• Communication
• Safety culture
• Healthcare quality improvement

Communication failure constitutes a key contributor to healthcare errors.1 ,2 In addition to poor communication and poor hand-offs, failure to speak up when one recognises a potential safety problem—unsafe acts or unprofessional behaviour—represents an important example of communication failure. Despite on-going calls for clinicians to speak up when they notice threats to patient safety, speaking up remains difficult due to fear of repercussions,3 ,4 power differences and authority gradients,1 ,5 among other factors. Some evidence suggests that clinicians may not speak up even when they perceive substantial potential for harm.6

In an effort to tackle the issue of speaking up, Martinez et al7 present preliminary psychometrics for a new measure of speaking up climate. This paper makes an important contribution to the literature, as the field can certainly benefit from a measure that focuses on perceptions and enablers of ‘speaking up’. Martinez et al study two scales. The first measures the climate for speaking up about traditional patient safety concerns (SUC-Safe), such as improper sterile technique or an inadequate hand off. The second scale focuses on perceptions of speaking up about professionalism-related safety concerns (SUC-Prof), such as covering up an error, false documentation or disruptive behaviour. Both of these areas—traditional patient safety concerns and unprofessional behaviours—clearly represent important targets for ‘speaking up’ by members of the care team.

Several of the findings from Martinez et al hold interest. Their results comparing per cent positive scores on their speaking up climate scales when compared with more general safety attitudes scores (measured using the Safety Attitudes Questionnaire8) highlight residents’ overall reluctance to speak up in general, but particularly regarding professionalism issues. These findings can drive change …