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Kee K, van Wieringen M, Nies H, Beersma B. The relationships between certified nursing assistants' voice behaviour and job satisfaction, work engagement and turnover intentions: A two-wave survey study. J Adv Nurs 2024. [PMID: 38733076 DOI: 10.1111/jan.16238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/18/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
AIM Whereas voice behaviour has been identified as a key precursor to safe and high-quality patient care, little is known about how voice relates to key workforce outcomes. This study aimed to investigate the relationships between certified nursing assistants' perceived promotive voice behaviour (speaking up with suggestions for future improvement) and prohibitive voice behaviour (speaking up about problems or potentially harmful situations) and their self-reported levels of job satisfaction, work engagement and turnover intentions. DESIGN AND METHODS Dutch certified nursing assistants were recruited for a two-wave survey study through non-random convenience sampling. The final sample contained 152 respondents. The data were analysed using multiple linear regression analyses. In all analyses, the dependent variable at time one was controlled for. RESULTS Certified nursing assistants' promotive and prohibitive voice behaviour at time one were found to be positively related to their level of job satisfaction at time two while controlling for job satisfaction at time one. No relationships with work engagement or occupational turnover intentions were found. CONCLUSION While previous research has found positive effects of voice on patient safety outcomes and team and organizational improvements in care organizations, we demonstrate that voice is also related to a key workforce outcome, that is, certified nursing assistants' job satisfaction. IMPLICATIONS AND IMPACT Recognizing the interplay between voice behaviour and job satisfaction underscores the importance of creating work environments where certified nursing assistants feel able and willing to make their voices heard-with ideas and suggestions, as well as information regarding problems and concerns. PATIENT OR PUBLIC INVOLVEMENT Three certified nursing assistants have contributed to the development of the survey.
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Affiliation(s)
- Karin Kee
- Department of Organization Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marieke van Wieringen
- Department of Organization Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk Nies
- Department of Organization Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bianca Beersma
- Department of Organization Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Soyer Er Ö, Gül İ. The Speaking Up Climate of Nurses for Patient Safety Concerns and Unprofessional Behaviors: The Effects of Teamwork and Safety Climate. J Perianesth Nurs 2024:S1089-9472(23)01070-5. [PMID: 38493404 DOI: 10.1016/j.jopan.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 03/18/2024]
Abstract
PURPOSE This study aims to investigate the influence of teamwork and safety climate on nurses' speaking up for patient safety concerns and unprofessional behaviors. DESIGN This study incorporates a cross-sectional research design. METHODS The study included 217 surgical nurses employed in a Turkish university hospital. The research data were collected between April and June 2023 using the Teamwork Climate, Safety Climate Survey, Speaking Up Climate for Patient Safety, and Speaking Up Climate for Professionalism instruments. The relationships between these scales were assessed using Pearson correlation analysis. The Turkish validity and reliability of the Speaking Up Climate for Patient Safety and Speaking Up Climate for Professionalism scales were verified. The research model was tested using path analysis. FINDINGS The mean age of the 217 surgical nurses was 25.88 ± 5.64 years. Teamwork climate showed a positive effect on safety climate and speaking up climate about patient safety concerns and unprofessional behaviors. Safety climate showed a positive association with nurses' speaking up climate about patient safety concerns and unprofessional behaviors. CONCLUSIONS Teamwork climate and safety climate both positively affect the speaking up climate about patient safety concerns and unprofessional behaviors. Nurse managers who wish to promote a culture of speaking up about patient safety and unprofessional behaviors should prioritize improvements in the teamwork climate and safety climate.
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Affiliation(s)
- Özlem Soyer Er
- Surgical Nursing Department, Afyonkarahisar Health Sciences University, Faculty of Health Sciences, Afyonkarahisar, Turkey
| | - İsa Gül
- Department of Healthcare Management, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
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Barlow M, Watson B, Jones E, Morse C, Maccallum F. The application of communication accommodation theory to understand receiver reactions in healthcare speaking up interactions. J Interprof Care 2024; 38:42-51. [PMID: 37702325 DOI: 10.1080/13561820.2023.2249939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023]
Abstract
Speaking up for patient safety is a well-documented, complex communication interaction, which is challenging both to teach and to implement into practice. In this study we used Communication Accommodation Theory to explore receivers' perceptions and their self-reported behaviors during an actual speaking up interaction in a health context. Intergroup dynamics were evident across interactions. Where seniority of the participants was salient, the within-profession interactions had more influence on the receiver's initial reactions and overall evaluation of the message, compared to the between profession interactions. Most of the seniority salient interactions occurred down the hierarchy, where a more senior professional ingroup member delivered the speaking up message to a more junior receiver. These senior speaker interactions elicited fear and impeded the receiver's voice. We found that nurses/midwives and allied health clinicians reported using different communication behaviors in speaking up interactions. We propose that the term "speaking up" be changed, to emphasize receivers' reactions when they are spoken up to, to help receivers engage in more mutually beneficial communication strategies.
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Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- School of Psychology, University of Queensland, St Lucia, Australia
| | - Bernadette Watson
- School of Psychology, University of Queensland, St Lucia, Australia
- Department of English and Communication, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Elizabeth Jones
- School of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Catherine Morse
- College of Nursing & Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St Lucia, Australia
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Bienefeld N, Kolbe M, Camen G, Huser D, Buehler PK. Human-AI teaming: leveraging transactive memory and speaking up for enhanced team effectiveness. Front Psychol 2023; 14:1208019. [PMID: 37599773 PMCID: PMC10436524 DOI: 10.3389/fpsyg.2023.1208019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
In this prospective observational study, we investigate the role of transactive memory and speaking up in human-AI teams comprising 180 intensive care (ICU) physicians and nurses working with AI in a simulated clinical environment. Our findings indicate that interactions with AI agents differ significantly from human interactions, as accessing information from AI agents is positively linked to a team's ability to generate novel hypotheses and demonstrate speaking-up behavior, but only in higher-performing teams. Conversely, accessing information from human team members is negatively associated with these aspects, regardless of team performance. This study is a valuable contribution to the expanding field of research on human-AI teams and team science in general, as it emphasizes the necessity of incorporating AI agents as knowledge sources in a team's transactive memory system, as well as highlighting their role as catalysts for speaking up. Practical implications include suggestions for the design of future AI systems and human-AI team training in healthcare and beyond.
