Implementing Psychological Safety in the Emergency Department Guided by the CFIR 2.0 Framework: Introducing the SAFE-ED Programme
DOI:
https://doi.org/10.47363/JCCEM/2026(5)200Keywords:
Psychological Safety, Psychological Safety Index, Leadership, Implementation Science, Emergency DepartmentAbstract
Organizations of all types and sizes need to enable employees to speak up without fear if they are to make the most of the resources they have and meet the challenges of this age of uncertainty.
Psychological Safety (PS) in the Emergency Department (ED) is the shared belief of every staff that the clinical environment is safe for interpersonal
risk taking, allowing individuals to speak up, admit mistakes, ask for help without fear of humiliation or retaliation. EDs are high stakes, fast-paced
environments with multi-tiered hierarchies, all of which increase risk to both patient and staff. PS directly correlates with improved diagnostic accuracy, lower burnout rates and lower patient mortality. However, PS is not experienced uniformly across all ED teams.
The SAFE-ED Programme (psychological Safety Acceleration FramEwork for Emergency Departments) represents a structured and practical implementation strategy to embed psychological safety into the culture and daily operations of the ED. It proposes a multilevel implementation strategy designed to embed psychological safety into the culture and daily operations of the ED; built directly on the Consolidated Framework for Implementation Science Research, CFIR 2.0 analysis, designed to address specific barriers and leverage specific facilitators identified across its five domains. The programme is organised around three interdependent pillars: Leadership Modelling, Structural Embedding, and Sustained Reinforcement. These pillars are intended to operate simultaneously and synergistically rather than sequentially, though the relative emphasis on each will shift across the phases of implementation.
The SAFE-ED Programme is proposed, not as a finished product but as a theoretically grounded starting point and platform for prospective evaluation, contextual adaptation, and cumulative knowledge-building. Its ultimate test will be in the lived experience of ED teams who implement it, and in the evidence that rigorous evaluation generates about what works, for whom, and under what conditions. That evidence, in turn, will contribute to the broader project of making EDs not only places of clinical excellence but genuinely safe environments for the staff, and through them, for the patients they serve.
