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

Martínez, William; Lehmann, Lisa Soleymani; Thomas, Eric J.; Etchegaray, Jason Michel; Shelburne, Julia; Hickson, Gerald B.; Brady, Donald; Schleyer, Anneliese M.; Best, Jennifer A.; May, Natalie; Bell, Sigall K.

doi:10.1136/bmjqs-2016-006284

Cited by 99 publications

(84 citation statements)

References 54 publications

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“…Additionally, none of the included studies specially focus on speaking up about unprofessional behaviours. A recent study24 reported that 75% of the respondents observed unprofessional behaviours, however, reported speaking up about unprofessional behaviours was uncommon.…”

Section: Discussionmentioning

confidence: 97%

Conflict resolution in anaesthesia: systematic review

2018

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BackgroundConflict is a significant and recurrent problem in most modern healthcare systems. Given its ubiquity, effective techniques to manage or resolve conflict safely are required.ObjectiveThis review focuses on conflict resolution interventions for improvement of patient safety through understanding and applying/teaching conflict resolution skills that critically depend on communication and improvement of staff members’ ability to voice their concerns.MethodsWe used the Population-Intervention-Comparator-Outcome model to outline our methodology. Relevant English language sources for both published and unpublished papers up to February 2018 were sourced across five electronic databases: the Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science.ResultsAfter removal of duplicates, 1485 studies were screened. Six articles met the inclusion criteria with a total sample size of 286 healthcare worker participants. Three training programmes were identified among the included studies: (A) crisis resource management training; (B) the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training; and (C) the two-challenge rule (a component of TeamSTEPPS), and two studies manipulating wider team behaviours. Outcomes reported included participant reaction and observer rating of conflict resolution, speaking up or advocacy-inquiry behaviours. Study results were inconsistent in showing benefits of interventions.ConclusionThe evidence for training to improve conflict resolution in the clinical environment is sparse. Novel methods that seek to influence wider team behaviours may complement traditional interventions directed at individuals.

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Section: Discussionmentioning

confidence: 97%

Conflict resolution in anaesthesia: systematic review

2018

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“…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%

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

et al. 2019

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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.

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“…In the study by Martinez and colleagues, residents reported witnessing unprofessional behaviour more frequently than they observed patient safety breaches (75% vs 46%; p<0.001) 5. They also reported speaking up less frequently about unprofessional behaviour than about traditional safety threats (46% vs 71%; p<0.001) despite their view that this is important for patient safety.…”

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confidence: 96%

“…Residents now undergo formal training about the importance of contributing to a culture of safety by speaking up to avoid errors or harm, but still face difficulties enacting these behaviours in practice 4. In this issue of the journal, Martinez et al have attempted to tease out differences in speaking-out behaviours between traditional and professionalism-related patient safety threats 5. The authors have raised several interesting points worthy of further exploration.…”

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confidence: 99%

“…It acknowledges that individual practitioners should not be held responsible for mistakes or errors that they commit in a system that is poorly or suboptimally designed; however, individuals are still very much responsible for their choices and actions regardless of the shortcomings in a system. Some actions can be considered ‘at-risk’ behaviours, such as taking short cuts or not completing important clinical tasks in a timely manner (eg, late signing off on discharge summaries), or perhaps, as in the example in Martinez et al ,5 not paying attention at rounds. Other behaviours can be considered reckless, such as deliberately ignoring key safety steps, which puts patients at risk.…”

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confidence: 99%

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