Table 1 Summary of studies
From: As a critical behavior to improve quality and patient safety in health care: speaking up!
Reference number | Author(s) and study year | Study type | Country | Number of the Respondents/Participants/Cases/Reports/Scenarios | Study topic | Results/Findings |
|---|---|---|---|---|---|---|
[27] | Szymczak J.E., (2015) | Cross Sectional | US | n: 103 Interviews with clinicians | Infections and interaction rituals in the organization: Clinician accounts of speaking up or remaining silent in the face of threats to patient safety | There are three influences on the decision to speak up that shaped by background conditions in the organization such as; mutual focus of attention, interactional path dependence and the presence of an audience. According to the findings, the decision to speak up in a clinical setting is dynamic, highly context-dependent, embedded in the interaction rituals that suffuse everyday work and constrained by organizational dynamics in healthcare. That article helps to understand of the reasons why speaking up in health care organization is not easy as thought. |
[34] | Yule S., Parker H. S., Wilkinson J., McKinley A., MacDonald J., Neill A., McAdam T., (2015) | RCT | US | n:16 (surgical residents) | Coaching Non-Technical skills Improves Surgical Residents’ Performance in a simulated Operating Room | Non-technical skills such as situation awareness, decision making, teamwork and leadership are critical for patient safety in the OR. Non- technical skills improved in the intervention group compared to those in control group (p: 0.04). Intervention group was faster to respond unstoppable bleeding (p: 0.03) |
[56] | Rosenstein H. A. (2015) | Progress Report | US | n/a | Physician Disruptive Behaviors: Five Year Progress Report | Disruptive behaviors in healthcare can have a significant adverse effect on staff interactions that can negatively impact staff satisfactions, staff performances and patient outcomes of care. |
[19] | Ulrich B., Kear T., (2015) | Cross Sectional | US | n: 979 (nephrology nurses) | Patient Safety Culture in Nephrology Nurse Practice Settings: Initial Findings | Results demonstrated that there is high rated teamwork among colleagues but also, there is a continued need for communication, additional education, medication safety and prioritization in practice. For the results of communication openness: the statement of “Staff will freely speak up if they see something may negatively affect patient care,” 23 % were rated as 'always' while 44 % of the respondents indicated as 'most of the time' (67 % positive response which is less than the AHRQ average of 76 %). Also 605 of the respondents highlighted that they were informed about errors that happen in their unit (it is also below the average of AHRQ of 67 % in 2014). The reasons of miss reporting safety events by nurses and patient care technicians were lack of time, cumbersome documentation systems, lack of managerial support or follow up for an event and actual or perceived punishment towards the employee reporting an event. |
[57] | Law Y. B., Chan A. E. (2015) | Cohort | Hong Kong | n:18 new graduates | The experience of learning to speak up: a narrative inquiry on newly graduated registered nurses | The study result demonstrated the complex process of learning to speak up schematically. Three threads were found essential and these are: 1) learning to speak up requires more than one-off training and safety tools 2) mentoring speaking up in the midst of educative and miseducative experiences and 3) making public spaces safe for telling secret stories. |
[44] | Reid J., Bromiley M., (2012) | Cross Sectional | UK | a case study | Clinical human factors: the need to speak up to improve patient safety | Speaking up is responsibility of everyone in the team. It is not essential just for operating theatre but also applicable to any other relevant situations in health organization. It is obviously needed when staff and patient are at risk or vulnerable, and when the team members have lack of awareness. Speaking up is an essential action considered belong professional accountability. |
