RT Journal Article SR Electronic T1 A cross-cultural survey of residents’ perceived barriers in questioning/challenging authority JF Quality and Safety in Health Care JO Qual Saf Health Care FD BMJ Publishing Group Ltd SP 277 OP 283 DO 10.1136/qshc.2005.017368 VO 15 IS 4 A1 H Kobayashi A1 M Pian-Smith A1 M Sato A1 R Sawa A1 T Takeshita A1 D Raemer YR 2006 UL http://qualitysafety.bmj.com/content/15/4/277.abstract AB Objectives: To identify perceived barriers to residents’ questioning or challenging their seniors, to determine how these barriers affect decisions, and to assess how these barriers differ across cultures. Method: A written questionnaire was administered to residents in teaching hospitals in the US and Japan to assess factors affecting residents’ willingness to question or challenge their superiors. The responses were analyzed for statistical significance of differences between the two cultures and to determine the importance of issues affecting decisions. Results: Questionnaires were completed by 175 US and 65 Japanese residents, with an overall response rate of 71%. Trainees from both countries believe that questioning and challenging contribute to safety. The perceived importance of specific beliefs about the workplace differed across cultures in seven out of 22 questions. Residents’ decisions to make a challenge were related to the relationships and perceived response of the superiors. There was no statistical difference between the US and Japanese residents in terms of the threshold for challenging their seniors. Conclusion: We have identified attributes of residents’ beliefs of communication, including several cross-cultural differences in the importance of values and issues affecting one’s decision to question or challenge. In contrast, there was no difference in the threshold for challenging seniors by the Japanese and US residents studied. Changes in organizational and professional culture may be as important, if not more so, than national culture to encourage “speaking up”. Residents should be encouraged to overcome barriers to challenging, and training programs should foster improved relationships and communication between trainers and trainees.