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Affiliation(s)
- Nadine Bienefeld
- Work and Organizational Psychology, Department of Management, Technology, and Economics, ETH Zürich, Zurich, Switzerland
| | - Michaela Kolbe
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni Camen
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominic Huser
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Karl Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Intensive Care Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Jeong JH, Kim SS. South Korean Nurses' Experiences of Speaking up for Patient Safety and Incident Prevention. Healthcare (Basel) 2023; 11:1764. [PMID: 37372881 DOI: 10.3390/healthcare11121764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the importance of speaking up for patient safety, hesitancy to do so remains a major contributing factor to communication failure. This study aimed to investigate the experiences of South Korean nurses in speaking up to prevent patient safety incidents. Twelve nurses responsible for patient safety tasks or with experience in patient safety education were recruited from five hospitals (three university hospitals, two general hospitals) in city "B". Data were collected through open-ended questions and in-depth interviews, transcribed, and analyzed using the inductive content analysis method. The study resulted in the identification of four main categories and nine subcategories that captured commonalities among the experience of the 12 nurses. The four main categories were as follows: the current scenario of speaking up, barriers to speaking up, strategies for speaking, and confidence training. There is a scarcity of research on speaking-up experiences for patient safety among nurses in South Korean. Overall, it is necessary to overcome cultural barriers and establish an environment that encourages speaking up. In addition, developing speaking-up training programs for nursing students and novice nurses is imperative to prevent patient safety incidents.
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Affiliation(s)
- Jeong Hee Jeong
- Department of Nursing Science, Kyungsung University, Busan 48434, Republic of Korea
| | - Sam Sook Kim
- Department of Nursing, Daedong College, Busan 46270, Republic of Korea
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Groves C, Hilton C. Montagu Lomax: The background and motivation of a 'remarkable man' who spearheaded lunacy reform. J Med Biogr 2023; 31:15-21. [PMID: 33884896 DOI: 10.1177/09677720211005268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums during the First World War inspired him to write The experiences of an asylum doctor: with suggestions for asylum and lunacy law reform. Published in 1921, the book acted as a catalyst for lunacy reform and stimulated improvements in the mental health services in the United Kingdom. Lomax spent the remainder of his retirement campaigning for lunacy reform. He suffered financial and personal hardship following the publication of the book and was castigated by his own profession. On the centenary of the publication of Experiences, this article explores the background and motivation of a remarkable man.
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Wawersik DM, Boutin ER, Gore T, Palaganas JC. Individual Characteristics That Promote or Prevent Psychological Safety and Error Reporting in Healthcare: A Systematic Review. J Healthc Leadersh 2023; 15:59-70. [PMID: 37091553 PMCID: PMC10120817 DOI: 10.2147/jhl.s369242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/13/2022] [Indexed: 04/25/2023] Open
Abstract
Background Healthcare errors continue to be a safety issue and an economic burden that causes death, increased length of stays, and emotional trauma to families and the person who commits the error. Speaking up and error reporting within a safety culture can reduce the incidence of error; however, this is complex and multifaceted. Aim This systematic review investigates individual characteristics that support or prevent speaking up behaviors when adverse events occur. This study further explores how organizational interventions designed to promote error reporting correlate to individual characteristics and perceptions of psychological safety. . Methods A systematic review of peer-reviewed articles in healthcare that contain characteristics of an individual that promote or prevent error reporting was conducted. The search yielded 1233 articles published from 2015 to 2021. From this set, 81 full-text articles were assessed for eligibility and ultimately extracted data from 28 articles evaluated for quality using Joanna Briggs Institute critical appraisal tools©. Principal Findings The primary themes for individual character traits, values, and beliefs that influence a person's decision to speak up/report an error include self-confidence and positive perceptions of self, the organization, and leadership. Education, experience and knowledge are sub themes that relate to confidence. The primary individual characteristics that serve as barriers are 1) self-preservation associated with fear and 2) negative perceptions of self, the organization, and leadership. Conclusion The results show that an individual's perception of their environment, whether or not it is psychologically safe, may be impacted by personal perceptions that stem from deep-seated personal values. This exposes a crucial need to explore cultural and diversity aspects of healthcare error reporting and how to individualize interventions to reduce fear and promote error reporting.
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Affiliation(s)
- Dawn M Wawersik
- MGH Institute of Health Professions, Boston, MA, USA
- Henry Ford College, Dearborn, MI, USA
- Correspondence: Dawn M Wawersik, Email
| | | | - Teresa Gore
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Janice C Palaganas
- MGH Institute of Health Professions, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Vian T, Agnew B, McInnes K. Whistleblowing as an anti-corruption strategy in health and pharmaceutical organizations in low- and middle-income countries: a scoping review. Glob Health Action 2022; 15:2140494. [PMID: 36356311 PMCID: PMC9661981 DOI: 10.1080/16549716.2022.2140494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Whistleblowing can bring suspected wrongdoing to the attention of someone who is in the position to rectify the problem. Whistleblowing research can help improve effectiveness of anti-corruption efforts in the health sector. OBJECTIVE The objective of this scoping review is to understand the extent and type of evidence on whistleblowing as an anti-corruption strategy in health and pharmaceutical organisations in low- and middle-income countries (LMICs). METHODS This scoping review searched the PubMed, Scopus, and EMBASE databases from 2005 to 2020, limited to English language. We also searched websites of multilateral agencies or international non-governmental organisations for policy documents, guidance and reports. Titles and abstracts were screened to remove those where the focus was not on health, pharmaceuticals, whistleblowing, or LMIC context. Articles focused on research misconduct were excluded. Full-text articles were assessed for eligibility on these same criteria. Included sources were analysed thematically, based on five categories including definitions and models; evidence of reporting frequency; factors influencing whistleblowing; cultural context; and outcomes. RESULTS The review found 22 sources including reports, policies, and guidance documents (12, 55%), news articles (4, 18%), policy analyses/reviews (3, 14%), commentaries (2, 9%), and empirical studies (1, 5%). Most sources described whistleblowing policy and system components such as how whistleblowing is defined, who can report, and how confidentiality is assured. Few articles documented types and frequencies of corruption identified through whistleblowing or factors associated with whistleblowing. Several studies mentioned cultural norms as a potential limitation to whistleblowing effectiveness. About one-third of the sources described fear of retaliation and noted the need to strengthen protection for whistleblowers. CONCLUSION Research on whistleblowing is scarce in health and pharmaceutical organisations in LMICs. Documentation of policies, factors associated with whistleblowing, and whistleblowing outcomes is needed and could help countries to mainstream whistleblowing as a sectoral anti-corruption strategy.
