WBB's Thought Leadership

Speaking up about Unprofessional Behavior is Critical to Patient Safety

May 22

Speaking up about care concerns and improvement opportunities is part of open communication between healthcare professionals and is essential to patient safety.

The study used an anonymous, cross-sectional survey of 1800 medical and surgical interns and residents at six US academic medical centers between 2013–2014. The study had a 47% response rate.

Excerpt: “Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.”

“[The study] objective [was to] compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.”

“Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.”

“Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001).

“Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).”


Source: BMJ Quality and Safety

WBB Take: Fear of repercussions and scapegoating is a major impediment to safety, and frequently results in increased waste and lost lives.

A basic principle of quality improvement is the establishment of a “no-blame” culture in which every stakeholder feels an obligation to report quality risks or issues, but also knows that the response will be to focus on the problem and a solution rather than on blaming the individuals. The need for “Speaking Up” is applicable to every healthcare facility and specialty, regardless of whether they are public or private institutions. The idea that if you “see something, say something” is very important no matter your "position" at the facility. Advocating for the patients is very important, and often times people will keep quiet because they are afraid of repercussions if they do speak up.

Deming included “Drive out fear” in his list of 14 Points for quality. He exhorted organizations to encourage effective two way communication as a means  to drive out fear throughout an organization. This enables everybody to work effectively, productively, and safely.

Cited by Matthew Loxton, Shannen Irwin



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