Associations of form and function of speaking up in anaesthesia: a prospective observational study

Lemke, Rahel; Burtscher, Michael J.; Seelandt, Julia; Grande, Bastian; Kolbe, Michaela

doi:10.1016/j.bja.2021.08.014

Cited by 23 publications

(18 citation statements)

References 52 publications

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“…); 5,792 (4.7%) participants were classified as “other” and 132 (0.11%) as administrative staff. Seven studies had unspecified samples (n = 2,609; 2.1%): Avgar et al ( 49 ) with 363 unspecified healthcare workers; Gupta and Ravindranath ( 66 ) with 1700 unspecified eye hospital employees; Hu and Casey ( 67 ) with 165 unspecified health care workers; Lawson et al ( 64 ) did not report sample size of participants (perfusionists); Lemke et al ( 68 ) did not specify on their sample of 49 anesthesia care providers; Mesdaghinia et al ( 69 ) reported a sample of 203 supervisors in a hospital; finally, Roussin et al ( 70 ) did not provide the numbers of nurses and physicians in their sample ( n = 129). Thus, based on the information provided, most of the participants were nurses (57.7% cumulative percentage of nurses, nurse managers and nurse experts).…”

Section: Resultsmentioning

confidence: 99%

“…This category includes measures that aimed at capturing aspects of externally observed speaking up/voice behaviors. The following seven distinct assessments were used to rate externally-observed speaking-up behaviors across seven observational studies: the Advocacy-Inquiry rubric in the study of Guris et al ( 92 ); the Co-ACT coding system in two studies ( 93 , 94 ); an observation system based on both organizational behavior and anesthesia research ( 68 ); the five-point modified Pian-Smith ( 95 ) grading scale ranging from 1 being silence to 5 being repeated inquiry ( 96 ); level of speaking-up during the scripted opportunities when speaking up was anticipated in two studies ( 92 , 97 ); assessment based on predefined desired actions for each event ( 97 ); and frequency of observed behaviors that were identified through focus groups as encouraging speaking up (e.g., restate; ask open questions; clarify, etc.) ( 65 ).…”

Section: Resultsmentioning

confidence: 99%

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An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

Lainidi,

Jendeby,

Montgomery

et al. 2023

Front. Psychiatry

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The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016–2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

Lainidi,

Jendeby,

Montgomery

et al. 2023

Front. Psychiatry

View full text Add to dashboard Cite

show abstract

“…Lemke et al describes the complexity of speaking up, e.g. the risk of unwanted answers and oblique hints [ 32 ]. This could be a reason why one team leader in our study did not speak up.…”

Section: Discussionmentioning

confidence: 99%

“…Debriefing is a key element in simulation [ 31 ], which provides the opportunity to reflect on NTS, such as the importance of ‘speaking up’. Lemke et al assess experienced anaesthesia personnel’s speaking up behaviours and its consequent reactions during anaesthesia induction and describe on the complexity of speaking up and its importance for patient safety [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

In situ simulation-based team training and its significance for transfer of learning to clinical practice—A qualitative focus group interview study of anaesthesia personnel

et al. 2023

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Background Anaesthesia personnel are an integral part of an interprofessional operating room-team; hence, team-based training in non-technical skills (NTS) are important in preventing adverse events. Quite a few studies have been done on interprofessional in situ simulation-based team training (SBTT). However, research on anaesthesia personnel’s experiences and the significance for transfer of learning to clinical practice is limited. The aim of this study is to explore anaesthesia personnel’s experience from interprofessional in situ SBTT in NTS and its significance for transfer of learning to clinical practice. Methods Follow-up focus group interviews with anaesthesia personnel, who had taken part in interprofessional in situ SBTT were conducted. A qualitative inductive content analysis was performed. Results Anaesthesia personnel experienced that interprofessional in situ SBTT motivated transfer of learning and provided the opportunity to be aware of own practice regarding NTS and teamwork. One main category, ‘interprofessional in situ SBTT as a contributor to enhance anaesthesia practice’ and three generic categories, ‘interprofessional in situ SBTT motivates learning and improves NTS’, ‘realism in SBTT is important for learning outcome’, and ‘SBTT increases the awareness of teamwork’ illustrated their experiences. Conclusions Participants in the interprofessional in situ SBTT gained experiences in coping with emotions and demanding situations, which could be significant for transfer of learning essential for clinical practice. Herein communication and decision-making were highlighted as important learning objectives. Furthermore, participants emphasized the importance of realism and fidelity and debriefing in the learning design.

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“…They provide the learning space to look beyond individual competence and discuss how team members interact with each other in the interest of patient care. For examples, speaking up with concerns and effectively responding to being spoken up to is particularly challenging in the diverse, status-driven team context in the operating room [33 ▪ ]. Debriefings allow for discussing norms and expectations for when and how to speak up and how to respectfully react to it [34].…”

Section: We Learn Together Day After Daymentioning

confidence: 99%

How to train thoracic anesthesia for residents and consultants?

Grande

Kolbe

2021

Current Opinion in Anaesthesiology

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Purpose of reviewThe training of anesthesiologists in thoracic surgery is a significant challenge. International professional societies usually provide only a case number-based or time-based training concept. There are only a few concepts of simulation trainings in thoracic anesthesia and interprofessional debriefings on a daily basis are rarely applied. In this review, we will show how professional curricula should aim for competence rather than number of cases and why simulation-based training and debriefing should be implemented. Recent findingsRecent curricula recommend so-called entrustable professional activities (EPAs)as a way out of the dilemma between the number of cases vs. competence. With these EPAs, competence can be mapped and prerequisites defined. Training concepts from simulation in healthcare have so far not explicitly reached anesthesia for thoracic surgery. In addition to mere technical training, combined technical-behavioral training forms have proven to be an effective training targeting the entire team in the context of the actual working environment in the operating theatre. SummaryInterdisciplinary and interprofessional learning can take place in simulation trainings and on a daily basis through postevent debriefings. When these debriefings are conducted in a structured way, an improvement in the performance of the entire team can be the result. The basis for these debriefings -as well as for other training approaches -is psychological safety, which should be established and maintained together with all professions involved.

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Associations of form and function of speaking up in anaesthesia: a prospective observational study

Cited by 23 publications

References 52 publications

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

In situ simulation-based team training and its significance for transfer of learning to clinical practice—A qualitative focus group interview study of anaesthesia personnel

How to train thoracic anesthesia for residents and consultants?

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