The Impact of a 22-Month Multistep Implementation Program on Speaking-Up Behavior in an Academic Anesthesia Department

Abstract

Background Speaking-up is a method of assertive communication that increases patient safety but often encounters barriers. Numerous studies describe programs introducing speaking-up with varying success; the common denominator seems to be the need for a multimodal and sustained approach to achieve the required change in behavior and culture for safer health care. Methods Before implementing a 22-month multistep program for establishing and strengthening speaking-up at our institution, we assessed perceived safety culture using the “Safety Attitudes Questionnaire.” After program completion, participants completed parts of the same Safety Attitudes Questionnaire relevant to speaking-up, and preresult and postresult were compared. In addition, levels of speaking-up and assertive communication were compared with a Swiss benchmark using results from the “Speaking-up About Patient Safety Questionnaire.” Results Safety Attitudes Questionnaire scores were significantly higher after program completion in 2 of 3 answered questions (median [first quartile, third quartile), 5.0 [4.0, 5.0] versus 4.0 [4.0, 5.0], P = 0.0002, and 5.0 [4.0, 5.0] versus 4.0 [4.0, 4.0] P = 0.002; n = 34). Our composite score on the Speaking-up About Patient Safety Questionnaire was significantly higher (mean ± SD, 5.9 ± 0.7 versus 5.2 ± 1.0; P < 0.001) than the benchmark (n = 65). Conclusions A long-term multimodal program for speaking-up was successfully implemented. Attitude and climate toward safety generally improved, and postprogram perceived levels of assertive communication and speaking-up were higher than the benchmark. These results support current opinion that multimodal programs and continued effort are required, but that speaking-up can indeed be strengthened.

Mapping Strategies for Strengthening Safety Culture: A Scoping Review

“…Communication [1,6,17,18,[22][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40]42,[45][46][47]49,[51][52][53][54][55][56][58][59][60][61]63,65,66,69,70] Improving communication within the organization is essential for resolving conflicts and promoting a positive culture in the workplace, contributing to patient safety.…”

“…Psychological Safety [1,17,25,28,34,37,38,40,51,60,61,70] Creating an environment where professionals feel free to express ideas, make suggestions, and openly discuss safety issues is essential for preventing errors.…”

“…Patient and Family Engagement [19,25,29,32,36,44,48,50,51,53,65,71] Encouraging the active participation of patients and families in the care process improves the safety and quality of care. 12 Education and Training [17,19,[22][23][24][25][28][29][30][32][33][34][35][36][37]39,40,42,43,48,49,51,53,55,[58][59][60][61]63,65,67,71,72] Continuous training of healthcare professionals in patient safety practices is essential for promoting a safety culture. 32…”