Londiwe Buthelezi
16 September 2026
On 17 September, hospitals and clinics around the world will mark World Patient Safety Day. Most of the conversation on the day tends to focus on protocols, checklists and systems. But in wards and clinics across South Africa, another quieter emergency shapes whether any of those systems actually work: the mental state of the people running them.
A 2025 study by the South African Depression and Anxiety Group surveyed close to a thousand employees across sectors including healthcare, and found that 52% had been formally diagnosed with a mental health condition. Depression affected 32% of respondents, clinical stress 25%, anxiety 18% and burnout 13%. Six in ten said they wished they could afford to quit their jobs. Healthcare workers in under-resourced public facilities were singled out as carrying some of the heaviest burden, driven by relentless workloads and emotional strain. The knock-on cost to the economy, through absenteeism, presenteeism and staff turnover, has been estimated at roughly R218-billion a year.
That exhaustion does not stay contained to the person carrying it. A study of nurses across four levels of the public health sector found they rated their overall practice environment as poor, with the weakest scores going to staffing adequacy and leadership support. Nearly a fifth of nurses surveyed graded patient safety in their own units as poor or failing, and more than a third said the quality of care they were able to deliver was only fair or poor.
Researchers studying patient safety culture in Gauteng’s public hospitals found a similar pattern: open communication about errors scored a moderate 68%, but staffing and work pace sat at only 57%, and comfort in reporting safety incidents was lower still, at around 55%. The researchers pointed to fear of blame, a lack of feedback when incidents are reported, and rigid hierarchies as reasons staff often stay quiet rather than flag a near-miss or a mistake. Sub-Saharan African healthcare settings in particular carry strong hierarchical traditions, which specialists in nursing leadership have described as a real barrier to nurses speaking up, asking for help, or challenging a decision they’re unsure about.
This is the connection that “Safety in Mind” is really about. Psychological safety, the belief that you can raise a concern, admit an error or ask a question without being punished or humiliated for it, is not a soft add-on to clinical practice. It is the mechanism through which errors actually get caught before they reach a patient. A nurse who fears being blamed for a medication mix-up is less likely to report it, or to ask a colleague to double-check the next one. A junior doctor who has been shouted down in a previous handover is less likely to interrupt a senior colleague who’s about to make a mistake.
South Africa’s own patient safety incident reporting system recorded 21,726 reported incidents in the Western Cape’s district health services in 2020/2021, up from 17,341 two years earlier. Whether that rise reflects more incidents or simply more willingness to report them isn’t fully settled, but researchers who reviewed the data noted only 51% compliance with reporting guidelines across facilities, with wide variation between provinces. Underneath every one of those numbers is a health worker deciding, in the moment, whether it feels safe to speak.
None of this excuses avoidable harm to patients. But it does reframe the question health facilities should be asking. It isn’t only “are our clinical protocols strong enough.” It’s also “do the people following those protocols feel safe enough, rested enough and supported enough to follow them properly, and to say something when they can’t.” This World Patient Safety Day, that second question deserves just as much attention in South Africa’s wards as the first – because psychological safety isn’t a wellness extra bolted onto the job. It’s the condition that makes patient safety possible at all.
