.	The outcome of this investigation is that organisational support plays a crucial role in creating a positive environment that ensures the well-being of employees including in healthcare settings.
Riguzzi and Gashi (202)	‘Lessons from the first wave of COVID-19: Work-related consequences, clinical knowledge, emotional distress, and safety-conscious behavior in healthcare workers in Switzerland.’	Reviewing this article, it is noticed that the authors leverage primary research methodology. The total number of participants was 185 and all the participants were healthcare workers.	This article, it revealed that during the pandemic period, healthcare professionals were going through huge psychological distress such as anxiety, stress and others which resulted in high burnout. In addition, safety consciousness such as following healthcare protocol also helps effectively prevent them from being affected as well as ensures their confidence to overcome the situation.	The outcome of the study is highlighted that safety-conscious behaviour within healthcare professionals not only reduces anxiety, and stress levels but also mitigates employee burnout. This highlighted a link between safety and psychological well-being.
Yayla and Eskici İlgin,  (2021)	‘The relationship of nurses’ psychological well‐being with their coronaphobia and work–life balance during the COVID‐19 pandemic: A cross‐sectional study.’	Within this article, the primary research methodology was followed for collecting data on the topic. The total population for the investigation was 295 nurses.	Reviewing this literature, it is noticed that during the pandemic period, there was a lack of safety notices for healthcare professionals which resulted in a high negative impact on psychological well-being as well as work-life balance. This indicates how important safety consciousness is for healthcare professionals.	The outcome of this topic is that the healthcare organisation needs to focus on the safety of the healthcare professionals as well as the healthcare workers also need to prioritise safety consciousness.
O’Donovan et al.  (2021)	Healthcare professionals experience of psychological safety, voice, and silence	34 interviews with healthcare professionals in a suburban hospital	Healthcare professionals’ experiences of psychological safety vary significantly based on personal characteristics, past experiences, and interpersonal relationships. Leadership is critical in influencing individuals’ choice to engage in voice or silence.	Psychological safety at the individual level is complex and involves multiple motivating and inhibiting factors. Intervention strategies should account for these diverse influences to improve psychological safety and encourage voice behaviour among healthcare workers.
San Juan et al. (2021)	Mental health and well-being of healthcare workers during the COVID-19 pandemic in the UK	Qualitative study with interviews (n = 33) and a rapid review of COVID-19 well-being guidelines (n = 14)	Front-line workers’ well-being needs differ from existing guidelines, emphasising structural conditions and external support, while guidelines focus more on psychological interventions. Barriers like understaffing hinder participation in these interventions.	Effective support for healthcare workers should integrate structural and community support, address practical barriers, and be adaptable to healthcare workers’ real-world challenges, especially during crises like the COVID-19 pandemic.
Denning et al. (2021)	Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic	Multinational cross-sectional study using a self-administered questionnaire (SAQ, OLBI, HADS) with 3,537 healthcare workers	High rates of burnout (67%), anxiety (20%), and depression (11%) were identified, with predictors including job role, redeployment, low safety attitudes, and mental health status. Testing for SARS-CoV-2 and high safety attitudes were inversely related to burnout.	Highlights the need for targeted support services for at-risk groups, proactive SARS-CoV-2 testing, and improved safety attitudes to support healthcare workers’ psychological well-being during the pandemic.

Table 4: Data Extraction Table

(Source: Self-Made)

3.2. Summary of the Articles 

Reviewing the literature it is noticed that there is a positive relationship between safety consciousness among healthcare professionals and their well-being. Reviewing the study of Capone et al. (2022), it is revealed that organisational support helps effectively reduce the negative impacts on healthcare professionals as well as reducing employee burnout. The policies which help effectively increase the safety awareness of healthcare professionals help in managing their anxiety stress as well as burnout.  Both the studies such as Riguzzi and Gashi (2021), and  Yayla and Eskici İlgin (2021), highlighted how the work-life balance and psychological well-being of healthcare professionals were impacted during the pandemic period.

