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Organizational Theory, Ethics, and Psychological Safety in Modern Healthcare

By Lisanne King-Rogers, MSHA, CPT (N.D. Candidate)
August 17th 2025

Introduction: Why This Topic, Why Now

When I first defined my code of ethics in 2018, I was guided by foundational principles, compassion, integrity, and accountability. But the world, and especially healthcare, has changed dramatically since then. The COVID-19 pandemic, workforce burnout, organizational breakdowns, and a growing awareness of psychological safety all exposed gaps in how we support healthcare professionals and patients alike. These experiences challenged me to revisit not only the systems we operate in, but also the ethical lens through which I lead. This topic, blending organizational theory with ethical leadership and modern research, felt like the right opportunity to reflect on those lessons, integrate new insights, and redefine the kind of leader I aim to be in today’s healthcare environment.

Classical Organization Theory in Healthcare

Classical organizational theory was grounded in the linear structure of authority, task specialization, and hierarchy. It emphasized key concepts such as the division of labor, scalar processes, organizational structure, and span of control (Ferdous, 2016). These concepts remain relevant in healthcare today, particularly in complex hospital systems where departments rely on specialized professionals (e.g., cardiac, neurology, and urology) to deliver high-quality, cost-effective care.

For example, the division of labor allows physicians and clinicians to operate within their expertise, boosting efficiency. Scalar processes, defined by structured relationships between management and staff, help maintain operational clarity. Span of control remains essential for managing large interdisciplinary teams without overextending supervisory capacity (Marume & Chikasha, 2016).

While classical models provide a stable backbone, modern healthcare environments demand more than linear control; they require adaptability, empathy, and ethical alignment.

Neoclassical Theory: Social Connection and Workplace Dynamics

Neoclassical theory brought attention to the emotional and psychological needs of employees. Stemming from the Hawthorne Studies (1920s, 1930s), researchers Elton Mayo and Fritz Roethlisberger argued that workers are more influenced by social dynamics and interpersonal relationships than by monetary incentives alone (Anteby & Khurana, n.d.).

This human-focused perspective remains essential today. A modern healthcare team functions best when there is mutual respect between managers and staff, and when communication is inclusive rather than top-down. Workers who feel heard and valued tend to be more engaged, responsible, and collaborative, especially in high-stakes environments like hospitals and emergency departments.

Modern Theory and the Rise of Psychological Safety

Modern organizational theory blends internal and external processes, adapts to change, and focuses on systems thinking. It emphasizes innovation, continuous improvement, and integration of cross-disciplinary knowledge. In healthcare, it supports:

• Continuous learning and adaptation
• Collaborative team structures
• Performance metrics tied to well-being, not just output

Recent research places psychological safety at the center of successful healthcare operations.

Key Insights from 2022–2025 Research:

• Psychological Safety Enables Innovation. In a study of emergency departments, researchers found that teams with higher psychological safety adapted more quickly to workflow changes, resulting in improved safety and efficiency (Dieckmann et al., 2022).
• Mental Health Under Pressure. A 2022 scoping review on distress during public health emergencies revealed that burnout and stress are exacerbated by poor organizational support, underscoring the need for psychological safety as a buffer (Palmer et al., 2022).
• Feeling Heard Prevents Burnout. Teams that encourage open dialogue and inclusivity reported lower burnout rates and greater adaptability during crises (Weaver et al., 2022).
• Barriers and Enablers of Safety. A qualitative study in primary care showed that hierarchy and lack of communication hinder safety, while inclusive leadership facilitates it (Remtulla et al., 2021).
• Work Environment Matters. A 2024 study of nurse practitioners demonstrated that autonomy, peer respect, and interprofessional collaboration reduce burnout through enhanced psychological safety (de Lisser et al., 2024).
• Psychosocial Safety Climate (PSC). The most recent 2025 scoping review by Amoadu et al. confirmed that PSC, a climate that promotes psychological health, drives better job satisfaction, resilience, and overall care quality (Amoadu et al., 2025).

Updated Personal Code of Ethics (2025 Edition)

As a healthcare professional and leader, I believe that ethical principles must evolve with our understanding of the environments we serve. In light of emerging research on psychological safety, staff burnout, and healthcare system strain, I’ve updated my code of ethics to reflect the realities of today’s workplace.

