Hierarchy in critical airway management

Bidwai, Arun V.; Beament, T.; Mercer, Simon

doi:10.1111/anae.13338

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…Bidwai et al argued that staff members attempt to speak up more in situations in which there is more clarity, whereas they may feel deterred from speaking up in ambiguous situations for fear that their actions might have negative consequences. 32 Therefore, knowing a patient’s plan of care and condition may mitigate the ambiguity of clinical decisions. This understanding fits well with our findings from the junior doctors, who indicated that they would speak up only when they had a strong, justified opinion or when they needed to clarify information relating to patient harm.…”

Section: Discussionmentioning

confidence: 99%

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

Pun

et al. 2017

BMJ Open

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ObjectivesDespite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up.DesignA mixed-methods design with quantitative and sequential qualitative components was used.Setting and participantsEighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices.ResultsThe participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases.ConclusionsCreating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.

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Section: Discussionmentioning

confidence: 99%

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

Pun

et al. 2017

BMJ Open

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“…(15) Accordingly, doctors often perceived speaking up as a risk with a fear of shame or repercussion, especially when the situation was uncertain or ambiguous. (24,25) In this study, high frequencies of withholding voices and speaking up, based on high frequencies of perceived concerns, among nurses showed that both behaviors frequently coexisted and were not opposed completely.…”

Section: Discussionmentioning

confidence: 58%

What causes less “speaking up” for patient safety among healthcare workers? – A cross sectional study in Malaysia

Kim,

Nishino,

Bujang

et al. 2023

Preprint

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Background In healthcare, “speaking up” refers to when healthcare workers raise concern regarding patient safety through questions, sharing information, or expressing their opinion to prevent harmful incidents and ensure patient safety. Conversely, withholding voice is an act of not voicing or raising concerns, which could be beneficial in certain situations. Factors associated with speaking up and withholding healthcare workers’ voices are not fully understood, especially in strongly hierarchical countries, such as Malaysia. This study aimed to examine the factors associated with speaking up and withholding the voices of healthcare workers in Malaysia, thus providing suggestions that can be used in other countries facing similar patient safety challenges. Methods This cross-sectional study was conducted in a tertiary hospital in Sarawak State, Malaysia. Data were collected from 474 healthcare workers from 43 departments using a self-administered questionnaire for speaking up and withholding voice measures in the 4 weeks prior to data analysis as well as socio-demographic factors of healthcare workers (gender, age, profession, department, weekly work hours for patient care, years of employment in the hospital, and the hierarchical level) and speaking up related climate of the working environment were recorded. Data were analyzed using descriptive statistics. Logistic regression was performed to find out (adjusted) odds ratio of speaking up and withholding voice. Results Nurse, long years of employment, high hierarchical levels, and an encouraging environment for speaking up were positively associated with frequent speaking up. Emergency and intensive care department, long weekly work hours for patient were negatively associated with frequent speaking up. An environment in which healthcare workers avoid speaking up was positively associated with frequent withholding of voice. Conclusions Working long hours for patient care and with healthcare workers from different disciplines where hierarchical structure does not work, as seen in emergency and intensive care department, cause less speaking up. Our study has unearthed the necessity of establishing an encouraging environment that promotes speaking up and prevents withholding of voices, especially in circumstances where multiple types of healthcare workers with various socio-demographics work together across hierarchical structure, to ensure patient safety and prevent harm.

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“…We excluded another 337 articles after reviewing the full-text citations largely because they neither identified individual NEs nor specified an existing framework (47%), or because they were non-scholarly (eg, media releases; 30%). Thus, our analyses were based on 367 articles 3 4 7–11 18–377. A full list of these articles and the information we extracted from them are found in online supplemental tables 1 and 2.…”

Section: Resultsmentioning

confidence: 99%

Identifying a list of healthcare ‘never events’ to effect system change: a systematic review and narrative synthesis

et al. 2023

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BackgroundNever events (NEs) are patient safety incidents that are preventable and so serious they should never happen. To reduce NEs, several frameworks have been introduced over the past two decades; however, NEs and their harms continue to occur. These frameworks have varying events, terminology and preventability, which hinders collaboration. This systematic review aims to identify the most serious and preventable events for targeted improvement efforts by answering the following questions: Which patient safety events are most frequently classified as never events? Which ones are most commonly described as entirely preventable?MethodsFor this narrative synthesis systematic review we searched Medline, Embase, PsycINFO, Cochrane Central and CINAHL for articles published from 1 January 2001 to 27 October 2021. We included papers of any study design or article type (excluding press releases/announcements) that listed NEs or an existing NE framework.ResultsOur analyses included 367 reports identifying 125 unique NEs. Those most frequently reported were surgery on the wrong body part, wrong surgical procedure, unintentionally retained foreign objects and surgery on the wrong patient. Researchers classified 19.4% of NEs as ‘wholly preventable’. Those most included in this category were surgery on the wrong body part or patient, wrong surgical procedure, improper administration of a potassium-containing solution and wrong-route administration of medication (excluding chemotherapy).ConclusionsTo improve collaboration and facilitate learning from errors, we need a single list that focuses on the most preventable and serious NEs. Our review shows that surgery on the wrong body part or patient, or the wrong surgical procedure best meet these criteria.

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Hierarchy in critical airway management

Cited by 4 publications

References 4 publications

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

What causes less “speaking up” for patient safety among healthcare workers? – A cross sectional study in Malaysia

Identifying a list of healthcare ‘never events’ to effect system change: a systematic review and narrative synthesis

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