Consequences of a toxic workplace environment on psychological safety in anaesthesia and intensive care

BACKGROUND: Toxic workplace environments in healthcare, characterised by discrimination, bullying, poor communication, and lack of support, have a negative effect on physicians' well-being and patient safety. Anaesthesiologists and intensivists are at high risk of burnout due to the intensity of their work. However, the prevalence and consequences of a toxic work environment in these specialties across Europe remain unknown. OBJECTIVES: The primary objective of this study was to evaluate psychological safety among European anaesthesiologists and intensivists and its relationship to toxic workplace environments. The secondary objectives were to explore associated sociodemographic and professional factors, perceived support and job satisfaction, the prevalence and consequences of toxic workplace experiences, and the coping strategies used in response to them. DESIGN: Cross-sectional, multinational survey study. SETTING: Online anonymous survey distributed via the European Society of Anaesthesiology and Intensive Care mailing list and social media platforms between April and June 2025. PARTICIPANTS: Some 859 respondents: 491 women (57.2%), 364 men (42.4%) and 2 gender-fluid (0.2%). They were predominantly White European (87.2%). Most participants worked in academic hospitals, mainly in anaesthesia alone (80.6%). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Psychological safety (Edmondson's 7-item scale), support/satisfaction (4-item scale), prevalence and consequences of toxic workplace experiences, and coping strategies. RESULTS: < 0.001). Poor communication (59.6%) and poor leadership (45.9%) were the leading causes of perceived toxicity. Thirty-five percent reported health problems, 17% considered changing specialty, and 14% effectively changed workplace. Coping strategies were mainly adaptive, though 7.9% reported self-medication. CONCLUSIONS: Toxic workplace environments are prevalent in European anaesthesiology and intensive care, strongly associated with burnout and adverse health outcomes. Organisational reforms targeting leadership, communication, and psychological safety are urgently needed.