… found that the hierarchical culture of medicine presents a barrier to speaking up about safety concerns, but that … the institution and within the hierarchy. … Umoren R, Kim S, Gray MM, et al. Interprofessional model on speaking up behaviour in healthcare professionals: a qualitative study. BMJ Lead. 2022;6(1):15-19. …

This review summarizes studies of training programs targeting healthcare professionals’ speaking up skills. The authors found that most training programs were limited to a one-time training delivered to a single profession (i.e., limited to doctors or nurses).  The majority of programs addressed legitimate power (i.e., social norms such as titles) but few addressed other types of power (e.g., reward or coercive power, personal resources) or the non-verbal (i.e., emotional) skills required in speaking-up behaviors.  

… of continuing education in nursing … J Contin Educ Nurs … A key aspect of a robust safety culture is that all team members feel  … This commentary describes the development and use of a speaking-up curriculum that focuses on communication …

Health care provider comfort with raising patient safety concerns is a critical aspect of safety culture. This survey of resident physicians at six academic medical centers demonstrated that trainees remain reluctant to speak up. Nearly half reported observing a patient safety threat. The majority spoke up about patient safety concerns, but a significant proportion did not. Although unprofessional behavior was more frequently observed, fewer trainees raised concerns about lack of professionalism than about patient safety. Even when respondents perceived the unprofessional behavior as having high potential for adverse patient consequences, they were not as likely to speak up about this compared to a traditional patient safety threat such as inadequate hand hygiene. The authors recommend specifically measuring tolerance for unprofessional behaviors as a part of safety culture assessment.

This study validated two new surveys (Speaking Up Climate-Safety and Speaking Up Climate- Professionalism) for measuring aspects of safety culture that are associated with resident physicians' likelihood of speaking up about patient safety concerns and unprofessional behavior. Both scales performed well on psychometric testing. These surveys may fill current gaps in widely used assessment tools.

… … Am J Med Qual … An advocate for clinical education (a nurse who rounded with medicine and surgery teams) provided …

… American Journal of Clinical Pathology … Am J Clin Pathol … A web-based questionnaire was used to assess patient safety …