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Affiliation(s)
- Taryn Vian
- Department of Health Professions, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA,WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada,CONTACT Taryn Vian School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA94117, USA
| | - Brianna Agnew
- Department of Health Professions, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
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Davey K, Aveyard H. Nurses' perceptions of their role in antimicrobial stewardship within the hospital environment. An integrative literature review. J Clin Nurs 2022; 31:3011-3020. [PMID: 35092116 PMCID: PMC9787640 DOI: 10.1111/jocn.16204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) has traditionally been the domain of doctors and pharmacists but there is a growing recognition that successful stewardship incorporates a multidisciplinary approach that includes nursing staff. This literature review explores nurses' perceptions of their role in antimicrobial stewardship within the hospital environment and provides new insights to inform future practice. METHODOLOGY An integrative literature review was undertaken. Five academic databases were searched, which identified six relevant studies. Whittemore and Knafl's method for conducting an integrative review was followed. ENTREQ guidelines have been adhered to. FINDINGS Two themes were identified: nurses' working in partnership with other professionals and engagement in education. DISCUSSION Antimicrobial stewardship illustrates the role of the nurse within the wider multidisciplinary team regarding wider patient safety issues and the need for education to enhance this role. RELEVANCE TO CLINICAL PRACTICE Nurses have a clear role to play in antimicrobial stewardship but need to be fully cognisant of the issues involved. Further clarity on how nurses should enact this role in their complex working environments is required. It is essential that both student and qualified nurses are able to speak up in order to maximise patient safety, fulfil their professional duty and promote the overall effectiveness of AMS if they witness poor antibiotic management practices.
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10
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Vauk S, Seelandt JC, Huber K, Grande B, Kolbe M. Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study. Br J Anaesth 2022; 129:776-787. [PMID: 36075775 DOI: 10.1016/j.bja.2022.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/27/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response. METHODS In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling. RESULTS The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%). CONCLUSION Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.
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Affiliation(s)
- Stefanie Vauk
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Katja Huber
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
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Ortiz-López N, Ponce-Arancibia S, Olea-Gangas C, Chacano-Muñoz R, Arancibia-Carvajal S, Solis I. Determinants of the intention to speak up about medical error in primary healthcare settings in Chile. Health Soc Care Community 2022; 30:e1202-e1211. [PMID: 34431150 DOI: 10.1111/hsc.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Medical error frequently occurs in ambulatory care, and healthcare professionals may encounter situations in which they need to speak up to ensure better practice. This study aims to investigate the factors that influenced the intention to speak up about medical errors among healthcare professionals in primary care settings. Data were generated through a national cross-sectional survey of primary healthcare centres in the Republic of Chile. A research instrument was designed using the constructs of the theory of planned behaviour and was analysed using the structural equation model technique. In total, 203 healthcare professionals were recruited between March and May 2020. The model showed that the intention to speak up was directly and positively influenced by attitudes towards speaking up and perceived control (standard deviation [SD] = 0.284 and 0.576, respectively). Subjective norms indirectly and negatively influenced the intention to speak up through attitudes towards speaking up and perceived control (total effect SD = -0.303). The exploratory construct of willingness to change self-behaviour positively influenced the attitude towards behaviour. The intention to speak up strongly influenced the speaking up behaviour (total effect SD = 0.631). The proposed model explained 40% of the variance in behaviour. Based on this model, it was concluded that the intention to speak up strongly influenced the speaking up behaviour and predicted it by 40%. Factors that modify the intention to speak up are expected to influence the occurrence of this behaviour. This knowledge will inform strategies to enhance communication among healthcare professionals, improve speaking up behaviour and improve patient care.
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Affiliation(s)
| | | | | | | | - Sara Arancibia-Carvajal
- Institute of Basic Sciences, Faculty of Engineering and Sciences, Diego Portales University, Santiago, Chile
| | - Ivan Solis
- University of Chile School of Medicine, Santiago, Chile
- Department of Medicine, University of Chile Clinical Hospital, Santiago, Chile
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12
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Lee SE, Dahinten VS, Ji H, Kim E, Lee H. Motivators and inhibitors of nurses' speaking up behaviours: A descriptive qualitative study. J Adv Nurs 2022; 78:3398-3408. [PMID: 35765723 DOI: 10.1111/jan.15343] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Seung Eun Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyunju Ji
- Severance Hospital, Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Eunkyung Kim
- Brain Korea 21 FOUR Project, Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Hyunjie Lee
- Severance Hospital, Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
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Daly Guris RJ, Toy S. Defining speaking up. Br J Anaesth 2022; 128:e289-e291. [PMID: 35144801 DOI: 10.1016/j.bja.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rodrigo J Daly Guris
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Serkan Toy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Rudolph JW, Pian-Smith MCM, Minehart RD. Setting the stage for speaking up: psychological safety and directing care in acute care collaboration. Br J Anaesth 2021; 128:3-7. [PMID: 34776122 DOI: 10.1016/j.bja.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/12/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Abstract
Managing a safe and efficient anaesthetic induction within a team involves the challenge of when, if, and how to surface, discuss, and implement the best plan on how to proceed. The Lemke and colleagues study in this issue of the British Journal of Anaesthesia is a unique view into real-world conversations that naturally occur in anaesthesia teams in moments of high task and cognitive load, such as induction of anaesthesia. The study spotlights important small moments of physician, nurse, and trainee team coordination. It illuminates key patterns of conversation in naturally occurring anaesthesia teams, and raises important questions about what the speaking up standard should be and the psychological safety-shaping role consultants play in setting the norms for speaking up.