The long working hours, and fear of getting infected and others increase anxiety, stress, and other psychological issues among healthcare professionals. However, safety awareness, consciousness about the safety protocols, and others helped in effectively reducing the fear and they were continued in their job roles. Reviewing these three articles, highlighted that there is a need to effectively increase safety awareness or consciousness among healthcare professionals. 

On the other hand, the research by O’Donovan et al. (2021) identified that the maintenance of psychological safety for all healthcare workers by the leaders is important as it can also help in improving personal characteristics among the leaders. The presence of psychological safety can help increase appropriate intervention approaches for the maintenance of burnout among all healthcare professionals. Furthermore, the research by San Juan et al. (2021), explained that the increased focus on the mental health of the healthcare professionals by the leader can help in understanding the requirements while managing the guidelines of well-being.

All the workers are required to adapt to structural conditions along with providing the required support to the community based on the mental health intervention approaches. However, as per Denning et al. (2021), at the time of COVID-19, the burnout ratio has been identified to be higher among healthcare professionals and it has mainly been created by safety-conscious leaders along with different safety attitudes.

 Chapter 4: Critical Analysis and Discussion

4.1. Chapter Overview

This chapter of the study has been developed to make discussions on the key findings in the previous chapter. The chapter has critically discussed the key themes uncovered in the thematic analysis. In this critical discussion, the researcher has critically analysed each notable finding with the work of other researchers for strong justification. Therefore, the themes have been linked to the research question followed by a discussion on the strengths and limitations of the research. Thereafter, an overview of this chapter has been provided in the chapter summary, concisely.

4.2. Thematic Analysis

4.2.1. Theme 1: Impact of Safety-Specific Leadership on Psychological Well-Being

The presence of safety-specific leadership approaches can help in making changes in the psychological health of healthcare professionals while developing a supporting and inclusive working environment. Through the provision of increased level priority to the safety measurements the well-being of the employees can be managed. As stated in the research by Irshad et al. (2021), leaders in healthcare settings who prefer the incorporation of appropriate safety protocols with proper emotional support can help decrease burnout rates while increasing the level of job satisfaction. The presence of transformational leadership which is safety-specific the mitigation of stress levels can also be done. The overall approach of incorporating transformational leadership aspects for increasing psychological health can manage safety behaviours at the workplace while focusing on the management of safety cultures at workplaces (Denning et al., 2021). The increased presence of strong leadership approaches mainly within the scenarios like COVID-19 can increase the burnout rates among healthcare professionals. As stated in the research by Hassan et al. (2023), the presence of a supportive type of leadership style can help in managing the safety protocol and well-being of all the employees among healthcare professionals while planning to decrease stress and increase job satisfaction levels.

4.2.2. Theme 2: Exploring the Relationship between Safety Consciousness among Healthcare Professionals and Their Well-being

Commitment and awareness approaches towards safety taken by the individuals are known as safety consciousness which can further help in managing the practices of safety protocols and it can also further affect the psychological health of all the professionals. As stated by Riguzzi and Gashi (2021), it has been identified that the increased presence of safety consciousness at the time of COVID-19 can help in decreasing the development of burnout and anxiety among healthcare professionals while planning to develop a link with psychological and safety behaviour approaches. On the other hand, Yayla and Eskici İlgin (2021), have also identified that healthcare workers who mainly focus on the maintenance of specific safety consciousness approaches are capable of managing a balance between work and life along with increasing the mental health status while incorporating safety awareness as well. By developing a mindset related to the prioritisation of safety protocols all healthcare professionals can not only help in protecting their physical health but can also maintain their psychological health with specific healthcare strategies.

4.2.3. Theme 3: Interplay Between Safety Culture and Individual Resilience in Enhancing Psychological Well-Being

The inclusion of a safety culture that is strong in the healthcare settings can further help in increasing individual health and support approaches as part of their psychological health. According to Zaheer et al. (2021), through a combination of safety consciousness and safety-specific leadership approaches a well-structured safety culture can be developed which can further help all the professionals of healthcare to develop a better working environment with reduced stress. Further analysis has also identified that the presence of a safety culture can not only help in enhancing the safety mechanisms within individuals but can also help in making healthcare professionals more confident about their work. With the incorporation of strategies for creating a balance between safety cultures and work pressure (San Juan et al., 2021). Moreover, it has also been identified that the presence of collaborative safety approaches and behaviour different types of safety-conscious behaviour can further help in increasing the mental health of healthcare professionals while focusing on the management of the leadership roles as well. 