[58] | Schwappach D.L.B., Gehring K., (2015) | Cross Sectional | Switzerland | n:759 (nurses and doctors) | Frequency of and predictors for withholding patient safety concerns among oncology staff: a survey study | 70 % of the staff had chosen to remain silent when they had concerns about patient safety for least once in the past. 37 % of the staff also remained silent when they have information to prevent safety event at least once. Respondents highlighted that level of interpersonal communication and coping with skills are important to speak up about safety event. Respondents also stated that assertiveness, resilience and frustration tolerance are required for openness to speak up. |
[22] | Schwappach D.L.B., Gehring K., (2014) | Cross Sectional | Switzerland | n:1013 (nurses and doctors) | Silence that can be dangerous: a vignette study to assess healthcare professionals’ likelihood of speaking up about safety concerns | For missed hand disinfection, speaking up was significantly higher among managerial staff. Compared to senior staff, junior staff had two times discomfort about speaking up. Likelihood of speaking up was strongly influenced by contextual factors and seniority of the actor. It was also influenced by clinical frames, the level of perceived potential harm and decision difficulty. As an expected result, respondents were less likely to speak up to senior doctors. Lover expressed likelihood of speaking up was linked to younger age, male gender, being nurse and working on ward. |
[46] | Lyndon A., Johnson M.C., Bingham D., Napolitani P.G., Joseph G., Maxfield D.G., O’Keeffle D.F. (2015) | Cross Sectional | US | n: 3282 (physicians, nurses and midwifes) | Transforming communication and safety culture in intrapartum care: a multi-organization blueprint | Respondents stated that they had experienced shortcuts, missing competencies, disrespect and performance problem. Majority of the respondents highlighted the observed concerns undermined patient safety, caused harm on patient, or led healthcare providers to consider leaving from their current positions. Few respondents indicated that they had discussing their concerns while most of respondents indicated that many of their concerns remained unaddressed. Respondents also reported that when the patients were put on the risk by other colleagues, they experienced lack of listening and responsiveness. Speaking up is a dynamic process and context-dependent. It is affected by multiple things such as person, group, organization, human factors and leadership. |
[26] | Jansen Lockett J., Barkley L., Stichler J., Palomo J., Kik B., Walker C., Donnelly J., Willon J., Sanborn J., O’Byrne N. (2015) | Literature Review | US | n: 16 articles | Defining Peer-to-Peer Accountability From the Nurse’s Perspective | If there was positive culture of safety in healthcare organization, peer to peer accountability and speaking up were at desired level. However, if culture of safety was negative which means that it involves punitive actions and blames then nurses were less likely to speak up in the team. Nurses were more likely to not speak up towards managers, physicians, and more senior staff that they have more experience than them. |
[25] | Martinez W., Etchegaray J.M., Thomas E.J., Hickson G.B., Lehmann L.S., Schleyer A.M., Best J.A., Shelburne J.T., May N.B., Bell S.K. (2015) | Cohort | US | n: 837 | Speaking up’ about patient safety concerns and unprofessional behaviour among residents: validation of two scales | Study provided two scales that they are “speaking up climates patient safety concerns (SUC-Safe)” and “speaking up climates unprofessional behaviour (SUC-Prof). Scales help to measure safety and teamwork climate, assess degree of a culture that encourages speaking up about safety and professionalism concerns, identify educational needs and track the progress in relevant interventions.” Study results indicated that: 1) SUC for safety and SUC for professionalism were different from each other. 2) Providing prior formal training about patient safety was linked with more positive perceptions of speaking up climates for safety, not for professionalism. 3) Compared to males, female respondents were more likely to have negative perceptions of SUC for professionalism. |
[59] | Putnam R.L., Levy M.S., Kellagher M. C., Etchegaray M.J., Thomas J.E., Kao S.L., Lally P.K., Tsao K., (2015) | Cohort | US | n: 136 (surgeons, anesthesiologists and nurses) | Surgical resident education in patient safety: where can we improve? | Three safety domains (Safety Culture, Teamwork and Speaking Up) were scored higher among perioperative staff than surgical staff however it was found significant just for safety culture. Compared with surgery residents, surgery faculty scored higher in safety culture and speaking up. Respondents scored lowest for “I feel free to question the decision or action of those with more authority”(30 %). Senior respondents scored lower than juniors in the speaking up however it was not statistically significant (p > 0.05). Compared with direct care providers (preoperative, circulating, scrub and postoperative nurses), surgical and anesthesia faculties scored lower in the speaking up although, these differences were not significant (p = 0.32) |
