PT  - JOURNAL ARTICLE
AU  - David Schwappach
AU  - Aline Richard
TI  - Speak up-related climate and its association with healthcare workers’ speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland
AID  - 10.1136/bmjqs-2017-007388
DP  - 2018 Oct 01
TA  - BMJ Quality & Safety
PG  - 827--835
VI  - 27
IP  - 10
4099  - http://qualitysafety.bmj.com/content/27/10/827.short
4100  - http://qualitysafety.bmj.com/content/27/10/827.full
SO  - BMJ Qual Saf2018 Oct 01; 27
AB  - 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 modelsSetting 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.