4.2.4. Theme 4: Barriers and Facilitators to Psychological Well-Being in Safety-Critical Healthcare Environments

All healthcare professionals often face several challenges in maintaining their psychological health within the environment which is safety-critical. Some of the major barriers have been identified to be excessive work pressure, understaffing, and decreased presence of supportive approaches for treating issues related to mental health. As stated by Capone et al. (2022), several structural issues within the healthcare sectors involve decreased periods as well which is responsible for preventing the healthcare workers from achieving success in managing the healthcare programmes. Apart from these challenges some of the facilitators are the involvement of strong leadership approaches and team support given by the leaders which are capable of improving job satisfaction levels along with the mental health status of all the healthcare professionals. According to O’Donovan et al. (2021), the inclusion of an environment that can motivate healthcare workers to share their issues without the presence of any fear is capable of enhancing open communication approaches as well. Focusing on the management of all the challenges while involving more facilitators based on the organisational approaches can help in improving the psychological health of the professional in healthcare settings.

4.3. Overall Interpretation of Research Findings

All the research findings from the selected research articles helped in identifying the specific impact of the leadership approaches which are safety-specific along with the approaches of safety-consciousness for the management of organisational culture on the psychological health among all the healthcare workers. The involvement of safety-specific leadership has been identified to be providing the required priority to the management of effective safety protocols while offering the required guidance to all the professionals and leaders. This can further help in managing supportive approaches within healthcare professionals so that job satisfaction rates can increase. The inclusion of appropriate safety-conscious leadership approaches can also help in decreasing stress and burnout levels mainly within situations involving increased levels of stress such as COVID-19.

The leaders in the healthcare sector are required to increase their focus on the management of a safe environment for developing a more supportive healthcare environment as well. The findings have also stated that by incorporating a supportive environment all the healthcare professionals can further feel secure to state their concerts while understanding the overall importance of the important safety standards to decrease distress levels. However, it has also been identified that the presence of safety consciousness can often influence the commitment of individuals related to the management of safety practices in the healthcare sector. Healthcare leaders and professionals who have increased experiences with the safety awareness approaches can further focus on maintaining their mental stability while contributing more to the healthcare approaches.

4.4. Comparison with Previous Literature

In theme 1, to examine how safety-specific leadership style affects healthcare professionals’ psychological well-being, researchers highlighted the profound impacts of leadership approaches that prioritise safety on the outcomes of mental health. It has been identified by Irshad et al. (2021) that healthcare worker’s psychological well-being can be improved by safety-specific transformational leadership. Leaders who prioritise safety, and offer clear guidance and support to their teams, experience lower burnout rates within healthcare organisations and higher job satisfaction (Søvold et al. 2021). Hassan et al. (2023) observed that supportive leadership approaches positively fostered well-being and job satisfaction among frontline workers. To support this finding, the research of Vonderlin et al. (2021) can be referred to. Vonderlin et al. (2021) have mentioned that within the complexities of healthcare organisations, supportive leadership addresses mental health issues among employees. In addition, the findings of Denning et al. (2021) report that a strong leadership approach within acute care settings often correlates with decreased levels of turnover intentions and stress. It has been proven that within intensive care units of healthcare organisations, employees face increased levels of stress and anxiety to handle the pressure. Therefore, a strong emphasis on healthcare leaders is expected to address employee conditions efficiently (Rink et al., 2023).

In theme 2, the relationship between consciousness of safety among healthcare progressional and their overall well-being under Objective 2, underscored the significance of organisational culture and behaviour within high-stress environments. It has been observed by Riguzzi and Gashi (2022) that safety-conscious behaviours such as strict protocol adherence were linked to lower burnout and anxiety among healthcare professionals within this sector in Switzerland. The study of Robin (2024) has drawn attention to a significant matter in this case. Nursing students have shown interest in safety-specific behaviours however, without the presence of sufficient clinical staff during practice, they expressed a negative attitude towards practice as stated by Yayla and Eskici İlgin (2021). Therefore, it can be stated that healthcare professionals admire safety-conscious behaviours within a collaborative workspace, leading to lower stress and dissatisfaction.