[36] | Lukewich J., Edge D.S., Tranmer J., Raymond J., Miron J., Ginsburg L., VanDenKerkhof E. (2015) | Cross Sectional | Canada | n:714 nursing students | Undergraduate baccalaureate nursing students’ self-reported confidence in learning about patient safety in the classroom and clinical settings: an annual cross-sectional study (2010–2013) | Majority of the nursing students didn’t feel comfortable to speak up when safety events occur. |
[41] | Kent L., Anderson G., Ciocca R., Shanks L., Enlow M., (2015) | Cohort | US | n/a | Effects of a senior practicum course on nursing students’ confidence in speaking up for patient safety | After senior practicum course applied to student, their confidence increased significantly however students’ confidences in questioning someone of authority were not found statistically significant. |
[60] | Hemingway W.M., O’Malley C., Silvestri S. (2015) | Cohort | US | n: 90 (RNs, Surgical Technologists, OR Assistants, Operational Associates) | Safety Culture and Care: A Program to Prevent Surgical Errors | There was 54 % increase in respondents that they would speak up if they are experiencing safety events. |
[61] | Nancy Y.J., Ryan D., Scott M.C., Daniele B., Katerune O., (2014) | Cross Sectional | US | n: 641 interviews | Communication and psychological safety in veterans health administration work environments | Interviewees indicated that they felt safer to speak up in a psychologically safe work environment. Shared workmates norms and values about speaking up affected willingness to speak up in the organization. So that, not just employee-leader interactions but also coworker relationship plays important role for building psychological safe environment to speak up. Lack of organizational response and confidence came up with unsafe psychological workplace. |
[28] | Barzallo Salazar M.J., Minkoff H., Bayya J., Gillett B., Onoriode H., Weedon J., Altshuler L., Fisher N. (2014) | RCT | US | n:55 (encouraged (n = 28) or discouraged (n = 27) groups) | Influence of surgeon behavior on trainee willingness to speak up: a randomized controlled trial | The study aimed to identify how surgeon’s behaviors can encourage or discourage medical students to speak up when there is a safety event. The results indicated that encouraged group were more likely to speak up than discouraged group. (82 % vs 30 % and p < 0.001). The senior surgeons plays an essential role to improve and enhance patient safety and intraoperative communication at OR. |
[40] | Hughes M.K., Benenson S. R., Krichten E.A., Clancy D.K., Ryan P.J., Hammond C., (2014) | Cohort | US | n:160 | A Crew Resource Management Program Tailored to Trauma Resuscitation Improves Team Behavior and Communication | After Crew Resource Management (CRM) training applied to employees, results showed that healthcare staff were more likely to speak up when they have concern about safety. (p < 0.002) |
[23] | Schwappach D.L., Gehring K., (2014) | Cross Sectional | Switzerland | n: 39 (32 physicians and 7 nurses at oncology unit) | Trade-offs between voice and silence: a qualitative exploration of oncology staff’s decisions to speak up about safety concerns | Damaging relationship with coworker was one of the barrier to speak up. Speaking up with well-known co-worker was relatively easier than speaking to other professionals. Lack of interpersonal relationships among professionals increased risks and potential cost of not speaking up. Respondents also concerned about speaking up while patient was present in same place. 1/3 of the interviewees thought that it caused lose in trust of the patient. Presence of other persons, knowledge gap, hierarchy, limited time and fears of speaking up were highlighted as barriers to speak up among the staff. |
