The well-being of healthcare workers is essential to the delivery of high quality, safe care. This article proposes a definition of “avoidable employee harm” (e.g., retaliation for speaking up about safety concerns) and describes how prioritizing organizational safety culture can increase both employee and patient safety.

Speaking up about safety concerns is an important component of safety culture. In this study, nurses in a variety of fields shared their experiences with speaking up during the COVID-19 pandemic. Three themes emerged: the ability to speak up or not, anticipated consequences of speaking up, and responses, or lack thereof, from managers.

A key component of patient safety culture is the ability of staff to speak up about patient safety concerns without fear of repercussions. An analysis of 34 studies on speaking-up behavior revealed two narrative themes on why interventions were or were not successful: hierarchical, interdisciplinary, and cultural relationships, and psychological safety. Although interventions varied, there were international similarities in workplace norms and culture. Improving speaking-up behavior in healthcare settings is complex and no intervention is one-size-fits-all.

This publication compared the use of the Global Trigger Tool with a two-stage retrospective review process to design a method to monitor health care–associated harm in Welsh National Health Service hospitals. Analyzing results from 11 of the 13 system hospitals, investigators determined that a hybrid incident review approach that does not rely on physician involvement can return reliable data.

Nurse leaders play a key role in patient safety. This interview study found that nurse executives advocate for quality and safety with executive boards by building relationships with board colleagues and presenting the rationale for quality and safety practices. The authors conclude the nurse perspectives are critical to providing insights about quality and safety actions to hospital boards.

Adverse events after hospital discharge are common, affecting nearly 20% of patients within 3 weeks of discharge. This study used data from the United Kingdom's National Reporting and Learning System to analyze the contributors to these adverse events. Principal contributing factors included inadequate discharge communication between hospital-based and outpatient physicians and insufficient assessment of patients' need for community-based services.

This commentary explores the differences between individuals failing to raise concerns and organizations disregarding problems that have been reported. Several organizational failures in the National Health Service provide context for this comparison and illustrate the need to build systems that reliably record and respond to shortcomings raised by staff.

Medication safety alerts issued by the National Patient Safety Agency had a significant impact on patient safety, although awareness of the alerts was much higher among pharmacists than physicians or medical directors.

This study demonstrated that simply designing "system" safeguards fails to prevent errors in subsequent monitoring and implementation. Investigators used three safety alerts, including latex allergy, as markers of how well these alerts were being adopted in practice by bedside nurses.