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Affiliation(s)
- Jenny W Rudolph
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Boston, MA, USA.
| | - May C M Pian-Smith
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Boston, MA, USA
| | - Rebecca D Minehart
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Boston, MA, USA
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Ito A, Sato K, Yumoto Y, Sasaki M, Ogata Y. A concept analysis of psychological safety: Further understanding for application to health care. Nurs Open 2021; 9:467-489. [PMID: 34651454 PMCID: PMC8685887 DOI: 10.1002/nop2.1086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022] Open
Abstract
AIM To clarify the concept of psychological safety in a healthcare context and to provide the first theoretical framework for improving interpersonal relationships in the workplace to better patient care. DESIGN A Rodgers' concept analysis. METHODS The concept analysis was conducted using a systematic search strategy on PubMed, CINAHL, PsycINFO and Ichushi-Web. RESULTS An analysis of 88 articles studying psychological safety in health care identified five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, group-level phenomenon, safe work environment for taking interpersonal risks and non-punitive culture. The antecedents included structure/system factors, interpersonal factors and individual factors. The four consequences included performance outcomes, organizational culture outcomes, and psychological and behavioural outcomes.
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Affiliation(s)
- Ayano Ito
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kana Sato
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoshie Yumoto
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Miki Sasaki
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasuko Ogata
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Lemke R, Burtscher MJ, Seelandt JC, Grande B, Kolbe M. Associations of form and function of speaking up in anaesthesia: a prospective observational study. Br J Anaesth 2021; 127:971-980. [PMID: 34511257 DOI: 10.1016/j.bja.2021.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up. METHODS Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding. RESULTS Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018). CONCLUSION Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions.
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Affiliation(s)
- Rahel Lemke
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Michael J Burtscher
- School of Applied Psychology, Zurich University of Applied Sciences, Switzerland; Universtiy of Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
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Lam BD, Bourgeois F, Dong ZJ, Bell SK. Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations. J Am Med Inform Assoc 2021; 28:685-694. [PMID: 33367831 DOI: 10.1093/jamia/ocaa293] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements. OBJECTIVE To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors. METHODS Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months. RESULTS 6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, "other," or "multiple" race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a "troublemaker" (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families. CONCLUSIONS About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.
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Affiliation(s)
- Barbara D Lam
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Zhiyong J Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Kritsotakis G, Gkorezis P, Andreadaki E, Theodoropoulou M, Grigoriou G, Alvizou A, Kostagiolas P, Ratsika N. Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses. J Adv Nurs 2021; 78:434-445. [PMID: 34337760 DOI: 10.1111/jan.14994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 12/29/2022]
Abstract
AIMS To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses. DESIGN Multicentre cross-sectional study. METHODS Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations. FINDINGS Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses. CONCLUSIONS Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety. IMPACT On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.
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Affiliation(s)
- George Kritsotakis
- Department of Bussiness Administration & Tourism, Hellenic Mediterranean University, Crete, Greece.,School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Panagiotis Gkorezis
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Faculty of Economics and Political Sciences, Aristotle University of Thessaloniki, Thesaloniki, Greece
| | - Eirini Andreadaki
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Aghios Nikolaos General Hospital, Crete, Greece
| | | | | | | | - Petros Kostagiolas
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Department of Archives, Library Science and Museology, School of Information Science and Informatics, Ionian University, Kerkyra, Greece
| | - Nikoleta Ratsika
- Department of Social Work, Hellenic Mediterranean University, Crete, Greece
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Lee SE, Dahinten VS. Psychological Safety as a Mediator of the Relationship Between Inclusive Leadership and Nurse Voice Behaviors and Error Reporting. J Nurs Scholarsh 2021; 53:737-745. [PMID: 34312960 PMCID: PMC9292620 DOI: 10.1111/jnu.12689] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
Purpose The purpose of this study was to examine psychological safety as a mediator of the relationship between inclusive leadership and nurses’ voice behaviors and error reporting. Voice behaviors were conceptualized as speaking up and withholding voice. Design This correlational study used a web‐based survey to obtain data from 526 nurses from the medical/surgical units of three tertiary general hospitals located in two cities in South Korea. Methods We used model 4 of Hayes’ PROCESS macro in SPSS to examine whether the effect of inclusive leadership on the three outcome variables was mediated by psychological safety. Findings Mediation analysis showed significant direct and indirect effects of nurse managers’ inclusive leadership on each of the three outcome variables through psychological safety after controlling for participant age and unit tenure. Our results also support the conceptualization of employee voice behavior as two distinct concepts: speaking up and withholding voice. Conclusions When leader inclusiveness helps nurses to feel psychologically safe, they are less likely to feel silenced, and more likely to speak up freely to contribute ideas and disclose errors for the purpose of improving patient safety. Clinical Relevance Leader inclusiveness would be especially beneficial in environments where offering suggestions, raising concerns, asking questions, reporting errors, or disagreeing with those in more senior positions is discouraged or considered culturally inappropriate.
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Affiliation(s)
- Seung Eun Lee
- Lambda Alpha at-Large, Assistant Professor, College of Nursing, Yonsei University, Seoul, South Korea
| | - V Susan Dahinten
- Associate Professor, School of Nursing, University of British Columbia, Vancouver, BC, Canada
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20
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Fagan A, Lea J, Parker V. Student nurses' strategies when speaking up for patient safety: A qualitative study. Nurs Health Sci 2021; 23:447-455. [PMID: 33733584 DOI: 10.1111/nhs.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two-phased approach included individual semi-structured interviews, followed by focus group discussions with students. Participants included 53 pre-registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students.