[35] | Schwappach D.L., Gehring K., (2014) | Cross Sectional | Switzerland | n: 32 | Saying it without words’: a qualitative study of oncology staff’s experiences with speaking up about safety concerns | Professionals often used non-verbal communication when the safety events occurred. Speaking up was strongly linked to safety problems. Being silence associated with issues such as hygiene, isolation and invasive procedures. There was a culture and desire to speak up however “how” is remained due to hierarchicy. |
[20] | Okuyama A., Wagner C., Bijnen B., (2014) | Literature Review | Japan | 26 studies | Speaking up for patient safety by hospital-based health care professionals: a literature review | There were some factors that influencing speaking up in healthcare organization. These were motivation to speak up, contextual factors (organizational support, interdisciplinary policy making, teamwork, interpersonal relationships and attitude of leaders), individual factors (satisfaction, responsibility, confidence, communication skill and educational background), the perceived efficacy of speaking up, the perceived safety of speaking up (having fear), tactics and targets. |
[50] | Gauld R., Horsburgh S., (2014) | Cross Sectional | New Zealand | n: 10303 registered health professionals | Healthcare professional perspectives on quality and safety in New Zealand public hospitals: findings from a national survey | 57 % of respondents indicated that they worked together as a team with their District Health Board. 70 % of professionals agreed that they involved patients for improving their care. 69 % of respondents indicated that it was easy for them to speak up if they experience a safety event. The study found that there was an association between perceptions of stronger leadership and performances about three questions and survey items. |
[39] | O’Connor P., Byrne D., O’Dea A., McVeigh T.P., Kerin M.J., (2013) | Cohort | Ireland | n: 110 interns (junior physicians) | “Excuse me:” teaching interns to speak up | Knowledge of the interns increased significantly due to training program. There was an evidence to support a shift in attitudes towards intended direction related to need for speaking up to seniors. There was not an effect of training on behaviors of interns. |
[62] | Buetow S., Davis R., Callaghan K., Dovey S., (2013) | Panel Report (structured two round survey) | New Zealand | n: 11 internationally recognized experts on patient safety | What attributes of patients affect their involvement in safety? A key opinion leaders’ perspective | There were 13 attributes that essential for patients who would like to maximize safer care. They were found as: autonomy, awareness, conscientiousness, knowledge, rationality, responsiveness and vigilance. For instance, autonomy involves the ability to speak up, freedom to act independently. |
[37] | Bowman C., Neeman N., Sehgal N.L., (2013) | Cross Sectional | US | n: 121 medical students | Enculturation of unsafe attitudes and behaviors: student perceptions of safety culture | Teamwork’ and ‘Organizational Learning’ were rated highest while ‘communication openness’ and ‘non-punitive response to error ‘were rated lowest among the students. 56 % of the medical student indicated that they would not speak up if they witness to a safety event. 55 % of the respondents were afraid of asking questions related to safety events. 48 % of the students felt that safety events were held against them. Medical students indicated desire to increase additional training regarding to patient safety. |
[48] | Lee S.H., Kim J.S, Jeong Y.C., Kwak D.K., Chun J.H., Lee H.M., (2013) | Report | South Korea | n/a | Patient safety in spine surgery: regarding the wrong-site surgery | In order to promote safety culture at OR, the surgeons need to set up horizontal communication (eliminate hierarchicy) and enable all team members to speak up in existence of a safety concern. Creating safety culture that promotes speaking up is important. All team members must feel free to speak up when safety event was recognized by them. |
[11] | Lyndon A., Sexton J.B., Simpson K.R., Rosenstein A., Lee K.A., Wachter R.M. (2013) | Cross Sectional | US | n: 125 nurses and obstetricians | Predictors of likelihood of speaking up about safety concerns in labour and delivery | Likelihood of speaking up while controlling bravery and assertiveness linked to higher perception of harm, respondent role, specialty experience and site. Compared to nurses, common potential harm was rated lower by physicians. 12 % of the professionals were unlikely to speak up even if they perceived high potential harm. |