These updates are grounded in what I’ve observed firsthand: healthcare professionals pushing themselves to the edge while systems evolve rapidly. We owe it to our teams and our patients to create cultures that are both compassionate and accountable.

My Code of Ethics

• Patient‑Centered Compassion
  I place the dignity, autonomy, and safety of patients at the core of all decisions, striving to treat each person not just as a case, but as a whole human being.
• Psychological Safety and Respect (New emphasis)
  I actively promote an inclusive environment where all voices, regardless of role or title, are heard and respected, knowing that speaking up saves lives and prevents harm.
• Integrity, Equity, and Justice
  I uphold fairness, transparency, and accountability in leadership and practice, while actively working to dismantle systemic barriers that affect patient access and staff opportunity.
• Collaboration and Adaptive Learning (Expanded focus)
  I encourage knowledge-sharing across disciplines and support change management efforts that prioritize resilience and innovation, even when they challenge tradition.
• Well‑being and Social Responsibility (New focus)
  I now recognize that protecting the mental health of healthcare providers is an ethical duty, not an operational preference. I advocate for workplace systems that address burnout, support work-life balance, and uphold moral integrity.

Conclusion

Healthcare today demands more than technical precision. It demands leaders who understand how structure, relationships, and safety interact, and who are willing to evolve both systems and themselves.

By combining classical stability, neoclassical humanism, and modern agility, healthcare organizations can become not only more efficient but also more ethical, resilient, and humane.

References

• Amoadu, M., Agyare, D. F., Doe, P. F., & Abraham, S. A. (2025). Examining the impact of psychosocial safety climate on working conditions, well‑being, and safety of healthcare providers: A scoping review. BMC Health Services Research, 25, Article 90. https://doi.org/10.1186/s12913-025-12254-2
• Anteby, M., & Khurana, R. (n.d.). The “Hawthorne Effect,” The Human Relations Movement. Baker Library, Harvard Business School. https://www.library.hbs.edu/hc/hawthorne/09.html
• de Lisser, R., Dietrich, M. S., Spetz, J., Ramanujam, R., Lauderdale, J., & Stolldorf, D. P. (2024). Psychological safety is associated with a better work environment and lower levels of clinician burnout. Health Affairs Scholarly Commons, 2(7), qxae091. https://doi.org/10.1093/haschl/qxae091
• Dieckmann, P., Tulloch, S., Dalgaard, A. E., et al. (2022). Psychological safety during the test of new work processes in an emergency department. BMC Health Services Research, 22, Article 307. https://doi.org/10.1186/s12913-022-07687-y
• Ferdous, J. (2016). Organization theories: From a classical perspective. International Journal of Business, Economics and Law, 9(1), 1–6. http://ijbel.com/wp-content/uploads/2016/05/K9_11.pdf
• Marume, S. B. M., & Chikasha, S. (2016). The concept hierarchy in organisational theory and practice. International Journal of Engineering Science Invention, 5(7), 55–58. http://ijesi.org/papers/Vol(5)7/H0507055058.pdf
• Palmer, J., Ku, M., Wang, H., et al. (2022). Public health emergency and psychological distress among healthcare workers: A scoping review. BMC Public Health, 22, Article 1396. https://doi.org/10.1186/s12889-022-13761-1
• Remtulla, R., Aojula, N., Menon, A., Thavarajasingam, S. G., & Meyer, E. (2021). Exploring the barriers and facilitators of psychological safety in primary care teams: A qualitative study. BMC Health Services Research, 21, Article 269. https://doi.org/10.1186/s12913-021-06232-7
• Thompson, R., Petch, E., Capron, L., & Morgan, J. (2021). Enabling psychological safety in mental health services: The role of leaders. International Journal of Mental Health Systems, 15, Article 60. https://doi.org/10.1186/s13033-021-00439-1
• Weaver, S. H., Simko, L. C., & Wharton, D. (2022). How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty. Health Care Management Review, 47(4), 274–282. https://doi.org/10.1097/HMR.0000000000000326