In theme 3, the analysis of the relationship between the cultural safety approaches and beliefs of individual healthcare approaches has been identified to develop an alignment with the benefits of having a supportive environment at work for the further maintenance of mental health as well. As stated by Zaheer et al. (2021), there is a requirement to involve a safety-conscious leadership approach to increase the safety commitment within the individuals while decreasing the levels of burnout and anxiety. While supporting this fact the research by Schultze-Lutter et al. (2016), has explained that the presence of a well-organised safety culture can often help in increasing confidence levels among healthcare professionals while managing the stress issues often developed by the leaders. Furthermore, the research by San Juan et al. (2021), has also discussed the presence of different perspectives within the healthcare leaders about safety programmes that are important to support mental health status. Another research by Djourova et al. (2020), has supported the fact of incorporating transformational leadership approaches for managing the direct effects of work pressure on the well-being of the individuals.

In theme 4, the presence of different facilitators and barriers for the management of a safety-critical environment in healthcare has been identified while focusing on the effects of some serious situations like the pandemic due to COVID-19 and other conditions like increased work pressure. As per Capone et al. (2022) and O’Donovan et al. (2021), the presence of increased work pressure and understaffing have been identified as the main challenges that are responsible for decreasing the level of job satisfaction and increasing burnout rates. All of these identified barriers developed alignment with the findings of Brown et al. (2020), stating that along with these factors, the presence of scheduling issues can also affect the mental health status of healthcare professionals. The management of this situation has been identified to increase the demand for proper work stress mitigation approaches which can be adaptable by the systems.

4.5. Implications of Findings

The overall findings in this systematic literature have been identified to be developing specific implications for all healthcare organisations, policymakers, and leaders for further improving the well-being of all healthcare professionals mainly within the environments which can be stated as safety-critical. The implementation of the findings mainly can help in increasing the leadership approaches that are safety-specific while enhancing the approaches related to safety consciousness. Through the presence of safety-specific leadership approaches the mitigation of stress can be done while improving the status of mental health within all the healthcare professionals (Wang et al., 2018). Moreover, all the leaders are required to prioritise the safety protocols in the environment while supporting all of the members of their teams to develop a well-organised and psychologically safe healthcare environment for all the healthcare professionals. Training programmes related to healthcare approaches need to focus on the provision of better skills to all leaders while planning to create a proper supportive environment at work (Brand et al., 2017). Through focusing on an appropriate leadership approach burnout rates can be decreased while ensuring proper mental stability among all healthcare professionals.

Another implication of the findings involves the enhancement of the awareness approaches related to safety consciousness among healthcare professionals. Individuals who suffer from increased levels of anxiety and other mental health issues are required to achieve an enhanced level of confidence which can be achieved by focusing on the maintenance of appropriate safety protocols (Stelnicki et al., 2021). All healthcare organisations need to encourage behaviours that are safety-conscious while focusing on the further management of the best practices related to mental healthcare aspects. As per Robles et al. (2020), workshops or any other courses on safety protocols can further help increase motivation within the staff while decreasing stress levels and developing control over the healthcare environment.

Moreover, an important implication of the findings further involves the inclusion of a safety culture which includes different types of leadership approaches and consciousness for individual safety that are also associated with appropriate team support. This type of implication can further help in incorporating a collaborative environment in the healthcare sector for the involvement of better safety responsibilities. According to Stelnicki et al. (2021), the promotion of open communication approaches and channels including feedback collection systems can further help in encouraging teamwork while contributing to the management of a safety culture that can further enhance the psychological well-being of all individuals.

Overall, through focusing on all the findings it has been identified that increased incorporation of the health and safety leadership approaches can encourage safety consciousness among the leaders and also within the healthcare professionals. Through the further development of safety culture in healthcare settings all the barriers can be mitigated which can further also help in increasing the psychological health of all the professionals. However, there is a requirement to involve structural support for further maintenance of the leadership approaches.

