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

Abstract

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.

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

“…Whiting, Maynes [ 18 ] suggested future studies need to ascertain how group membership of the voicer (speaker) and rater (receiver), could possibly influence these outcomes. Our study confirms that speaking up conversations within the health context are strongly influenced by group membership, as defined by clinical discipline and seniority [ 25 ]. We recommend further research needs to be undertaken to see if the inclusion of recommendations as a generic and standard speaking up process enhances or inhibits message reception, and in what context (low or high stakes situations).…”

“…Schwappach and Gehring [ 32 ] found that the presence of the patient inhibited speaking up, mostly due to the speaker’s desire not to humiliate a colleague in public or lose patient trust. Our work across multiple receiver focused studies has found that indeed, the presence of an audience consistently influences the receiver’s reactions and responses, particularly nurses and midwives and when the speaker uses less accommodative language [ 25 , 46 ]. Clearly, to enhance message reception, both the speaker and receiver need to negotiate not just the raised concern, but also the context in which the conversation occurs (in nonlife-threatening situations).…”

“…Simulation was used as a means to create a situation where a patient safety negotiation was required. The authors have previously studied receiver behaviour (message reception and response) in one-to-one interactions (one speaker, one receiver) [ 5 , 25 ]. This study extended the knowledge of receivership and added the complexity of speaking up to an interdisciplinary team without a clearly identified receiver.…”

“…Communication Accommodation Theory (CAT) [ 26 ] posits that how a message is delivered and its perceived level of accommodation (meeting the receiver’s communication needs and level of communication competence) influences message reception, response, attributions made by the receiver and their behaviour in future interactions [ 27 ]. Within our other receiver focused studies via self-reported data, the application of CAT has helped to demonstrate how receiver reactions and responses have been consistently influenced by message delivery [ 25 ]. Therefore, we deemed it important that the speaking up messages should vary in tone, manner, and phrasing to ascertain if the level of speaker accommodation influenced receiver reactions and responses within an observed interaction (simulation).…”