Table 1

Two vignettes for assessing the likelihood of speaking up about traditional and professionalism-related patient safety threats

Clinical frameScenarioSpeaking up judgementsResponse options*
Traditional safety threat (breach of sterile field)You are talking with your patient in their hospital room when a clinician comes in to place a central catheter (eg, peripherally inserted central catheter, PICC or internal jugular central line) on the patient. The clinician sets up the supplies and prepares the patient. The clinician puts on a sterile gown and sterile gloves. Without noticing, the clinician then places a gloved hand on a non-sterile part of the bedside ultrasound machine and proceeds to grab the catheter, preparing to place the line.Likelihood of speaking up if the clinician was a(n):

  1. Nurse

  2. Intern

  3. Resident

  4. Attending

  1. Not at all likely

  2. Slightly likely

  3. Moderately likely

  4. Very likely

  5. Completely likely

Professionalism-related safety threat (inattentive colleague)You are rounding on new critically ill admissions to the intensive care unit. A member of your team is starting their shift and has not previously cared for these patients. The team member appears distracted on rounds. They have been looking down at their phone and texting throughout the first two patient presentations and have not participated in the discussion of either patient. The texting is not patient related.Likelihood of speaking up if the team member was a(n):

  1. Nurse

  2. Intern

  3. Resident

  4. Attending

  1. Not at all likely

  2. Slightly likely

  3. Moderately likely

  4. Very likely

  5. Completely likely

  • For each vignette, respondents also rated the potential for harm to patients (Likert scale from 1=very low to 5=very high). For the professionalism safety vignette, respondents rated the potential for harm to the patients separately for each of the four variations in the context of the clinical situation (ie, if the distracted provider was a(n) nurse, intern, resident and attending physician).

  • *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’.