[63] | Garon M., (2012) | Cross Sectional | US | n:33 interviews (nurses) | Speaking up, being heard: registered nurses’ perceptions of workplace communication | Three domains were found that they played an important role in speaking up. These were ‘influences’ where organizational (peers, managers and administration) and individual things (cultural background, values, how they were raised, language and educational background) had an effect on nurses to speak up, ‘message transmission’ how safety relevant message was delivered and received and ‘outcomes’ about what were results of speaking up? Were there changes and feedbacks? |
[64] | Entwistle V.A., McCaughan D., Watt I.S., Birks Y., Hall J., Peat M., Williams B., Wright J., (2010) | Cross Sectional | UK | n: 71 individual interviews and 12 group discussions | Speaking up about safety concerns: multi-setting qualitative study of patients’ views and experiences | Ability to speak up depended on some evaluations such as workloads, priorities, relative importance of staff concerns, confidence about reasoning for relevant concern, roles, responsibilities, likely consequences of speaking up and gravity of threat of harm. There were diverse results of speaking up. Healthcare staff were sometimes averted harm or provided welcome while sometimes made anxieties which ended up with potential harm on patient. |
[49] | Banja J.D., Craig K., (2010) | Cross Sectional | US | 5 scenarios | Speaking up in case management, part II: implementing speaking up behaviors | Healthcare staff often remain silent due to fear of unhealthy relations with their peers. In order to enable healthcare staff to speak up, organizations and employees should recognize the value of speaking up mutually. |
[65] | Banja J.D., Craig K., (2010) | Cross Sectional | US | 5 scenarios | Speaking up in case management, part I: ethical and professional considerations | Fear of retaliation or organizational nonresponsiveness make “speaking up” often difficult. Ethical responsibility of case managers are ensuring their clients’ health and welfare rather than their professional self-interests. |
[66] | Donnelly F.L., Dickerson M.J., Goodfriend A.M., Muething E.S., (2010) | Cross Sectional | US | n:125 interviews | Improving Patient Safety in Radiology: Concepts for a Comprehensive Patient Safety Program | Creating a safety culture where professionals expected and encouraged to speak up is one of the components of culture transformation in healthcare organization. |
[67] | Bromiley M., Mitchell L., (2009) | Cross Sectional | UK | a case study | Would you speak up if the consultant got it wrong? …and would you listen if someone said you’d got it wrong? | The article suggested healthcare professionals to reflect around human error, teamwork, personal responsibilities about safety and non-technical skills (for example: speaking up). |
[68] | Blanco M., Clarke J.R., Martindeli D., (2009) | Cross Sectional | US | Analyzed 97 wrong site surgery cases | Wrong site surgery near misses and actual occurrences | Two of importance of teamwork and leadership aspects were empowering professionals to acknowledge concerns and speak up. |
[69] | Pian-Smith M.C., Simon R., Minehart R.D., Podraza M., Rudolph J., Walzer T., Raemer D. (2009) | Cross Sectional | US | n:40 subjects. 2 cases | Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety | Usage of the two-challenge rule and advocacy-inquiry which improved residents’ “speaking up” increased after debriefing. Frequency and quality of challenges towards doctors improved while there was no change for nurses. |
[43] | Seiden S.C., Galvan C., Lamm R., (2006) | Cross Sectional | US | 4 cases | Role of medical students in preventing patient harm and enhancing patient safety | Medical students may be good opportunity to prevent safety events and ensure safety in health care organizations. Cultural changes for patient safety were needed to increase proactive contribution of medical student. |
[30] | Saufl N.M., (2003) | Cross Sectional | US | n/a | Patients encouraged to “Speak Up” | Proactive patients were associated with better safety outcomes. Patient involvement and participating to decision making process were found as ways to reduce occurrence of medical events. |
