Improving safety through speaking up: An ethical and financial imperative

Finding Your Voice: A Large-Scale Nursing Training in Speaking up and Listening Skills

BACKGROUND

Training in speaking up skills for nursing professionals provides the groundwork for promoting a culture of curiosity and inquiry. At the foundation of speaking up is psychological safety for team members to disagree, offer alternative ideas, and ask questions.

METHOD

A large-scale training session, Finding Your Voice: Speaking Up & Listening Skills, was designed and delivered to 1,306 nurses at an academic medical center.

RESULTS

Most participants reported that the session met the training goals (97%). There was an increase in participants' confidence in speaking up (pretraining 69% ± 19%; posttraining 73% ± 15%; p < .0001), and listening (pretraining 68% ± 19%; post-training 74% ± 15%; p < .0001). Leaders showed greater increases in confidence in listening and responding to nurses speaking up (leaders 5.6% vs. nonleaders 4.2%, p < .00001).

CONCLUSION

Nurses benefited from an interactive educational experience by practicing strategies for speaking up and listening. [J Contin Educ Nurs. 2024;55(6):309-316.].

What inhibits "speaking up" for patient safety among healthcare workers? A cross-sectional study in Malaysia

BACKGROUND

In healthcare, "speaking up" refers to when healthcare workers raise concerns 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 raising concerns, which could be beneficial in certain situations. Factors associated with speaking up and withholding voices are not fully understood, especially in strong authoritarian societies, 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 voices measures in 4 weeks prior to data analysis as well as socio-demographic factors of healthcare workers (sex, age group, 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 frequent speaking up and withholding voices.

RESULTS

Nurse compared to doctors and healthcare workers with short weekly working hours were more likely to speak up. Healthcare workers in emergency and intensive care department, those with short years of employment, and those who worked at low hierarchical levels were less likely to speak up. Healthcare workers in discouraging environment towards speaking up were more likely to withhold their voices.

CONCLUSIONS

This study demonstrates the characteristics of healthcare workers who speak up and those who withhold their voices in Malaysia. To ensure patient safety and prevent harm, it is essential to establish an encouraging environment that promotes speaking up and prevents withholding voices among healthcare worker, especially in circumstances where multiple types of healthcare workers with different socio-demographic backgrounds work together.

Having a Say in Patient Care: Factors Associated with High and Low Voice among Home Care Workers

OBJECTIVES

To identify factors associated with high and low "voice"-or level of input in patient care decisions-among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions.

DESIGN

We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument.

SETTING AND PARTICIPANTS

The survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English- or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible.

METHODS

HCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice.

RESULTS

The 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P = .001), depersonalization-related burnout (OR 1.14, P = .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P = .04) and job satisfaction (OR 1.22, P = .001).

CONCLUSIONS AND IMPLICATIONS

Organizational factors such as team communication practices-including among non-English speakers-may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.

Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review

AIM

To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people.

DESIGN

Scoping review.

METHODS

The updated Joann Briggs Institute scoping review methodological guidelines were followed.

DATA SOURCES

CINAHL, PubMed, PsycINFO, and Scopus were searched.

RESULTS

A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention.

CONCLUSION

There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care.

IMPACT

Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people.

REPORTING METHOD

The PRISMA-ScR (Tricco et al., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in this review.

Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals

PURPOSE

The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of employment within their hospital sites, age, gender and their ongoing exposure to unprofessional behaviours.

DESIGN/METHODOLOGY/APPROACH

Responses to a survey by 4,851 staff across seven sites within a hospital network in Australia were analysed to interrogate whether speaking up by hospital employees is influenced by employees' symbolic capital and situated subjecthood (SS). The authors utilised a Bourdieusian lens to interrogate the relationship between the symbolic capital afforded to employees as a function of their professional, personal and psycho-social resources and their self-reported capacity to speak up.

FINDINGS

The findings indicate that employee speaking up behaviours appear to be influenced profoundly by whether they feel empowered or disempowered by ongoing and pre-existing personal and interpersonal factors such as their functional roles, work-based peer and supervisory support and ongoing exposure to discriminatory behaviours.

ORIGINALITY/VALUE

The findings from this interdisciplinary study provide empirical insights around why culture change interventions within healthcare organisations may be successful in certain contexts for certain staff groups and fail within others.

Motivators and inhibitors of nurses' speaking up behaviours: A descriptive qualitative study

AIMS

To identify factors that motivate or inhibit nurses' speaking up for patient safety.

DESIGN

A descriptive qualitative study.

METHODS

We conducted semi-structured interviews with 15 nurses from four Korean hospitals between December 2020 and January 2021. Data were analysed using inductive content analysis.

RESULTS

We identified safety culture, supportive unit managers and role models, positive reactions from or familiarity with others, high-risk situations and personal characteristics and beliefs as motivators of nurses' speaking up. Hierarchies and power differentials, seniority and unit tenure, concerns about relationships, and heavy workloads inhibited nurses' speaking up.

CONCLUSION

Individual, organizational and cultural characteristics influence nurses' decisions on whether or not to voice their concerns, suggestions or ideas. Certain characteristics of Korean culture, such as strong hierarchies and the valuing of good relationships, play an important role in nurses' speaking up behaviours. Our findings can be used to inform educational interventions and management expectations about interpersonal behaviours, especially in a culture where age- and seniority-based hierarchies and collectivism are prevalent.

IMPACT

Nurses perceived speaking up as a challenging behaviour, and they sometimes withhold their voices even when speaking up is needed for patient safety. We found that individual, organizational, and contextual factors affect the speaking up behaviours of nurses. Nurse managers can create environments that are more supportive of nurses' speaking up behaviours by using inclusive leadership to create psychological safety, by inviting and showing appreciation for staff input, and by helping physicians and senior nurses understand the importance of all nurses' voices.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient or public contribution does not apply to this study as its purpose was to explore the speaking up experiences of nurses themselves.