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Affiliation(s)
- Anthea Fagan
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Vicki Parker
- School of Health, University of New England, Armidale, New South Wales, Australia
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21
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Kesselheim JC, Shelburne JT, Bell SK, Etchegaray JM, Lehmann LS, Thomas EJ, Martinez W. Pediatric Trainees' Speaking Up About Unprofessional Behavior and Traditional Patient Safety Threats. Acad Pediatr 2021; 21:352-357. [PMID: 32673764 DOI: 10.1016/j.acap.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 06/01/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Speaking up is increasingly recognized as essential for patient safety. We aimed to determine pediatric trainees' experiences, attitudes, and anticipated behaviors with speaking up about safety threats including unprofessional behavior. METHODS Anonymous, cross-sectional survey of 512 pediatric trainees at 2 large US academic children's hospitals that queried experiences, attitudes, barriers and facilitators, and vignette responses for unprofessional behavior and traditional safety threats. RESULTS Responding trainees (223 of 512, 44%) more commonly observed unprofessional behavior than traditional safety threats (57%, 127 of 223 vs 34%, 75 of 223; P < .001), but reported speaking up about unprofessional behavior less commonly (48%, 27 of 56 vs 79%, 44 of 56; P < .001). Respondents reported feeling less safe speaking up about unprofessional behavior than patient safety concerns (52%, 117 of 223 vs 78%, 173 of 223; P < .001). Respondents were significantly less likely to speaking up to, and use assertive language with, an attending physician in the unprofessional behavior vignette than the traditional safety vignette (10%, 22 of 223 vs 64%, 143 of 223, P < .001 and 12%, 27 of 223 vs 57%, 128 of 223, P < .001, respectively); these differences persisted even among respondents that perceived high potential for patient harm in both vignettes (20%, 16 of 81 vs 69%, 56 of 81, P < .001 and 20%, 16 of 81 vs 69%, 56 of 81, P < .001, respectively). Fear of conflict was the predominant barrier to speaking up about unprofessional behavior and more commonly endorsed for unprofessional behavior than traditional safety threats (67%, 150 of 223 vs 45%, 100 of 223, P < .001). CONCLUSIONS Findings suggest pediatric trainee reluctance to speak up when presented with unprofessional behavior compared to traditional safety threats and highlight a need to improve elements of the clinical learning environment to support speaking up.
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Affiliation(s)
- Jennifer C Kesselheim
- Boston Children's/Dana-Farber Cancer and Blood Disorders Center, Harvard Medical School (JC Kesselheim), Boston, Mass.
| | - Julia T Shelburne
- McGovern Medical School, Texas Children's Hospital, Baylor College of Medicine (JT Shelburne), Houston, Tex
| | - Sigall K Bell
- Beth Israel Deaconess Medical Center, Harvard Medical School (SK Bell), Boston, Mass
| | | | - Lisa Soleymani Lehmann
- National Center for Ethics in Health Care - U.S. Department of Veterans Affairs, Harvard Medical School, Harvard T.H. Chan School of Public Health (LS Lehmann), Boston, Mass
| | - Eric J Thomas
- University of Texas Houston-Memorial Hermann Center for Healthcare Quality and Safety, McGovern Medical School, University of Texas Health Science Center at Houston (EJ Thomas)
| | - William Martinez
- Division of General Internal Medicine, Vanderbilt University Medical Center, (W Martinez), Nashville, Tenn. Dr Shelburne is now with the Texas Children's Hospital, Baylor College of Medicine, Houston Tex
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22
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Luff D, O'Donnell M, Johnston PR, Martinez W, Slanetz P, Bell SK, Brown SD. Radiology Trainees' Perceptions of Speaking up Culture Related to Safety and Unprofessional Behavior in Their Work Environments. AJR Am J Roentgenol 2021; 216:1081-7. [PMID: 33534622 DOI: 10.2214/AJR.20.22833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to compare radiology trainees' perceptions of the culture regarding speaking up about patient safety and unprofessional behavior in the clinical environment and to assess the likelihood that they will speak up in the presence of a medical hierarchy. MATERIALS AND METHODS. The study included radiology trainees from nine hospitals who attended a communication workshop. Trainees completed questionnaires assessing their perceptions of the support provided by their clinical environment regarding speaking up about patient safety and unprofessional behavior. We also queried their likelihood of speaking up within a team hierarchy about an error presented in a hypothetical clinical vignette. RESULTS. Of 61 participants, 58 (95%) completed questionnaires. Of these 58 participants, 84% felt encouraged by colleagues to speak up about safety concerns, and 57% felt encouraged to speak up about unprofessional behavior (p < .001). Moreover, 17% and 34% thought speaking up about safety concerns and unprofessional behavior, respectively, was difficult (p < .02). Trainees were less likely to agree that speaking up about unprofessional behavior (compared with speaking up about safety concerns) resulted in meaningful change (66% vs 95%; p < .001). In a vignette describing a sterile technique error, respondents were less likely to speak up to an attending radiologist (48%) versus a nurse, intern, or resident (79%, 84%, and 81%, respectively; p < .001). Significant predictors of the likelihood of trainees speaking up to an attending radiologist included perceived potential for patient harm as a result of the error (odds ratio [OR], 6.7; p < .001), perceptions of safety culture in the clinical environment (OR, 5.0; p = .03), and race or ethnicity (OR, 3.1; p = .03). CONCLUSION. Radiology trainees indicate gaps in workplace cultures regarding speaking up, particularly concerning unprofessional behavior and team hierarchy.
