• speaking up, patient engagement, patient experience, patient safety, communication

When Taiichi Ohno introduced ‘Stop the Line’ manufacturing, people were sceptical.1 2 Each assembly line worker was entrusted with the responsibility to push a red button to stop the line if she/he noticed something wrong. The idea was to catch problems early, before they got out of control. But the approach seemed at odds with production goals, namely keeping assembly lines running at full speed. Why not have managers, more trained in production, oversee the line and make fewer stops? Ohno’s idea seemed too risky to some managers, who resisted. Indeed, managers who implemented Stop the Line experienced a productivity drop. Investigating and fixing problems took time. But soon, things flipped. The teams using Stop the Line were faster and more reliable than those that did not and Stop the Line manufacturing became a standard Toyota approach.

When patients enter the hospital, they entrust clinicians to push a red button if they sense something wrong. But patients themselves, increasingly championed as ‘members of the team’ and ‘co-producers’ of health, are not always given a button nor taught how to use it.3–5 Patients and families—vigilant stakeholders—hold unique knowledge and can make important contributions to patient safety, having repeatedly demonstrated the ability to identify problems in care, including ones missed by clinicians.6–11 Parents, like James Titcombe, whose son died 9 days after birth from a delayed sepsis diagnosis, are often the first to detect important clues in their child’s course.12–14 Patients like Serena Williams, who correctly suspected a postpartum pulmonary embolism but was initially unheeded by her care team, may be the first to know something is wrong.15

In this issue of BMJ Quality & Safety, Fisher and colleagues16 studied patients’ speaking up to enable organisational learning. Adding a new question to the Hospital Consumer …