Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies

Morrow, Kelly J.; Gustavson, Allison M; Jones, Jacqueline

doi:10.1016/j.ijnurstu.2016.09.014

Cited by 152 publications

(132 citation statements)

References 20 publications

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“…Even though they had similar frequencies of perceiving concern, HCWs of lower hierarchical level had lower frequencies of speaking up, higher frequencies of withholding voice, and generally less positive climate scores. These results support previous research which has shown that authority gradients and power dynamics greatly inhibit the decision to speak up (Morrow et al, ). More generally, staff of lower hierarchical level often perceive safety climate as poorer as those of higher management levels (Singer et al, ).…”

Section: Discussionsupporting

confidence: 92%

“…Vignette ratings † , mean (SD) greatly inhibit the decision to speak up (Morrow et al, 2016). More generally, staff of lower hierarchical level often perceive safety climate as poorer as those of higher management levels (Singer et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…In addition, as professionalism-related safety threats are increasingly recognised, we provide quantitative data on both prevalence and resident responses to such behaviours in the clinical learning environment, as called for by thought leaders to help better frame the problem and motivate solutions 28. Similar to prior studies,12 13 15 17 25 46 we found the likelihood of speaking up to be highly context-dependent, offering additional insights for organisational leaders to best support such advocacy. Although a study of labour and delivery nurses and obstetricians showed that bravery and assertiveness were not independently associated with speaking up, we found that moral courage was associated with the likelihood of speaking up, highlighting the importance of this specific virtue among physicians, and the potential unique role for this metric 39…”

Section: Discussionmentioning

confidence: 54%

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

et al. 2017

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“…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%

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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Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies

Cited by 152 publications

References 20 publications

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

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

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

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

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