Building a Workplace-Based Learning Culture: The “Receiver's” Perspective on Speaking Up

Barlow, Melanie; Watson, Bernadette Maria; Jones, Liz; Morse, Kate J.; Maccallum, Fiona; Rudolph, Jenny W.

doi:10.1177/00218863231190951

The Journal of Applied Behavioral Science

2023

DOI: 10.1177/00218863231190951

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Building a Workplace-Based Learning Culture: The “Receiver's” Perspective on Speaking Up

Melanie Barlow

Bernadette Maria Watson

Liz Jones

et al.

Abstract: Nurturing psychological safety has become a vital antidote to the psychological depletion driving clinicians from healthcare. How to support the clinician's voice, the question at the heart of this study, has never been more important. Here, we explore a hidden aspect of speaking up conversations, how “receivers” experience the dialog. If, when, and how clinicians take in clinically relevant concerns from others is crucial to patient safety. Yet we know little about how different forms of speaking up impact th… Show more

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Cited by 5 publications

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React, reframe and engage. Establishing a receiver mindset for more effective safety negotiations

Barlow,

Watson,

Morse

et al. 2023

JHOM

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PurposeThe response of the receiver to a voiced patient safety concern is frequently cited as a barrier to health professionals speaking up. The authors describe a novel Receiver Mindset Framework (RMF) to help health professionals understand the importance of their response when spoken up to.Design/methodology/approachThe framework draws on the broader receiver-focussed literature and integrates innovative findings from a series of empirical studies. These studies examined different receiver behaviour within vignettes, retrospective descriptions of real interactions and behaviour in a simulated interaction.FindingsThe authors' findings indicated that speaking up is an intergroup interaction where social identities, context and speaker stance intersect, directly influencing both perceptions of and responses to the message. The authors' studies demonstrated that when spoken up to, health professionals poorly manage their emotions and ineffectively clarify the speaker's concerns. Currently, targeted training for receivers is overwhelmingly absent from speaking-up programmes. The receiver mindset framework provides an evidence-based, healthcare specific, receiver-focussed framework to inform programmes.Originality/valueGrounded in communication accommodation theory (CAT), the resulting framework shifts speaking up training from being only speaker skill focussed, to training that recognises speaking up as a mutual negotiation between the healthcare speaker and receiver. This framework provides healthcare professionals with a novel approach to use in response to speaking up that enhances their ability to listen, understand and engage in point-of-care negotiations to ensure the physical and psychological safety of patients and staff.

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React, reframe and engage. Establishing a receiver mindset for more effective safety negotiations

Barlow,

Watson,

Morse

et al. 2023

JHOM

View full text Add to dashboard Cite

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The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study

et al. 2023

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Background Research focused on understanding what enables or hinders health professionals to speak up about a safety concern has been to date predominately atheoretical and speaker focused. However, the role the receiver of the message plays in these often-difficult encounters is highly influential. To date, speaking up programs have created conversational mnemonics that technically should respectfully engage the receiver, yet speaking up remains challenging. This paper utilises Communication Accommodation Theory to explore the impact the communication behaviour and speaker characteristics has on the receiver of a speaking up message, and if these impacts differ between receiver groups (clinical disciplines). Method Clinicians (N = 208) from varying disciplines responded to two hypothetical speaking up vignettes, where participants were the receivers of speaking up messages. Analysis of variance was used to explore any potential differences between receiver groups. Results Findings indicated that the level of perceived accommodation and group membership, whether defined by speaker discipline or seniority, collectively influenced how the receiver of a speaking up message evaluated the interaction, which influenced their anticipated response to the speaker. Conclusions The receiver’s perceptions and evaluations of the message, their own professional identity and the presence of others, influenced receivers’ anticipated responses. This has direct implications on healthcare speaking up training and provision of care, as the varying clinical disciplines received and responded to the same messages differently.

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Identification of the barriers and enablers for receiving a speaking up message: a content analysis approach

et al. 2023

Self Cite

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Background Within healthcare, the barriers and enablers that influence clinicians’ ability to speak up are well researched. However, despite the receiver of the message being identified as a key barrier to a speaker voicing a concern, there have been very few receiver-focused studies. As a result, little is known about the barriers and enablers that influence message reception. Understanding these can help inform speaking up training and ultimately enhance patient safety through more effective clinical communication. Objectives To identify enabling or inhibiting factors that influence the receiver’s reception and response to a speaking up message, and if the identified barriers and enablers are related to speaker or receiver characteristics. Design and methods Twenty-two interdisciplinary simulations were video recorded and transcribed. Simulation participants formed the patient discharge team and were receivers of a speaking up message, delivered by a nurse at the patient’s bedside. How the message was delivered (verbose or abrupt wording), was manipulated and counterbalanced across the simulations. Within the post simulation debriefs, barriers and enablers of being a receiver of a message were explored using content analysis. Setting/participants This study took place in a large Australian tertiary healthcare setting. Participants were qualified clinicians of varying disciplines and specialties. Results A total of 261 barriers and 285 enablers were coded. Results showed that how the message was delivered (differing tone, phases, and manner) influenced what receivers identified as barriers and enablers. Additionally, the receiver’s own cognitive processes, such as making positive attributions of the speaker and attempting to build rapport and collegiality, better enabled message reception and response. Receiver behaviour was negatively impacted by listening to fix, rather than understand, and not knowing in the moment how to manage their own reactions and appropriately frame a response. Conclusion The debriefings identified key barriers and enablers to receiving a speaking up message that differ from those previously identified for senders of the speaking up message. Current speaking up programs are predominately speaker centric. This study identified that both speaker and receiver behaviour influenced message reception. Therefore, training must place equal attention on both the speaker and receiver and be inclusive of experiential conversational rehearsal of both positive and challenging encounters.

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Building a Workplace-Based Learning Culture: The “Receiver's” Perspective on Speaking Up

Cited by 5 publications

References 53 publications

React, reframe and engage. Establishing a receiver mindset for more effective safety negotiations

React, reframe and engage. Establishing a receiver mindset for more effective safety negotiations

The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study

Identification of the barriers and enablers for receiving a speaking up message: a content analysis approach

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