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Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents
  1. William Martinez1,
  2. Lisa Soleymani Lehmann2,3,
  3. Eric J Thomas4,
  4. Jason M Etchegaray5,
  5. Julia T Shelburne6,
  6. Gerald B Hickson7,
  7. Donald W Brady8,
  8. Anneliese M Schleyer9,
  9. Jennifer A Best9,
  10. Natalie B May10,
  11. Sigall K Bell11
  1. 1Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  3. 3National Center for Ethics in Health Care, Veterans Health Administration, Washington DC, USA
  4. 4Memorial Hermann Center for Healthcare Quality and Safety, The University of Texas Medical School at Houston, Houston, Texas, USA
  5. 5The RAND Corporation, Santa Monica, California, USA
  6. 6Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas, USA
  7. 7Quality, Safety & Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  8. 8Office of Graduate Medical Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  9. 9Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  10. 10Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
  11. 11Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr William Martinez, Division of General Internal Medicine, Vanderbilt University Medical Center, 1215 Twenty-first Avenue South, 6000 Medical Center East, NT, Nashville, TN 37232-8300, USA; william.martinez{at}vanderbilt.edu

Abstract

Background Open communication between healthcare professionals about care concerns, also known as ‘speaking up’, is essential to patient safety.

Objective Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.

Design Anonymous, cross-sectional survey.

Setting Six US academic medical centres, 2013–2014.

Participants 1800 medical and surgical interns and residents (47% responded).

Measurements Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.

Results Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).

Conclusions Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.

  • Safety culture
  • Communication
  • Graduate medical education

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Footnotes

  • Twitter Follow William Martinez @DrWillMartinez

  • Contributors Study conception and design: WM, LSL, EJT, JME, GBH and SKB. Acquisition of data: WM, JTS, DWB, AMS, JAB and NBM. Analysis of data: WM and JME. Interpretation of data and critical revision: all authors. Drafting of manuscript: WM.

  • Funding American Philosophical Society; National Center for Advancing Translational Sciences (UL1 TR000445); The Arnold P. Gold Foundation; Brigham and Women's Hospital; National Institute of Child Health and Human Development (1K24HD053771); Health Resources and Services Administration (T32HP10251).

  • Competing interests None declared.

  • Ethics approval IRB at each study site.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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