Psychological safety of patients: a grounded theory study based on 12320 health hotline data in Guangzhou, China

Background Patient psychological safety–patients’ confidence that they will not be psychologically harmed during care–is increasingly recognized as an indicator of doctor-patient relationship quality. It is related to but distinct from patient safety. Existing research remains fragmented and lacks an integrated framework, especially in Chinese public hospitals. This study explores factors associated with and constituting patient psychological safety using first-hand health hotline records. Methods We analyzed 3,673 de-identified appeal records from the 12320-GZ health hotline, covering six tertiary public hospitals in Guangzhou, China, from January 1 to December 31, 2024. Systematic grounded theory was used with open, axial, and selective coding. Methodological rigor was supported by reflexive memoing and theoretical saturation testing. Results The factors associated with patient psychological safety were personal traits, management model, and environmental interaction. These factors were perceived to be associated with psychological safety through three pathways: self-regulation, support assurance, and collaborative benefit. Together, they formed a dynamic interactive system that may be associated with patients’ subjective sense of safety during medical encounters. Conclusion The findings offer a psychological perspective for improving medical service quality and empirical evidence for fostering harmonious doctor-patient relationships. They suggest actionable strategies for hospital management optimization and targeted intervention in doctor-patient conflicts. Given the retrospective and qualitative nature of the data, these relationships should be interpreted as interpretive and hypothesis-generating rather than causal.