[38] | Sayre M.M., McNeese-Smith D., Leach L.S., Phillips L.R. (2012) | Case Control | US | n: 104 RNs (51 control arm, 53 intervention arm) | An educational intervention to increase “speaking-up” behaviors in nurses and improve patient safety | Study results showed that, registered nurses in intervention arm had a significant difference in ‘mean speaking up scores’ from baseline to posttest (p < 0.0001) while control group was having no significant change (p = 0.68). There was a statistically significant differences in mean scores on the ‘list of individual nurse behaviors for intervention group (p = 0.0015) while there was no significant differences in control arm (p = 0.27). Training nurses regarding to speaking up can increase their perceptions of ability to improve safety and speak up. |
[70] | Rainer J., (2015) | Literature Review | US | 48 articles | Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy | Literature review showed that abilities to speak up may be depend on organizational culture, leadership support, communication style, oppression, power and culture. Theoretical framework on speaking up was illustrated in the study. |
[71] | Abdi Z., Delgoshaei B., Ravaghi H., Abbasi M., Heyrani A., (2015) | Cross Sectional | Iran | 20 interviews | The culture of patient safety in an Iranian intensive care unit | Lack of speaking up’ was found as a one of the safety challenges. |
[31] | Hrisos S., Thomson R., (2013) | Cross Sectional | UK | n: 59 (16 patients, 4 patients’ relatives, 39 healthcare staff) | Seeing it from both sides: do approaches to involving patients in improving their safety risk damaging the trust between patients and healthcare professionals? An interview study | Overall, positive results were founded however patients thought that speaking up might result with unintended consequences. Speaking up might appear rude or disrespectful, makes staff upset and endanger their care. Healthcare staff were found that they were welcoming patient’s questions. Providers thought that if patients asked many questions and wrote something, they probably will complain about them. Patient-mediated approaches which prompt patients to speak up criticized by professionals due to rarely considering the needs of healthcare staff. |
[51] | Jones A., Kely D., (2014) | Cross Sectional | UK | n/a | Deafening silence? Time to reconsider whether organizations are silent or deaf when things go wrong | Focusing just for organizational silence is a mistake due to misrepresenting safety events and complexities of safety culture. In order to find solutions, study suggested to focus on why healthcare organizations are deaf and disregard to staff concerns. Influencing and promoting for better culture of speaking up exist in such systems where there are better listening and valuing of provider concerns. Healthcare staff generally raise their concerns about safety events and expect to receive feedback (action taken or reasons for not acting). |
[72] | Spruce L., (2014) | Cross Sectional | US | n/a | Back to basics: preventing surgical site infections | Surgical site infection can be avoided via speaking up when sterile technique was broken by colleagues. Accountability to others and empowerment to speak up were found essential for improving quality of healthcare. |
[54] | Etchegaray J.M., Thomas E.J., (2015) | Literature Review | US | n:42 studies | Engaging Employees: The Importance of High-Performance Work Systems for Patient Safety | The High-Performance Work Systems survey (HPWSs) was found as a strongest predictor of extent to which healthcare practitioners felt confident to speak up about safety events. |
[73] | Liao J.M., Thomas E.J., Bell S.K., (2014) | Cross Sectional | US | a case study | Speaking up about the dangers of the hidden curriculum | Learning environment was shaped by individual decision to speak up or remain silent, promoting unprofessional behavior or following up better alternatives. Progress in creating safety culture with consideration of those things may enable students, residents, faculty and patients to speak up about safety event. |
[42] | Gupta R.T., Sexton J.B., Milne J., Frush D.P., (2015) | Cohort | US | n = 64 (11 physicians, 12 imaging fellows or residents, 19 nurses and 5 technologist or administrative staff) | Practice and quality improvement: successful implementation of TeamSTEPPS tools into an academic interventional ultrasound practice | Speaking up’ was one of the most respondent part of the study. After implementation of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), participants rated lower for “In this clinical area, it is difficult to speak up if I perceive a problem with patient care” (before implementation 69.4 % of agreement, after implementation 25.5 % agreement, p < 0.001) |