4.6. Relation to the Research Objectives

All the findings of this research have been identified to be developing an alignment with the objectives of this research while focusing on the importance of having safety consciousness and safety-specific leadership approaches for maintaining the mental health and well-being of all healthcare professionals. The first objective involves the identification of the effects of safety-specific leadership on the psychological well-being of all healthcare professionals has been identified to be maintained by leaders who are not only supportive but are also focused on the safety protocols. All the leaders who actively support the healthcare professional teams in creating a safe environment at work can further manage to decrease burnout levels while promoting mental healthcare approaches as stated by Hassan et al. (2023) and Irshad et al. (2021). Moreover, the second objective involving the exploration of the relationship between healthcare professionals and safety consciousness has identified the presence of an increased level of safety awareness for decreasing the level of anxiety in individuals.

As stated by Riguzzi and Gashi (2021), the inclusion of appropriate awareness approaches can further help in increasing the understanding of the behaviour that is associated with safety consciousness among all healthcare professionals for maintaining mental health. The last objective which mainly focuses on the investigation of the effects of safety consciousness and safety-specific leadership on the overall psychological health of the healthcare professionals made an alignment with the research themes stating the identification of the barriers and also cultural independence. As stated by O’Donovan et al. (2021) and Zaheer et al. (2021), the presence of individual safety approaches and leadership approaches can help in developing a positive working environment within the healthcare organisations while focusing on maintaining an alignment with all the appropriate safety initiatives taken by all the healthcare leaders.

4.6. Strengths and Limitations

4.7.1. Strengths

There are several strengths that have been identified through the development of this systematic review and the first strength involves the appropriate use of the systematic approach for increasing the understanding of the effects of the safety consciousness and safety-specific leadership within all the healthcare professionals.

The use of a systematic review approach has helped in developing a better alignment within all the research objectives and research findings. This particular method has also helped in enhancing the validity of all the findings while analysing the overall understanding of the safety-conscious leadership approaches mainly in the maintenance of psychological well-being.

Another strength involves the use of thematic analysis which has helped in deeply analysing the presence of safety culture in healthcare organisations. This has further been identified as one of the important aspects of maintaining the impact of leadership approaches on the psychological health of healthcare professionals.

This systematic review’s increased focus on the relevant approaches within the healthcare settings has also been identified to be important for developing appropriate healthcare intervention approaches. Overall, the findings of this research develop an alignment with the approaches of the policymakers and also the leaders of the organisations.

4.7.2. Limitations

Apart from all the identified strengths several limitations can also be seen within this systematic review. One of the major limitations is increased dependence on secondary data from different relevant literature focusing on the effects of safety-conscious leadership on healthcare professionals. The use of different research methodology approaches in different research has also been identified as another limitation.

A limited timeline has been followed for the collection of relevant research as per the inclusion and exclusion criteria which on one hand has helped in providing more recent data but has failed in making a comparison with the previous data on the effective approaches involving safety-conscious leadership aspects.

The systematic review has also lacked in identifying the effects of the safety protocols within the subgroups in the healthcare organisations involving all the administrative staff and nurses who are also capable of developing different challenges within their mental health.

4.8. Chapter Summary

Through the development of this chapter, an appropriate thematic analysis has been done while focusing on the overall findings within all the selected research based on the research topic. Further analysis has also helped in understanding the overall strengths and limitations of this systematic review along with the relation with all the objectives.

Chapter 5: Conclusion and Recommendations

5.1. Summary/Reflection on the Research

The following SLR has systematically analysed the particular part and role of safety-specific leadership, safety consciousness, and safety culture on the psychological well-being of healthcare professionals. The thematic analysis presented in the previous chapter identified several essential findings that align very closely with the research objectives, providing insight into how healthcare organisations can improve mental health outcomes through strategic leadership and cultural initiatives.

Firstly, the SLR emphasised the profound impact and influence of safety-specific leadership on psychological well-being. Leaders who very actively implement and develop safety protocols and provide emotional and professional support create an environment where healthcare professionals feel much more valued and secure. This, as identified by Irshad et al. (2021), reduces and minimises burnout and increases job satisfaction, essential for maintaining an effective and motivated workforce. Secondly, safety consciousness among healthcare workers emerged as a crucial factor. Individuals who prioritise safety and are aware of the importance of adhering to safety protocols reported lower levels of anxiety and burnout, as evidenced by the works of Riguzzi and Gashi (2021).

