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Abstract
Objectives To determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice.
Design Cross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression models
Setting 4 hospitals with a total of nine sites from the German, French and Italian speaking part of Switzerland.
Participants Survey data were collected from 979 nurses and doctors.
Main outcome measures Frequencies of perceived patient safety concerns, of withholding voice and of speaking up behaviour. Speak up-related climate measures included psychological safety, encouraging environment and resignation.
Results Perceived patient safety concerns were frequent among doctors and nurses (between 62% and 80% reported at least one safety concern during the last 4 weeks depending on the single items). Withholding voice was reported by 19%–39% of HCWs. Speaking up was reported by more than half of HCWs (55%–76%). The frequency of perceived concerns during the last 4 weeks was positively associated with both speaking up (OR=2.7, p<0.001) and withholding voice (OR=1.6, p<0.001). An encouraging environment was related to higher speaking up frequency (OR=1.3, p=0.005) and lower withholding voice frequency (OR=0.82, p=0.006). Resignation was associated with withholding voice (OR=1.5, p<0.001). The variance in both voicing behaviours attributable to the hospital-site level was marginal.
Conclusions Our results strengthen the importance of a speak up-supportive safety climate for staff safety-related communication behaviours, specifically withholding voice. This study indicates that a poor climate, in particular high levels of resignation among HCWs, is linked to frequent ‘silence’ of HCWs but not inversely associated with frequent speaking up. Interventions addressing safety-related voicing behaviours should discriminate between withholding voice and speaking up.
- communication
- patient safety
- safety culture
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Footnotes
Contributors DS and AR designed the study and interpreted the results. AR led the field phase. DS conducted the statistical analyses. Both authors approved the final manuscript.
Funding This study was funded by the Federal Office of Public Health, Switzerland (grant no. 15.002825).
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval The study was exempted from full ethical review by the Ethics Committee of the Canton of Zurich, Switzerland (BASEC-Nr. Req-2016-00462).
Provenance and peer review Not commissioned; externally peer reviewed.