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Long J, Jowsey T, Garden A, Henderson K, Weller J. The flip side of speaking up: a new model to facilitate positive responses to speaking up in the operating theatre. Br J Anaesth 2020; 125:1099-1106. [PMID: 32943191 DOI: 10.1016/j.bja.2020.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Speaking up is important for patient safety, but only if the concern raised is acknowledged and responded to appropriately. While the power to change the course of events rests with those in charge, research has focussed on supporting those in subordinate positions to speak up. We propose responsibility also rests with senior clinical staff to respond appropriately. We explored the perceptions of senior staff on being spoken up to in the operating theatre (OT), and factors moderating their response. METHODS We undertook interviews and focus groups of fully qualified surgeons, anaesthetists, nurses, and anaesthetic technicians working in OTs across New Zealand. We used grounded theory to analyse and interpret the data. RESULTS With data from 79 participants, we conceptualise three phases in the speaking up interaction: 1) the content of the speaker's message and the tone of delivery; 2) the message interpreted through the receiver's filters, including beliefs on personal fallibility and leadership, respect for the speaker, understanding the challenges of speaking up, and personal cultural and professional norms around communication; and 3) the receiver's subsequent response and its effects on the speaker, the observing OT staff, and patient care. CONCLUSIONS The speaking up interaction can be high stakes for the whole OT team. The receiver response can strengthen team cohesion and function, or cause distress and tension. Our grounded theory uncovers multiple influences on this interaction, with potential for re-framing and optimising the speaker/receiver interaction to improve team function and patient safety.
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Affiliation(s)
- Jennifer Long
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Alexander Garden
- Department of Anaesthesia, Capital and Coast Health, Wellington, New Zealand
| | - Kaylene Henderson
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Auckland, New Zealand.
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Fagan A, Lea J, Parker V. Conflict, confusion and inconsistencies: Pre-registration nursing students' perceptions and experiences of speaking up for patient safety. Nurs Inq 2020; 28:e12381. [PMID: 32881137 DOI: 10.1111/nin.12381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
There is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under-explored, especially in the Australian context. This two-phased qualitative study used Interpretive Description to explore 53 pre-registration nursing students' perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students' decisions to speak up or remain silent. Understanding students' perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up.
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Affiliation(s)
- Anthea Fagan
- University of New England, Armidale, NSW, Australia
| | - Jackie Lea
- University of Southern Queensland, Toowoomba, QLD, Australia
| | - Vicki Parker
- University of New England, Armidale, NSW, Australia
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25
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Martin GP, Chew S, Dixon-Woods M. Uncovering, creating or constructing problems? Enacting a new role to support staff who raise concerns about quality and safety in the English National Health Service. Health (London) 2020; 25:757-774. [PMID: 31984819 PMCID: PMC8485254 DOI: 10.1177/1363459319901296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Employee voice is an important source of organizational intelligence about possible problems in quality and patient safety, but effective systems for encouraging and supporting those who seek to speak up have remained elusive. In the English National Health Service, a novel role known as the ‘Freedom to Speak Up Guardian’ has been introduced to address this problem. We critically examine the role and its realization in practice, drawing on semi-structured interviews with 51 key individuals, including Guardians, clinicians, managers, policymakers, regulators and others. Operationalizing the new role in organizations was not straightforward, since it had to sit in a complex set of existing systems and processes. One response was to seek to bound the scope of Guardians, casting them in a signposting or coordinating role in relation to quality and safety concerns. However, the role proved hard to delimit, not least because the concerns most frequently voiced in practice differed in character from those anticipated in the role’s development. Guardians were tasked with making sense of and dealing with issues that could not always straightforwardly be classified, deflected to the right system or escalated to the appropriate authority. Our analysis suggests that the role’s potential contribution might be understood less as supporting whistleblowers who bear witness to clear-cut wrongdoing, and more as helping those with lower-level worries to construct their concerns and what to do with them. These findings have implications for how voice is understood, imagined and addressed in healthcare organizations.
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Levine KJ, Carmody M, Silk KJ. The influence of organizational culture, climate and commitment on speaking up about medical errors. J Nurs Manag 2019; 28:130-138. [PMID: 31733166 DOI: 10.1111/jonm.12906] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/15/2019] [Accepted: 11/13/2019] [Indexed: 12/01/2022]
Abstract
AIM Speaking up about medical errors is an essential behaviour for nurses in pursuit of their goal of maintaining patient safety. This study was designed to understand how a hospital's culture and climate can impact a nurse's active behaviour in this important health care activity. BACKGROUND Research shows that while medical errors happen frequently, there is great variability on whether these errors are reported. As such, organizational culture, climate and commitment as well as employee perceptions associated with the reporting process were investigated to determine their impact on participants' intentions to speak up about medical errors. METHODS Focus groups and one-on-one interviews were used to collect these data and were analysed using content analysis. RESULTS/KEY ISSUES Nurses in the hospital perceive and understand both the benefits and barriers to reporting medical errors. Commonly reported benefits include patient safety, promoting education and awareness, and the improvement of internal processes or systems. Barriers include an inefficient reporting system and organizational influences such as perceived consequences and unequal status/position of the individual who made the error and the person reporting the error. Participants are aware that the organization believes that the responsibility to report medical errors falls to everyone. CONCLUSIONS Results indicate that the organization's existing culture does not facilitate the reporting of medical errors and that the organizational climate interferes with the reporting process. Lastly, organizational commitment is not related to the perception of importance given to the reporting of medical errors by the hospital. IMPLICATIONS FOR NURSING MANAGEMENT Nurses and nurse managers are an essential part of any hospital. In their role, they can effect change on the organization's culture and climate, but often do not realize the connection between organizational culture and patient safety. Results indicate that promoting organizational commitment to speaking up through the creation of a positive organizational culture can both promote speaking up about medical errors and increase patient safety.
