Raising and responding to frontline concerns in healthcare

Mannion, Russell; Davies, H. T. O.

doi:10.1136/bmj.l4944

Cited by 16 publications

(19 citation statements)

References 11 publications

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“…Our study is the first to suggest that programs for strengthening the ability of hospital workers to identify and speak up about unprofessional behaviour could ameliorate some of its negative impact. The effective elements in these programs need to be identified, as well as factors that support their sustainability and scalability, including the organisational context in which staff are asked to speak up; exhortations to do so often “… belie the complexity and ambiguity that it creates for staff.”18 Individuals must decide when it is safe to speak up, or to stay silent 19…”

Section: Discussionmentioning

confidence: 99%

“…Just providing staff with the skills and knowledge to speak up is consequently insufficient for reducing the incidence and impact of unprofessional behaviour in organisations perceived to have poor management processes and with limited supervisory support for managing behaviour. Speaking up requires a psychologically safe environment; this requires that giving and receiving feedback is regarded as normal, and that teams are cohesive and authority gradients minimal 18…”

Section: Discussionmentioning

confidence: 99%

“…Training hospital leaders in how to engage with colleagues to counter disruptive and unprofessional behaviour is critical,9 including being receptive when staff speak up, and having both the skills and processes for an effective response 18. While the central role of senior hospital management and professional leaders in ensuring low tolerance for unprofessional behaviour is recognised,22 there are few effective interventions for achieving such environments.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals

Westbrook

Sunderland

et al. 2020

Medical Journal of Australia

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals

Westbrook

Sunderland

et al. 2020

Medical Journal of Australia

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“…Toxic health care environments are neither beneficial to patient care nor the well-being of medical students [45]. Our medical students and junior medical officers need the confidence, skills and opportunity to speak up when they are witness or victim to unprofessional behaviours [46]. This requires that students have the confidence and means to act on their moral judgements.…”

Section: Discussionmentioning

confidence: 99%

Moral judgement development during medical student clinical training

et al. 2021

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Background Whereas experience and cognitive maturity drives moral judgement development in most young adults, medical students show slowing, regression, or segmentation in moral development during their clinical years of training. The aim of this study was to explore the moral development of medical students during clinical training. Methods A cross-sectional sample of medical students from three clinical years of training were interviewed in groups or individually at an Australian medical school in 2018. Thematic analysis identified three themes which were then mapped against the stages and dimensions of Self-authorship Theory. Results Thirty five medical students from years 3–5 participated in 11 interviews and 6 focus groups. Students shared the impacts of their clinical experiences as they identified with their seniors and increasingly understood the clinical context. Their accounts revealed themes of early confusion followed by defensiveness characterised by desensitization and justification. As students approached graduation, some were planning how they would make moral choices in their future practice. These themes were mapped to the stages of self-authorship: External Formulas, Crossroads and Self-authorship. Conclusions Medical students recognise, reconcile and understand moral decisions within clinical settings to successfully reach or approach self-authorship. Curriculum and support during clinical training should match and support this progress.

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“…Consequently, healthcare organisations are aiming for a so called 'open culture' (open OC) and emphasise its importance. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] research to date has not yet defined the elements of an open OC in healthcare.…”

Section: Introductionmentioning

confidence: 99%

Open organisational culture: what does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique

et al. 2021

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ObjectivesOpen organisational culture in hospitals is important, yet it remains unclear what it entails other than its referral to ‘open communication’ in the context of patient safety. This study aims to identify the elements of an open hospital culture.MethodsIn this group consensus study with a Delphi technique, statements were constructed based on the existing patient safety literature and input of 11 healthcare professionals from different backgrounds. A final framework consisting of 36 statements was reviewed on inclusion and exclusion, in multiple rounds by 32 experts and professionals working in healthcare. The feedback was analysed and shared with the panel after the group reached consensus on statements (>70% agreement).ResultsThe procedure resulted in 37 statements representing tangible (ie, leadership, organisational structures and processes, communication systems, employee attitudes, training and development, and patient orientation) and intangible themes (ie, psychological safety, open communication, cohesion, power, blame and shame, morals and ethics, and support and trust). The culture themes’ teamwork and commitment were not specific for an open culture, contradicting the patient safety literature. Thereby, an open mind was shown to be a novel characteristic.ConclusionsOpen culture entails an open mind-set and attitude of professionals beyond the scope of patient safety in which there is mutual awareness of each other’s (un)conscious biases, focus on team relationships and professional well-being and a transparent system with supervisors/leaders being role models and patients being involved. Although it is generally acknowledged that microlevel social processes necessary to enact patient safety deserve more attention, research has largely emphasised system-level structures and processes. This study provides practical enablers for addressing system and microlevel social processes to work towards an open culture in and across teams.

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Raising and responding to frontline concerns in healthcare

Abstract: Frontline staff are well placed to identify failings in care, but speaking up requires a supportive organisational culture to be effective, say Russell Mannion and Huw Davies

Cited by 16 publications

References 11 publications

The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals

The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals

Moral judgement development during medical student clinical training

Open organisational culture: what does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique

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