Exploratory multivariate logistic regression analysis of factors associated with speaking up in traditional and professionalism-related safety threat vignettes
| Predictor | Traditional vignette: breach of sterile field OR (99% CI) | Professionalism vignette: inattentive colleague OR (99% CI) |
|---|---|---|
| Vignette characteristics | ||
| Speaking-up to a | ||
| Nurse | 1.07 (0.70 to 1.65) | 0.76 (0.56 to 1.02) |
| Intern (PGY-1) | 2.49 (1.49 to 4.16)* | 2.00 (1.48 to 2.70)* |
| Resident (PGY-2+) | 1.00 (reference) | 1.00 (reference) |
| Attending | 0.18 (0.12 to 0.26)* | 0.11 (0.07 to 0.16)* |
| Potential for patient harm (high)† | 2.80 (2.09 to 3.74)* | 5.47 (4.27 to 7.01)* |
| Perceived patient safety climates | ||
| SAQ-teamwork (positive perception, score ≥75) | 1.90 (1.36 to 2.66)* | 1.31 (0.99 to 1.74) |
| SAQ-safety (positive perception, score ≥75) | 0.97 (0.69 to 1.37) | 1.11 (0.84 to 1.47) |
| SUC-safe (positive perception, score ≥75) | 1.46 (1.02 to 2.09)* | 1.01 (0.77 to 1.33) |
| SUC-prof (positive perception, score ≥75) | 1.84 (1.05 to 3.20)* | 1.76 (1.23 to 2.50)* |
| Respondent characteristics | ||
| Male | 1.20 (0.90 to 1.59) | 1.52 (1.20 to 1.93)* |
| Intern (PGY-1) | 0.37 (0.28 to 0.50)* | 0.42 (0.32 to 0.55)* |
| Surgical specialty‡ | 1.65 (1.20 to 2.28)* | 3.03 (2.34 to 3.92)* |
| Moral courage (≥75th percentile) | 1.72 (1.13 to 2.62)* | 1.44 (1.08 to 1.92)* |
| Self-reported patient safety training | 1.02 (0.64 to 1.62) | 1.44 (0.94 to 2.20) |
| Study site† | ||
| Institution A | 0.91 (0.56 to 1.47) | 1.40 (0.95 to 2.06) |
| Institution B | 1.21 (0.72 to 2.03) | 1.11 (0.75 to 1.66) |
| Institution A/B§ | 0.92 (0.49 to 1.74) | 0.64 (0.39 to 1.02) |
| Institution C | 0.56 (0.35 to 0.88)* | 1.00 (0.67 to 1.47) |
| Institution D | 1.00 (reference) | 1.00 (reference) |
| Institution E | 0.70 (0.41 to 1.18) | 0.97 (0.63 to 1.49) |
| Institution F | 0.61 (0.37 to 1.02) | 1.71 (1.11 to 2.63)* |
| Model fit | ||
| c-Statistic | 0.83 | 0.84 |
| Hosmer-Lemeshow p value | 0.53 | 0.09 |
Traditional vignette: N=817 participants, n=3268 vignette judgements. Professionalism vignette: N=816 participants, n=3263 vignette judgements. Twenty participants were excluded due to missing data for one or more of the covariates, one participant did not complete the professionalism vignette and another did not complete one of the four professionalism vignette potential for harm judgements.
For our analyses, we categorised very or completely likely to speak up as ‘speaking up’ and not at all, slightly and moderately likely as ‘reticence’.
*OR with 99% CI that excludes 1.
†Perceived potential for harm to patients was dichotomised very low/low/moderate (low) versus high/very high (high).
‡Includes general surgery, plastic surgery, neurosurgery, orthopaedic surgery, urology and obstetrics and gynaecology.
§Interns and residents in combined residency programmes affiliated with both institutions A and B.
PGY, postgraduate year; SAQ, Safety Attitudes Questionnaire; SUC-Prof, Speaking Up Climate for Professionalism scale; SUC-Safe, Speaking Up Climate for Patient Safety scale.