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Affiliation(s)
- Kenneth J Levine
- Department of Communication, Michigan State University, East Lansing, Michigan
| | - Molly Carmody
- Department of Communication, Michigan State University, East Lansing, Michigan
| | - Kami J Silk
- Department of Communication, University of Delaware, Newark, Delaware
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Abstract
Following the events at Mid Staffordshire NHS Foundation Trust, Sir Robert Francis was commissioned to undertake a public inquiry. During this process, from speaking to NHS workers and from the evidence submitted to the inquiry, he found that staff had tried to speak up about their concerns, but that they had been ignored, or victimised as a result. This experience was not confined to Mid Staffordshire and a further report, Freedom to speak up, was commissioned. Freedom to speak up made two recommendations, which were accepted by all NHS organisations and the Department of Health. The report included principles and actions about the culture and practice in the NHS, the appointment of freedom to speak up guardians in NHS trusts and foundation trusts and a national guardian to lead this network, undertake case reviews and provide support and challenge to the system. In this article, I will describe the work of freedom to speak up guardians and the National Guardian's Office, the impact of these on workers in NHS trusts and other organisations, and the next steps in the journey to make speaking up business as usual.
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28
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Schwappach D, Sendlhofer G. Speaking Up about Patient Safety in Perioperative Care: Differences between Academic and Nonacademic Hospitals in Austria and Switzerland. J INVEST SURG 2019; 33:730-738. [PMID: 30644786 DOI: 10.1080/08941939.2018.1554016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose of the Study: In perioperative care, communication about patient safety concerns is both difficult and valuable. Research into speaking up has mostly been conducted in single countries; the aim of this study was to compare speaking up-related climate and behaviors in academic and nonacademic hospitals. Materials and Methods: The study is based on two surveys conducted in Austria and Switzerland. The Swiss survey was conducted in five nonacademic hospitals, the Austrian survey in one university hospital. Results: 768 questionnaires were returned (nonacademic: n = 360; response rate: 37%; academic: n = 408; response rate: 32%). There were differences (p < 0.001) concerning speaking up episodes (at least one episode of speaking up in the past four weeks) between nonacademic hospitals (68%) and the academic hospital (96%). Withholding voice was reported by 32% of nonacademic and 43% of academic staff (p = 0.003). The speak up-related climate in the Swiss sample was more positive. Nurses compared to doctors scored higher on all items of the "resignation scale." Important differences emerged in ratings of a clinical scenario of missed hand disinfection: Nonacademic health-care workers perceived the risk of harm for patients higher compared to academic (5.3 vs. 2.5; p < 0.001). Responders higher in hierarchy felt better with speaking up in nonacademic hospitals. Conclusions: The study is one of the first to address differences in academic and nonacademic hospitals in speaking up behaviors and demonstrated differences. This analysis helps to put local data in perspective and to target further activities for improvement.
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Affiliation(s)
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, Landeskrankenhaus-Universitatsklinikum Graz, Graz, Austria.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Research Unit for Safety in Health, Medizinische Universitat Graz, Graz, Austria
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Beament T, Mercer SJ. Speak up! Barriers to challenging erroneous decisions of seniors in anaesthesia. Anaesthesia 2018; 71:1332-1340. [PMID: 27734483 DOI: 10.1111/anae.13546] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/30/2022]
Abstract
'Speaking up' or the ability to effectively challenge erroneous decisions is essential to preventing harm. This mixed-methods study in two parts explores the concept of 'barriers to challenging seniors' for anaesthetic trainees, and proposes a conceptual framework. Using a fully immersive simulation scenario with unanticipated airway difficulty, we investigated how junior anaesthetists (one to two years of training) challenged a scripted error. We also conducted focus groups with senior trainees (three to seven years of training) and undertook a 'thematic network analysis' of responses. Junior anaesthetic trainees challenged erroneous decisions effectively, but trainees with an additional year of experience challenged more quickly and effectively, combining 'crisp-advocacy-inquiry challenge' with 'non-verbal cues'. Focus group analysis conceptualised a 'barrier network' with three main themes: concerns around relationships; decision-making; and risk/cost-benefit. Emotional maturity is an important protective layer around decisions to challenge. Despite significant multifactorial barriers, systematic training in effective 'speaking up' could improve the confidence and ability of juniors to challenge erroneous decisions.
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Affiliation(s)
- T Beament
- Alb Fils Kliniken, Goeppingen, Germany.
| | - S J Mercer
- Aintree University Hospital NHS Foundation, Liverpool, UK.,Centre for Simulation and Patient Safety, Liverpool, UK
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Omura M, Stone TE, Levett-Jones T. Cultural factors influencing Japanese nurses' assertive communication. Part 1: Collectivism. Nurs Health Sci 2018; 20:283-288. [PMID: 29405591 DOI: 10.1111/nhs.12411] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/14/2017] [Accepted: 12/10/2017] [Indexed: 11/29/2022]
Abstract
Culture influences the way health-care professionals communicate with each other and their ability to relate to colleagues in an assertive manner. Cultural barriers can also make it difficult for nurses to speak up even when they have concerns about patient safety. An understanding of the potential impact of cultural factors is therefore needed when developing assertiveness communication training programs. This paper presents the findings from a study that explored Japanese nurses' perceptions of how culture and values impact assertive communication in health care. Semistructured interviews with 23 registered nurses were undertaken, and data were analyzed using directed content analysis. Two major themes were identified: collectivism and hierarchy/power. In the present study, we discuss the cultural values related to collectivism that included four categories of "wa" (harmony), "uchi to soto" (inside and outside), implicit communication/ambiguity, and "nemawashi" (groundwork). The findings highlight the impact of culture on nurses' assertive communication behaviors and can be used to inform the design of culturally-appropriate assertiveness communication training programs for Japanese nurses working both within their own country or internationally.