The interplay between safety culture and resilience was also analysed. A strong safety culture that incorporates leadership commitment and employee engagement was found to promote confidence and decrease stress. Finally, identifying and tackling barriers and facilitators in safety-critical healthcare environments revealed and illustrated that excessive work pressure, understaffing, and insufficient mental health support pose significant challenges. Conversely, team support and open communication were identified as facilitators that improved job satisfaction and reduced stress.

Overall, this SLR highlighted the multifaceted approach needed and required to support healthcare professionals’ well-being, demonstrating that leadership, cultural, and individual factors and elements must align to foster and leverage a safe and mentally healthy working environment.

5.2. Importance of the Topic to Management of HealthCare Organisations

The findings from this SLR hold significant importance and essentiality for the management of healthcare organisations. Ensuring the important psychological well-being of healthcare professionals is much more crucial not only just for the workforce’s mental health but also for maintaining high standards of patient care. Leadership and organisational culture have been demonstrated and shown to directly influence job satisfaction, productivity, and staff retention, making these areas critical for healthcare management to address.

Healthcare organisations operate and function under intense pressure, with staff frequently encountering high-stakes situations that can affect their psychological health. When leaders prioritise safety and support, it cultivates an environment where employees are encouraged to express concerns and seek help without fear of judgment. This supportive atmosphere leads to enhanced safety compliance and overall workplace morale. Furthermore, promoting safety consciousness ensures that healthcare workers remain much more vigilant and proactive in protecting and safeguarding themselves and their patients, contributing to a culture of safety that is integral to healthcare quality management.

The importance of these findings is underscored and illustrated by the challenges and issues posed during crises such as the COVID-19 pandemic, where healthcare professionals faced unprecedented types of stress and workload. Strong leadership and an established safety culture proved essential in navigating these challenges effectively, highlighting the need for healthcare management to very proactively develop and sustain these frameworks.

5.3. Recommendations

Based on the findings of this SLR, the following recommendations are significantly proposed to healthcare organisations for improving and enhancing the psychological well-being of their staff:

Leadership Training: Prioritise leadership development mainly focusing on safety-specific and transformational practices. Equip leaders with potential kinds of skills in empathy, communication, and crisis management to support staff very effectively, especially during high-stress periods (Blake, 2024).

Open Communication Culture: Foster an effective environment where staff feel safe to share concerns without fear (O’Donovan et al., 2019). Implement and develop feedback mechanisms such as anonymous surveys and encourage open dialogue through team meetings that prioritise psychological safety.

Comprehensive Support Systems: Introduce mental health initiatives like peer support, counselling, and workshops on stress management and mindfulness (Ahorsu et al., 2021). Ensure these kinds of services are well-promoted and easily accessible.

Address Barriers to Well-Being: Tackle any kinds of challenges and issues like understaffing and excessive workloads by investing in adequate staffing levels and offering flexible scheduling (Daniels et al., 2022). Provide and offer incentives and career development opportunities to enhance job satisfaction.

Strengthen Safety Culture: Embed safety as a very core value through regular training and collaborative practices, ensuring staff understand its importance and feel much more empowered to maintain safety and well-being (Flynn et al., 2018).

Technology for Monitoring: Utilise digital tools for anonymous mental health assessments and easy access to resources (Gould et al., 2020). This allows leaders to identify and recognise stress trends and evaluate the impact of support measures.

Team-Based Support: Promote and leverage teamwork through structured activities and collaborative projects to build resilience and mutual support, fostering a very positive work environment (Hartwig et al., 2020).

Policy Advocacy: Work with policymakers to support and assist legislation that prioritises mental health, including funding for programs, adequate staffing, and flexible work policies that support healthcare professionals’ well-being (Jain et al., 2021).

These kinds of measures very collectively aim to create a supportive, safe, and resilient environment, enhancing both staff well-being and patient care quality.  

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