Barriers to Speaking Up About Patient Safety Concerns

Etchegaray, Jason Michel; Ottosen, Madelene J.; Dancsak, Theresa; Thomas, Eric J.

doi:10.1097/pts.0000000000000334

Cited by 71 publications

(51 citation statements)

References 18 publications

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“…The decision to engage in reflective practice and use guidance is predominantly an individual behaviour, less reliant on external factors such as systems. In addition, both behaviours have arguably less potential negative implications than raising a concern Table 4 Comparison of the TPB constructs among UK and non-UK graduates in three professional behaviours: a) raising concerns, b) reflective practice and c) use of confidentiality guidance) does for a doctor, which has ramifications for others and come with a host of obstacles including organisational culture norms, hierarchies and power dynamics and anxiety about damaging relationships [19,20,22,23].…”

Section: Tpb Use In Predicting Professional Behavioursmentioning

confidence: 99%

“…However, in real world practice, all three behaviours can be challenging to perform. For example, research has identified multiple barriers to speaking about patient safety concerns, such as organisational culture norms, power dynamics, and fears of damaging relationships [19][20][21][22][23]. Similarly, reflection is a complex construct which does not have a singular agreed definition and comes with its own challenges.…”

Section: Introductionmentioning

confidence: 99%

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A theory-based study of doctors’ intentions to engage in professional behaviours

Rich

Medišauskaitė

Potts³

et al. 2020

BMC Med Educ

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Background: The Theory of Planned Behaviour (TPB) has been proposed as an appropriate model for creating a theory-driven approach to teaching medical professionalism. However, there is a lack of empirical evidence into its efficacy. This study explores if the TPB can assess UK medical doctors' professional behaviours and explores if there are differences in the TPB's efficacy depending on doctors' primary medical qualification (UK or outside). Methods: Three hundred fourteen doctors in England at 21 NHS Trusts completed a questionnaire about reflective practice, using the General Medical Council's confidentiality guidance, and raising a patient safety concern. The majority of participants were male (52%), white (68%), consultants (62%), and UK medical graduates (UKGs) (71%). Results: The TPB variables of attitudes, subjective norms, and perceived behavioural control were predictive of intention to engage in raising concerns (R 2 = 35%), reflection (R 2 = 52%), and use of confidentiality guidance (R 2 = 45%). Perceived behavioural control was the strongest predictor of intentions to raise a concern (β = 0.44), while attitude was the strongest predictor of intentions to engage in reflective practice (β = 0.61) and using confidentiality guidance (β = 0.38). The TBP constructs predicted intention for raising concerns and reflecting for both UKGs and non-UKGs (Fs ≥ 2.3; ps ≤ .023, βs ≥ 0.12). However, only perceived behaviour control was predictive of intentions to use guidance for both UKGs and non-UKGs (β = 0.24) while attitudes and norms were just predictive for UKGs (βs ≥ 0.26).Conclusions: This study demonstrates the efficacy of the TPB for three professional behaviours. The implications for medical educators are to use the variables of the TPB (attitudes, subjective norms, and perceived behavioural control) in the education of professionalism, and for medical education researchers to further our understanding by employing the TPB in more empirical studies of non-clinical behaviours.

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Section: Tpb Use In Predicting Professional Behavioursmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A theory-based study of doctors’ intentions to engage in professional behaviours

Rich

Medišauskaitė

Potts³

et al. 2020

BMC Med Educ

View full text Add to dashboard Cite

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“…A recent review of 4,371 medical charts from 14 inpatient psychiatric units identified adverse events in 14.5% and medical errors in 9% of hospitalizations (Vermeulen et al, 2018). Experts have identified medication and diagnostic errors, harm from use of restraints and seclusion, errors in treating suicidal or self-harm tendencies, and patients' well-being, personality and professional experience, hierarchical standing, past interactions, support from superiors or team members, perceived efficacy of speaking up, the presence of an audience, fear of damaging professional relationships, and fear of retaliation have been identified as important factors influencing speaking up behaviour (Etchegaray et al, 2017;Morrow et al, 2016;Okuyama et al, 2014;Schwappach & Gehring 2014c;Szymczak 2016).…”

Section: Introductionmentioning

confidence: 99%

Speaking up about patient safety in psychiatric hospitals – a cross‐sectional survey study among healthcare staff

Schwappach

Niederhauser

2019

Int J Mental Health Nurs

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Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up‐related behaviour and climate for the first time in psychiatric hospitals. A cross‐sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up‐related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up‐related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%–65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13–25% of HCWs, and speaking up was reported by 53%–72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self‐reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure.

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“…hospital-acquired pressure ulcers [16], falls [17,18], and medicine [19]), disease-based [20][21][22], and patient-safety culture-based (e.g. Communication [23], Speak Up [24], and patient safety campaign [25]). Patient Safety Officers provide patients and families with personal patient education, large patientsafety campaigns, brochures, patient-safety videos, and other resources to increase patient engagement.…”

Section: How To Involve Patients and Familymentioning

confidence: 99%

Can patient and family education prevent medical errors? A descriptive study

Kim

et al. 2020

BMC Health Serv Res

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Background: This study aims to increase understanding of how patient and family education affects the prevention of medical errors, thereby providing basic data for developing educational contents. Methods: This descriptive study surveyed patients, families, and Patient Safety Officers to investigate the relationship between educational contents and medical error prevention. The Chi-square test and ANOVA were used to derive the results of this study. The educational contents used in this study consisted of health information (1. current medicines, 2. allergies, 3. health history, 4. previous treatments/tests and complications associated with them) and Speak Up (1. handwashing, 2. patient identification, 3. asking about medical conditions, 4. asking about test results, 5. asking about behaviour and changes in lifestyle, 6. asking about the care plan, 7. asking about medicines, and 8. asking about medicine interactions). Results: In this study, the first criterion for choosing a hospital for treatment in Korea was 'Hospital with a famous doctor' (58.6% patient; 57.7% families). Of the patients and their families surveyed, 82.2% responded that hospitals in Korea were safe. The most common education in hospitals is 'Describe your medical condition', given to 69.0% of patients, and 'Hospitalisation orientation', given to 63.4% of families. The most important factors in preventing patient safety events were statistically significant differences among patients, family members, and Patient Safety Officers (p = 0.001). Patients and families had the highest 'Patient and family participation' (31.0% of patients; 39.4% of families) and Patient Safety Officers had the highest 'Patient safety culture' (47.8%). Conclusions: Participants thought that educational contents developed through this study could prevent medical errors. The results of this study are expected to provide basic data for national patient safety campaigns and standardised educational content development to prevent medical errors.

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Barriers to Speaking Up About Patient Safety Concerns

Cited by 71 publications

References 18 publications

A theory-based study of doctors’ intentions to engage in professional behaviours

A theory-based study of doctors’ intentions to engage in professional behaviours

Speaking up about patient safety in psychiatric hospitals – a cross‐sectional survey study among healthcare staff

Can patient and family education prevent medical errors? A descriptive study

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