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Affiliation(s)
- Mieko Omura
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Teresa E Stone
- Faculty of Nursing, Chiang Mai University, Muang, Chiang Mai, Thailand
| | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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D'Agostino TA, Bialer PA, Walters CB, Killen AR, Sigurdsson HO, Parker PA. A Communication Training Program to Encourage Speaking-Up Behavior in Surgical Oncology. AORN J 2017; 106:295-305. [PMID: 28958315 DOI: 10.1016/j.aorn.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/17/2017] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
Patient safety in the OR depends on effective communication. We developed and tested a communication training program for surgical oncology staff members to increase communication about patient safety concerns. In phase one, 34 staff members participated in focus groups to identify and rank factors that affect speaking-up behavior. We compiled ranked items into thematic categories that included role relations and hierarchy, staff rapport, perceived competence, perceived efficacy of speaking up, staff personality, fear of retaliation, institutional regulations, and time pressure. We then developed a communication training program that 42 participants completed during phase two. Participants offered favorable ratings of the usefulness and perceived effect of the training. Participants reported significant improvement in communicating patient safety concerns (t40 = -2.76, P = .009, d = 0.48). Findings offer insight into communication challenges experienced by surgical oncology staff members and suggest that our training demonstrates the potential to improve team communication.
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Ng GWY, Pun JKH, So EHK, Chiu WWH, Leung ASH, Stone YH, Lam CL, Lai SPW, Leung RPW, Luk HW, Leung AKH, Au Yeung KW, Lai KY, Slade D, Chan EA. Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses. BMJ Open 2017; 7:e015721. [PMID: 28801406 PMCID: PMC5724079 DOI: 10.1136/bmjopen-2016-015721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. DESIGN A mixed-methods design with quantitative and sequential qualitative components was used. SETTING AND PARTICIPANTS Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. RESULTS The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. CONCLUSIONS Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.
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Affiliation(s)
- George Wing Yiu Ng
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Jack Kwok Hung Pun
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- Department of Education, St Antony’s College, University of Oxford, Oxfordshire, Oxford, UK
| | - Eric Hang Kwong So
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wendy Wai Hang Chiu
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Avis Siu Ha Leung
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Yuk Han Stone
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Chung Ling Lam
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Sarah Pui Wa Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Rowlina Pui Wah Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Hing Wah Luk
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Anne Kit Hung Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kin Wah Au Yeung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kang Yiu Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Diana Slade
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- School of Literature, Languages and Linguistics, Australian National University, Canberra, Australia
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
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Robbins J, McAlearney AS. Encouraging employees to speak up to prevent infections: Opportunities to leverage quality improvement and care management processes. Am J Infect Control 2016; 44:1224-30. [PMID: 27130901 DOI: 10.1016/j.ajic.2016.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/23/2016] [Accepted: 03/02/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are associated with increased morbidity, mortality, and cost for U.S. hospitals, but many infections are preventable. Employees' willingness to speak up about errors or opportunities for improvement has been associated with a stronger safety culture in hospitals. However, the link between organizations' efforts to promote speaking up and prevent CLABSIs has not been studied. METHODS This exploratory, qualitative study included interviews with 158 key informants, including hospital executives, managers, and staff employees, in 6 hospitals that participated in the federally funded On the CUSP-Stop BSI initiative. Verbatim transcripts were analyzed to examine whether and how speaking up was addressed in CLABSI prevention efforts. RESULTS Hospitals implementing evidence-based practices for CLABSI prevention facilitated employees' improvement-oriented speaking up by leveraging quality improvement and care management processes. Leader behavior, employee training, and error reporting systems also facilitated speaking up. Although the focus of this study was on CLABSI prevention, broader organizational practices to improve patient safety were salient in creating a nonpunitive, highly inclusive environment in which employees felt comfortable speaking up. CONCLUSIONS These findings provide insight into the factors that may support speaking up to foster a safety culture and prevent health care-associated infection at unit and organization levels.
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Putnam LR, Pham DH, Ostovar-Kermani TG, Alawadi ZM, Etchegaray JM, Ottosen MJ, Thomas EJ, Lesslie DP, Kao LS, Lally KP, Tsao K. How Should Surgical Residents Be Educated About Patient Safety: A Pilot Randomized Controlled Trial. J Surg Educ 2016; 73:660-667. [PMID: 27137661 DOI: 10.1016/j.jsurg.2016.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/16/2016] [Accepted: 02/27/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The Accreditation Council for Graduate Medical Education mandates patient safety education without specific curricular guidelines. We hypothesized that a dedicated, adjunctive resident safety workshop (SW) led by surgical faculty compared with an online curriculum (OC) for hospital personnel alone would improve residents' patient safety perceptions and behaviors. MATERIALS AND METHODS A pilot randomized controlled trial was performed from 2014 to 2015 within a university-based general surgery residency. Control and intervention groups, stratified by postgraduate year, participated in a hospital-based OC; the intervention group participated in an additional SW. Primary outcomes were perceptions of safety culture, teamwork, and speaking up as per the validated safety attitudes questionnaire (SAQ) at 6 and 12 months postintervention. Secondary outcomes included behavioral scores from blinded surgical faculty using the Oxford NonTechnical Skills scale. RESULTS A total of 51 residents were enrolled (control = 25, intervention = 26). SAQ response rates were 100%, 100%, and 76% at baseline, 6 months, and 12 months, respectively. SAQ scores were similar at baseline between groups and did not change significantly at 6 or 12 months, independent of postgraduate year (PGY) level. Overall NonTechnical Skills scores were similar between groups, but senior residents (≥PGY 4) in the OC + SW group scored significantly higher in teamwork, decision-making, and situation awareness (all p < 0.05). CONCLUSION An adjunctive, dedicated resident SW compared with a hospital-based OC alone did not significantly improve overall perceptions of patient safety. However, senior residents participating in the SW demonstrated improved patient safety perceptions and had significantly better intraoperative safety behaviors than senior residents in the OC group. Future curricular enhancements should include PGY-level specific education, iterative reviews, and increased faculty involvement. A larger randomized trial may be warranted.
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Affiliation(s)
- Luke R Putnam
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Dean H Pham
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas
| | - Tiffany G Ostovar-Kermani
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas
| | - Zeinab M Alawadi
- Department of General Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Jason M Etchegaray
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Madelene J Ottosen
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Eric J Thomas
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Donald P Lesslie
- Department of General Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Lillian S Kao
- Department of General Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
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