Speak up-related climate and its association with healthcare workers’ speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland

Abstract

ObjectivesTo determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice.DesignCross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression modelsSetting4 hospitals with a total of nine sites from the German, French and Italian speaking part of Switzerland.ParticipantsSurvey data were collected from 979 nurses and doctors.Main outcome measuresFrequencies of perceived patient safety concerns, of withholding voice and of speaking up behaviour. Speak up-related climate measures included psychological safety, encouraging environment and resignation.ResultsPerceived patient safety concerns were frequent among doctors and nurses (between 62% and 80% reported at least one safety concern during the last 4 weeks depending on the single items). Withholding voice was reported by 19%–39% of HCWs. Speaking up was reported by more than half of HCWs (55%–76%). The frequency of perceived concerns during the last 4 weeks was positively associated with both speaking up (OR=2.7, p<0.001) and withholding voice (OR=1.6, p<0.001). An encouraging environment was related to higher speaking up frequency (OR=1.3, p=0.005) and lower withholding voice frequency (OR=0.82, p=0.006). Resignation was associated with withholding voice (OR=1.5, p<0.001). The variance in both voicing behaviours attributable to the hospital-site level was marginal.ConclusionsOur results strengthen the importance of a speak up-supportive safety climate for staff safety-related communication behaviours, specifically withholding voice. This study indicates that a poor climate, in particular high levels of resignation among HCWs, is linked to frequent ‘silence’ of HCWs but not inversely associated with frequent speaking up. Interventions addressing safety-related voicing behaviours should discriminate between withholding voice and speaking up.

Speaking up about patient safety in psychiatric hospitals – a cross‐sectional survey study among healthcare staff

“…Scores on the negatively worded resignation‐related items were rather low, which is a positive finding. Resignation is associated with higher levels of withholding voice (Schwappach & Richard ), and if reinforced over a long time, it can turn into organizational silence.…”

“…The SUPS‐Q has been validated and successfully used to assess different speak up dimensions in the acute care setting (Richard et al, ; Schwappach & Richard ; Schwappach et al, ). In this study, we used the adapted SUPS‐Q‐PSYCH for the first time.…”

“…Development and psychometric evaluation of the SUPS‐Q are reported elsewhere (Richard et al, ). The survey has been used to study speaking up in a variety of hospitals in Switzerland and recently Austria (Schwappach ; Schwappach & Richard ; Schwappach et al, ). In brief, the instrument assesses speak up‐related behaviour with 11 items organized in three scales: i) the frequency of perceived safety concerns (3 items); ii) the frequency of withholding voice, that is NOT speaking up in specific situations (4 items); and iii) the frequency of speaking up (4 items).…”

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

“…In the social sciences, speaking up in order to exchange ideas, information or concerns that may benefit the organisation is often referred to as 'voice behaviour'. 1,12,[17][18][19][20] Three types of voice can be distinguished: the suggestion-focused, the problem-focused and the opinion-focused voice. 1,21 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.…”

“…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.…”