The application of communication accommodation theory to understand receiver reactions in healthcare speaking up interactions

ABSTRACT

Speaking up for patient safety is a well-documented, complex communication interaction, which is challenging both to teach and to implement into practice. In this study we used Communication Accommodation Theory to explore receivers’ perceptions and their self-reported behaviors during an actual speaking up interaction in a health context. Intergroup dynamics were evident across interactions. Where seniority of the participants was salient, the within-profession interactions had more influence on the receiver’s initial reactions and overall evaluation of the message, compared to the between profession interactions. Most of the seniority salient interactions occurred down the hierarchy, where a more senior professional ingroup member delivered the speaking up message to a more junior receiver. These senior speaker interactions elicited fear and impeded the receiver’s voice. We found that nurses/midwives and allied health clinicians reported using different communication behaviors in speaking up interactions. We propose that the term “speaking up” be changed, to emphasize receivers’ reactions when they are spoken up to, to help receivers engage in more mutually beneficial communication strategies.

KEYWORDS:

• Clinicians
• communication accommodation theory
• healthcare communication
• patient safety
• receiver
• safety voice
• social identity
• speaking up

Acknowledgments

Thank you to the clinicians who were generous in sharing their stories

Disclosure statement

This study was part of the author’s doctoral work, which was supported by the Australian Government Research Training Program Scholarship. There are no conflicts of interest to declare. Study participants were paid employees of the health organisation in which the study took place and who voluntarily consented to participate.

Data availability statement

All data are reported. The data that support the study findings are available from the corresponding first author, upon reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Melanie Barlow

Melanie Barlow, RN, MN, PhD(c), is the national Academic Lead for Specialised learning environments and simulation at the Australian Catholic University, Australia. She has a passion for helping to improve healthcare communication and using experiential learning to enhance skills, knowledge, and teamwork.

Bernadette Watson

Bernadette Watson, PhD, is a psychologist and Professor in the area of health communication. She is Honorary Professor at The University of Queensland, Australia, and Adjunct Professor at The Hong Kong Polytechnic University. Her research interests include psychological wellbeing and health, interdisciplinary health professional communication, language and social psychology, and intercultural communication.

Elizabeth Jones

Elizabeth Jones, PhD, is a psychologist and Professor and Head of Department of Psychology at Monash University Malaysia. She is also an adjunct professor at Griffith University, Australia. Her research interests include psychological wellbeing and health, interdisciplinary health professional communication, organisational communication, and intercultural communication.

Catherine Morse

Catherine Morse, PhD, is an advanced practice nurse, the Assistant Dean for Experiential Learning and Innovation, and an Associate Clinical Professor of Nursing at Drexel University, USA. She has expertise in simulation methodology and research, including debriefing, feedback, speaking up, curriculum design.

Fiona Maccallum

Fiona Maccallum, PhD, is a clinical psychologist and lecturer at the University of Queensland, Australia. Her research interests are in grief & loss, trauma, and anxiety. She undertakes experimental and clinical investigations of autobiographical memory, self-identity and future thinking, attachment, emotion regulation, and motivation.