Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses’ willingness to speak up

Alingh, Carien W; Wijngaarden, Jeroen D H van; Voorde, Karina Van De; Paauwe, Jaap; Huijsman, Robbert

doi:10.1136/bmjqs-2017-007163

Cited by 83 publications

(105 citation statements)

References 53 publications

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“…This study replicates and extends prior research regarding the occurrence of failing to speak out and advocate on behalf of patients when adverse events or near misses occur. This study, like previous studies, exemplifies that there remains a need to integrate a culture of safety into the foundation of nursing practice, whereby RNs feel free to speak out for patient safety concerns without fear of retaliation (Agency for Healthcare Research & Quality, ; Alingh et al, ; Godlock et al, ; Sabol & Caughey, ; Vrbnjak et al, ). Nurses' failure to speak out regarding patient safety concerns is further humanized through the Joint Commission's, Sentinel Alert Event.…”

Section: Conclusion and Implications For Nursing Administrationsupporting

confidence: 64%

“…Moreover, the implications of this study are consistent with the current literature in that organizations and nursing leadership, through a systems‐thinking approach, need to have reporting systems in place to capture data involving near misses (Thoroman, Goode, & Salmon, ) in order to determine resolutions to achieve safe care delivery performance (AHRQ, ). Furthermore, the literature and healthcare entities such as the American Nurses Association, Agency for Healthcare Research and Quality and the Joint Commission are clear that it is critical that leadership establish a commitment‐based management approach that encourages staff to verbalize patient safety concerns without fear of retaliation (Alingh et al, ; Hall et al, ). Additionally, nurse educators also need to incorporate teaching strategies to increase student awareness of medication error prevention (Latimer, Hewitt, Stanbrough, & McAndrew, ) and help develop students into future health professionals who are empowered to report errors and safety concerns in the workplace (Fagan, Parker, & Jackson, ).…”

Section: Conclusion and Implications For Nursing Administrationmentioning

confidence: 99%

“…To Err is Human acknowledges the individual dedication and collective contributions of hospital staff who do their best to improve and save patient lives (Godock, Miltner, & Sullivan, ; Sabol & Caughey, ). However, while hospitals respond aggressively to patient safety issues with new technologies (Echevarria & Thorman, ) and quality improvement systems, there is a deeper problem that must be resolved, namely the need for nurses to speak out regarding issues and concerns that can potentiate patient harm (Hall, Klein, Betts, & DeRanieri, ), which is also a global concern (Alingh, Wijngaarden, Voorde, Paauwe, & Huijsman, ; Picolotto, Barrella, Moraes, & Gasperi, ).…”

Section: Introductionmentioning

confidence: 99%

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The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

et al. 2019

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Aim:To identify workplace factors that influence patient advocacy among registered nurses (RNs) and their willingness to report unsafe practices.Background: A prior study by Black illustrated that 34% of respondents were aware of conditions that may have caused patient harm but had not reported the issue. The most common reasons identified for failing to report issues were fear of retaliation and a belief that nothing would prevail from the reports. Method:Using Black's study as a model, reporting data were collected from a sample of RNs actively practicing in acute care hospitals.Results: While reasons for reporting are consistent with Black's study, data suggest that a nurse's experiences and working environment are prime factors in their willingness to report patient care issues. Conclusion:Although RNs may not have personally experienced workplace retaliation, fear of retaliation when reporting unsafe patient care practices still exists.Nursing leadership's ability to facilitate a culture of safety by proactively addressing unsafe practices fosters a level of comfort for patient advocacy and willingness to report issues. Education, professional associations and existing protection laws are available resources which contribute to organizational support systems. Implications for Nursing Management:The findings of this study are consistent with the literature in that organizations need to create a supportive workplace environment whereby, through collective input and leadership, reporting protocols are in place that empower RNs to report unsafe conditions. Direct care nurses are positioned, especially well to identify and speak up regarding conditions that may result in near misses or actual adverse events. Therefore, it is the responsibility, and duty, of nursing management to create and facilitate reporting systems that will be utilized without fear of retaliation and that will contribute to a culture of safety and patient advocacy. K E Y W O R D S patient advocacy, registered nurses, workplace factors | 1177 COLE Et aL.

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Section: Conclusion and Implications For Nursing Administrationsupporting

confidence: 64%

Section: Conclusion and Implications For Nursing Administrationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

et al. 2019

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“…Nurse Managers are an essential part of any hospital or health care facility. In their role, these professionals can effect change on the organization's culture and climate, however the results demonstrate that these managers do not realize the connection between organizational culture and patient safety (Alingh, Wijngaarden, Voorde, Paauwe, and Huijsman (). Results also indicate that promoting organizational commitment to speaking up through the creation of a positive organizational culture will both promote speaking up about medical errors and increase patient safety and as such, the burden is not only on the Nurse Managers but also the nursing staff to incorporate the organization's culture into everyday practice.…”

Section: Discussionmentioning

confidence: 95%

The influence of organizational culture, climate and commitment on speaking up about medical errors

2019

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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/KeyIssues: 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. K E Y W O R D S organizational culture, patient safety, speaking up | 131 LEVINE Et aL.

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“…Importantly, these changes also affect hierarchy and leadership in a team (e.g., Tschan et al, 2006), which in turn might affect members' voice behaviour. In healthcare, most studies have examined voice using surveys instead of observing actual team communication behaviour (Alingh et al, 2019;Martinez et al, 2017;Noort et al, 2019). This is problematic because attitudes towards voice in theory can vary from voice in practice: How participants think they would act (i.e., self-report) can differ from how they actually act (i.e., observation of behaviour during simulation scenario) in real teamwork situations (Argyris, 1980;Argyris and Schon, 1974).…”

Section: Introductionmentioning

confidence: 99%

Nurses’ voice: the role of hierarchy and leadership

Krenz

Burtscher

Grande

et al. 2020

LHS

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Purpose Voicing concerns and suggestions is crucial for preventing medical errors and improving patient safety. Research suggests that hierarchy in health-care teams impair open communication. Hierarchy, however, can vary with changing team composition, particularly during acute care situations where more senior persons join the team later on. The purpose of this study is to investigate how changes in hierarchy and leadership were associated with nurses’ voice frequency and nurses’ time to voice during simulated acute care situations. Design/methodology/approach This study’s sample consisted of 78 health-care providers (i.e. nurses, residents and consultants) who worked in 39 teams performing complex clinical scenarios in the context of interprofessional, simulation-based team training. Scenarios were videotaped and communication behaviour was coded using a systematic coding scheme. To test the hypotheses, multilevel regression analyses were conducted. Findings Hierarchy and leadership had no significant effect on nurses’ voice frequency. However, there were significant relationships between nurses’ time to voice and both hierarchy (γ = 30.00, p = 0.002; 95 per cent confidence interval [CI] = 12.43; 47.92) as well as leadership (γ = 0.30, p = 0.001; 95 per cent CI = 0.12; 0.47). These findings indicate that when more physicians are present and leadership is more centralised, more time passes until the first nurses’ voice occurred. Originality/value This study specifies previous findings on the relationships between hierarchy, leadership and nurses’ voice. Our findings suggest that stronger hierarchy and more centralised leadership delay nurses’ voice but do not affect the overall frequency of voice.

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Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses’ willingness to speak up

Cited by 83 publications

References 53 publications

The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

The influence of organizational culture, climate and commitment on speaking up about medical errors

Nurses’ voice: the role of hierarchy and leadership

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