Supporting doctors as healthcare quality and safety advocates: Recommendations from the Association of Surgeons in Training (ASiT)

Abstract

These results highlight worrying issues around reporting concerns, with trainees often "silent witnesses" to poor performance in healthcare. Adverse events must provide opportunities for learning to improve future outcomes. Herein, ASiT proposes 14 recommendations to improve protection for trainees in raising patient safety concerns. These include the creation of a positive workplace culture, promoting the active involvement of trainees in quality improvement discussions, with clear mechanisms for trainees to raise concerns.

Snitches Get Stitches and End Up in Ditches: A Systematic Review of the Factors Associated With Whistleblowing Intentions

“…Trust, commitment, intentions to stay or leave, role identity, and value of whistleblowing within organization, were identified as lower-order themes within the feeling toward organization theme. Trust in one's organization and management were positively associated with intentions to blow the whistle across 16 studies (Attree, 2007;Brennan and Kelly, 2007;Binikos, 2008;Curtis and Taylor, 2009;Seifert et al, 2014;Alleyne, 2016;Lavena, 2016;Arifah et al, 2017;Guthrie and Taylor, 2017;Aydan and Kaya, 2018;Fleming et al, 2018;Taylor, 2018;Taylor and Curtis, 2018;Wilson et al, 2018;Ugaddan and Park, 2019). Commitment to one's organization was positively associated with whistleblowing intentions across 10 studies (Sims and Keenan, 1998;Curtis, 2010, 2018;Caillier, 2013;Chen and Lai, 2014;Alleyne, 2016;Surya et al, 2017;Alleyne et al, 2018Alleyne et al, , 2019Latan et al, 2018).…”

“…Two studies explored how individual's evaluation of their future career prospects, as a consequence of whistleblowing, impacted intentions. Both studies found that individuals who expected that their career development would suffer, were less intent on blowing the whistle (Liu and Ren, 2017;Fleming et al, 2018). If individuals anticipated hostility in the form of intimidation (Lyndon et al, 2012), they were less intent on blowing the whistle.…”

“…The process of whistleblowing across different organizations also impacted intentions. For example, a lack of confidence (Fleming et al, 2018), a complicated process (Francalanza and Buttigieg, 2016), a sub-certification process (Lowe et al, 2015), or a tedious investigative process were also associated with decreased intentions to blow the whistle on wrongdoing. Being aware and having the opportunity to blow the whistle was positively reported with intentions in the study by Latan et al (2019c).…”

A Narrative Review of Strategies to Increase Patient Safety Event Reporting by Residents

“…44 Desbiens 51 described how their setting used an event reporting records audit process coupled with program director meetings with residents as an example of reinforcing adverse event reporting behavior. Finally, in an attempt to address resident concerns around repercussions of reporting patient safety events (ie, predisposing factors), Fleming and colleagues 70 proposed a set of 14 recommendations to improve protection for residents in raising patient safety concerns. These recommendations include calls for educating physicians on their professional duty and responsibility to report adverse events and developing open and positive workplace cultures where patient safety events can be discussed and resident input is welcomed.…”

“…These recommendations include calls for educating physicians on their professional duty and responsibility to report adverse events and developing open and positive workplace cultures where patient safety events can be discussed and resident input is welcomed. 70…”