[29] | Muniak M.A., Cochrane D.D., Dijk V.M., Hamilton A., Schwarz K.W.S., O’Connor P.J., Sahjpaul L.R., (2014) | Cross Sectional | Canada | n/a | What Would I Want For My Surgery? | Changing OR safety culture to where all members of team have a common understanding of patient, patient’s needs, operative plan and the goals can facilitate detection of safety issue. In a better safety culture, members are more likely to speak up when they experience safety event. |
[24] | Raemer D.B., KolbeM., Minehart RD, Rudolph J.W., Pian-Smith M.C. (2015) | RCT | US | n = 71 [intervention (n = 35) and control (n = 36) groups] | Improving Anesthesiologists’ Ability to Speak Up in the Operating Room: A Randomized Controlled Experiment of a Simulation-Based Intervention and a Qualitative Analysis of Hurdles and Enablers | There was no statistically significant differences between intervention and control groups regarding to respect to speaking up actions. Uncertainty about the issue, familiarity with the individual, stereotypes of the others on the team, respect for experience and the repercussion expected were found as the five most frequent barriers to speak up. Having a second opinion or getting help, realizing the speaking up problem, certainty about the consequences of the speaking up and having a speaking up rubric were found as the five most frequent enablers for speaking up. |
[74] | Sur M.D., Schindler N., Singh P., Angelos P., Langerman A., | Cross Sectional | US | n = 18 interviews (senior residents across 4 surgical subspecialties) | Young surgeons on speaking up: when and how surgical trainees voice concerns about supervisors’ clinical decisions | A tension between prioritizing obligations to the patient and conceding ultimate decision making authority to supervisors were highlighted by the participants. There were factors that influencing the willingness to voice concerns such as supervisory (approachability), systematically (culture of safety in department, resident autonomy), clinically (risk of harm, evidence quality) and trainee (knowledge). Most of the concerns were expressed by the participants via using question form while few of the participants preferred to voice directly. |
[32] | Rance S., McCourt C., Rayment J., Mackintosh N., Carter W., Watson K., Sandall J.(2013) | Cross Sectional | UK | n = 58 patients (postnatal women) | Women’s safety alerts in maternity care: is speaking up enough? | Half of the women indicated that there were insistent and vehement communication with staff while experiencing failures. Interviewees also highlighted receiving lack of listening and responds from professionals. 14 women thought that they experienced urgent safety issues. The patients thought that the presence of their partners or relatives encouraged them to speak up when they have concerns. Distress and harm were described by the several women when the professionals failed to listen them. |
[33] | Rainey H., Ehrich K., Mackintosh N., Sandall J. (2015) | Cross Sectional | UK | n = 20 interviews (13 patients and 7 relatives) | The role of patients and their relatives in ‘speaking up’ about their own safety - a qualitative study of acute illness | Raising concerns from patients and their relatives were depend on their ability to recognize changes in ‘self-monitoring’, ‘culture and system of health care’, ‘clinical condition’ and ‘confidence and trust’. Healthcare staff displayed a role of mediator when there were concerns from patients and their relatives. |
[75] | Rabøl L.I., Andersen M.L., Ostergaard D., Bjørn B., Lilja B., Mogensen T. (2011) | Cross Sectional | Denmark | n = 84 root cause analyses reports (RCAR) of six hospitals | Republished error management: Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals | Verbal communication errors were identified in 44 reports which generated 52 % of the total number of the reports. ‘Hesitance in speaking up’ was found in 10 reports which generated 23 % of the verbal communication errors. |
[76] | Beyea S.C., (2008) | Cross Sectional | US | n/a | Speaking up for quality and patient safety | Raising concerns requires to have knowledge and understanding of best practices and scientific rationale. In order to advocate patient and serve to him/her, professional require to take a risk of voicing their concerns. Holding each other as an accountable or addressing safety events to peers were the things that needed for speaking up. |