Commentary on Speaking Up About Patient Safety in Perioperative Care: Differences Between Academic and Non-academic Hospitals in Austria and Switzerland

This article refers to:

Speaking Up about Patient Safety in Perioperative Care: Differences between Academic and Nonacademic Hospitals in Austria and Switzerland

Open communication is a key factor in patient safety, and speaking up behavior by health care professionals is expected to improve patient safety and quality of health care [1]. However, health care professionals, particularly younger staff, tend to be hesitant about speaking up even when they have concerns about patient safety because of the steep hierarchy at hospitals and perceived risks associated with speaking up. Recently, multiple researchers have investigated the difficulties that many health care professionals have with speaking up in a variety of situations. However, few studies have examined the differences in speaking up behavior in various countries with different cultural backgrounds. A recent study titled “Speaking up about patient safety in perioperative care: differences between academic and non-academic hospitals in Austria and Switzerland” reported differences in speaking up behavior and climate between the two studied countries and between academic and nonacademic hospitals [2]. This study highlights the importance of encouraging speaking up behavior by health care professionals.

The current study reported that the levels of resignation with speaking up were higher among nurses than medical doctors in both academic and nonacademic hospitals in Austria and Switzerland [2], which is a very interesting result. Our previous studies also found a similar trend of nurses having a more positive attitude toward speaking up than medical residents (unpublished data). On the other hand, a previous study in Hong Kong reported that doctors responded more positively than nurses to many aspects of communication openness [3]. These studies show that speaking up behavior differs among professionals even in same hospital, and we should acknowledge that some differences in speaking up behavior by health care professionals exist.

The authors of the current study also reported that nonacademic hospitals had a more positive speaking up-related climate than academic hospitals [2]. This result indicates that the local culture influences speaking up behavior by health care professionals. It is difficult to capture local culture by studying a single hospital or country. By comparing two countries, the authors show that local culture is important for enhancing speaking up behavior by health care professionals. However, the relationship between safety climate and speaking up behavior is not simple. A previous study in the U.S. reported that the relationship between safety culture and teamwork scores was significantly more positive in survey respondents who indicated they would always speak up [4]. In clinical practice, many staff worry about speaking up because of their perceived personal safety (intimidation and hierarchy concerns) [5]. Both the level of perceived teamwork and personal safety affect speaking up behaviors. A previous study on speaking up behavior reported the results of a cluster analysis and found that nurses fall into four subgroups based on specific combinations of their attitudes toward speaking up, perceived contextual factors, assertiveness, and organizational commitment [6]. They then identified differences in nurses’ speaking up behaviors and characteristics across these clusters. For example, nurses in two selected groups reported high levels of teamwork. Nurses in one group reported increased willingness to speak up. However, nurses in the other groups reported moderate willingness to speak up. Nurses in the latter group perceived higher negative personal consequences for speaking up (e.g., feelings of incompetence, lack of confidence). We should take care to understand these staff members’ attitudes toward speaking up as well as the perceived organizational factors (e.g., level of teamwork, hospital type).

Previous studies found that staff with higher levels of power reported more willingness to speak up [1,5]. However, the current study showed opposite results [2]. The authors reported that higher levels of power were negatively associated with self-reported likelihood to speak up among health care workers. In this study, senior doctors and head nurses were less likely to raise their voices than nurses and residents. However, the response rate was lower, so it is difficult to draw conclusions. In these hospitals, it can be a key that hospital administrators show positive attitudes toward speaking up and then push senior clinical leaders to speak up as well.

To enhance speaking up behavior, we must understand a variety of factors (e.g., professional role, safety climate, health care workers’ attitudes toward speaking up, and the perceived safety of speaking up in particular). The current study shows us that we need to assess multiple points to enhance speaking up behavior by health care professionals. It also helps us put local data in perspective and target further activities for improvement [2].

DECLARATION OF INTEREST

There are no conflicts of interest to declare. The author is responsible for the content and writing of the article.