Barriers of Pediatric Residents to Speaking Up About Patient Safety

Landgren, Rachel M.; Alawadi, Zeinab M.; Douma, Caryn; Thomas, Eric J.; Etchegaray, Jason Michel

doi:10.1542/hpeds.2016-0042

Cited by 41 publications

(64 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, as professionalism-related safety threats are increasingly recognised, we provide quantitative data on both prevalence and resident responses to such behaviours in the clinical learning environment, as called for by thought leaders to help better frame the problem and motivate solutions 28. Similar to prior studies,12 13 15 17 25 46 we found the likelihood of speaking up to be highly context-dependent, offering additional insights for organisational leaders to best support such advocacy. Although a study of labour and delivery nurses and obstetricians showed that bravery and assertiveness were not independently associated with speaking up, we found that moral courage was associated with the likelihood of speaking up, highlighting the importance of this specific virtue among physicians, and the potential unique role for this metric 39…”

Section: Discussionmentioning

confidence: 54%

“…This was particularly notable when they considered being in a bystander role, where only a third of residents reported a supportive environment for speaking up. Given prior research demonstrating that perceived personal responsibility for patients, perceived efficacy of speaking up and encouragement from senior team members may facilitate speaking up,2 13 14 42 our results underscore the importance of fostering collective accountability, caring and capable leadership, and continued focus on cultivating a supportive clinical learning environment 43…”

Section: Discussionmentioning

confidence: 60%

See 1 more Smart Citation

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 60%

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Moreover, employees who speak up can be viewed as tiring or strenuous, neither of which is favourable for residents . Thus, the benefits of speaking up are not self‐evident, especially not in the traditionally authoritarian health care context . The purpose of this study is to identify and test which factors are associated with speaking up by medical residents.…”

Section: Introductionmentioning

confidence: 99%

“…Most research on speaking up by medical residents stems from the quality and safety literature, it describes speaking up with an expected preventive effect and refers to the problem‐focused voice. This voice makes expressions of concern about work practices, incidents or behaviours that can be harmful to the organisation, such as in speaking up about (un)professional behaviour, (hand) hygiene, ethical issues and risky or deficient actions on the part of medical staff . In this study, we address a different type of speaking up, namely the use of the ‘suggestion‐focused voice’, which refers to the proactive communication of suggestions or ideas that might improve current work practices.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Speaking up, support, control and work engagement of medical residents. A structural equation modelling analysis

et al. 2019

View full text Add to dashboard Cite

ObjectivesMedical residents can play key roles in improving health care quality by speaking up and giving suggestions for improvements. However, previous research on speaking up by medical residents has shown that speaking up is difficult for residents. This study explored: (i) whether two main aspects of medical residents’ work context (job control and supervisor support) are associated with speaking up by medical residents, and (ii) whether these associations differ between in‐hospital and out‐of‐hospital settings.MethodsSpeaking up was operationalised and measured as voice behaviour. Structural equation modelling using a cross‐sectional survey design was used to identify and test factors pertaining to speaking up and to compare hospital settings.ResultsA total of 499 medical residents in the Netherlands participated in the study. Correlational analysis showed significant positive associations between each of support and control, and voice behaviour. The authors assumed that the associations between support and control, and voice behaviour would be partially mediated by engagement. This partial mediation model fitted the data best, but showed no association between support and voice. However, multi‐group analysis showed that for residents in hospital settings, support is associated with voice behaviour. For residents outside hospital settings, control is more important. Engagement mediated the effects of control and support outside hospital settings, but not within the hospital.ConclusionsThis study shows that in order to enable medical residents to share their suggestions for improvement, it is beneficial to invest in supportive supervision and to increase their sense of control. Boosting medical residents’ support would be most effective in hospital settings, whereas in other health care organisations it would be more effective to focus on job control.

show abstract

Improving safety through speaking up: An ethical and financial imperative

Novak

2019

J of Healthc Risk Manag

View full text Add to dashboard Cite

This article is ASHRM CE eligible. Earn 1.0 credit hours of Continuing Education by passing an online quiz based on your reading at Learning.ASHRM.org/JournalCEs. Background: Fostering a culture that empowers staff to speak up when concerned about the quality or safety of patient care is both an ethically 1 and economically 2 responsible endeavor. The Michigan Health & Hospital Association (MHA) Keystone Center has implemented the Speak-Up! Award program that acknowledges frontline health care staff for voicing their concerns and making care safer. The objective of this effort was to advance patient safety in Keystone Center member organizations through widespread, measurable culture improvement. After extensive data collection and analysis, there was a discernable improvement in culture survey results across a 2-year period coinciding with the launch and sustainment of the award program. Furthermore, in an effort to demonstrate the power of speaking up among staff, the Keystone Center applied a cost-savings framework to the types of harm avoided. Results from the cost-savings analysis suggest that each instance of speaking up by staff saves patients, families, and health care organizations an average of more than $13,000. Methods: Keystone Center Speak-Up! Award nominations were submitted through an electronic form that collects open, closed, and Likert-type question responses, producing a data array on type and severity of harm prevented, as well as the difficulty and magnitude of the decision to speak up. All data were then coded by harm type and subsequently applied to a tailored version of the cost-savings estimation framework used in the Great Lakes Partnership for Patients Hospital Improvement and Innovation Network. Safety culture was Results: The Keystone Center Speak-Up! Award program received 416 nominations across the 2-year study period, of which 62% (n = 258) were coded as a specific harm type. Adverse drug events (n = 153), imaging errors (n = 42), and specimen errors (n = 27) were the most common harm types prevented by speaking up. After applying the cost-savings framework to these data, it is estimated that for every instance of speaking up, approximately $13,000 in total expenses were avoided, which is in line with the findings from a report on the economic impact of medical errors sponsored by the Society of Actuaries. 3 Furthermore, culture survey results improved by 6% between 2015 and 2017, coinciding with the Keystone Center Speak-Up! Award program. Conclusions: The KeystoneCenter Speak-Up! Award has proven to be a valuable tool in recognizing staff awareness and willingness to raise concerns about quality and safety in health care. Data analysis from this program presents evidence that fostering a psychologically safe culture of speaking up yields fiscal and humanistic returns, both of which are crucial to sustainable, meaningful progress in safety and quality. However, further research is required to adequately gauge the degree to which safety culture improvement is proportional to cost...

show abstract

Barriers of Pediatric Residents to Speaking Up About Patient Safety

Cited by 41 publications

References 13 publications

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

Speaking up, support, control and work engagement of medical residents. A structural equation modelling analysis

Improving safety through speaking up: An ethical and financial imperative

Contact Info

Product

Resources

About