Despite widespread promotion of strategies such as structured handover, speaking-up training, and psychologically safe policies, uptake and sustainability remain inconsistent. This narrative review aims to identify the principal barriers to the effective implementation of these strategies. This review was conducted across the literature on surgical education, patient safety, and organisational behaviour. The analysis identified four primary domains of recurring barriers. System constraints included workload intensity, staffing instability, shift-work transitions, high trainee rotation, and insufficient protected time for supervision and observation. Culture and hierarchy barriers encompassed authority gradients, low trust in reporting systems, fear of reprisal or reputational harm, and inconsistent managerial responses that undermine confidence in 'just culture.' Educational process barriers involved inconsistent supervisor skill in delivering behaviour-based feedback, unclear thresholds for escalation or remediation, and 'failure-to-fail' dynamics resulting from inadequate documentation and disputed performance judgments. Measurement barriers included limited feedback-loop data, poor visibility into handover quality, and a lack of sustained audit or coaching infrastructure. Bridging the gap between the desired clinical culture and current practice is limited less by knowledge deficits and more by barriers to implementation and sustainability. Effective approaches integrate psychological safety with explicit accountability, clarify distinctions between feedback and mistreatment, and establish reliable systems for handover standards, documentation, audit, and remediation. These measures support honest teaching and reduce the risk of silence driven by fear.