Encouraging frontline healthcare workers to voice concerns is an important component of safety culture. This systematic review of 76 qualitative studies explored how speaking up behaviors and silence are measured in healthcare. The authors identified several evidence gaps, including a reliance on self-reported data and overrepresentation of certain demographic characteristics.

When faced with a patient safety concern, staff need to decide whether to speak up or remain silent. Leaders play a crucial role in addressing contextual factors behind employees’ decisions to remain silent. This article offers support for leaders to create a culture of psychological safety and encourage speaking up behaviors.

Difficulty speaking up about patient safety concerns and unprofessional behavior indicates a safety culture deficiency. This article discusses the relationship between silence, burnout, and quality of care, emphasizing how silence evolves during medical education and continues into clinical training, eventually impacting healthcare professional burnout, patient safety and quality of care.

This survey study linked negative gossip in hospitals to health care professional burnout and suboptimal patient care. However, it is not clear whether negative gossip is a risk factor for compromised patient safety or a response to an already poor safety culture.

Many health care professionals exhibit symptoms of burnout, and national studies have shown that approximately one-third of practicing physicians and nurses display hallmark symptoms of emotional exhaustion and diminished sense of personal accomplishment. This commentary explores how medical schools, organizational culture, and working while sick can contribute to physician burnout. The author advocates for a systematic bottom-up approach to address the problem.