We can keep patients safer by identifying problems and speaking up about them. But apparently, this systematic review found that previous literature have not really operationally defined “speaking up” in a consistent manner. The authors’ suggested definition is as follows –
Therefore, our suggested definition for speaking up for patient safety was adapted from Law and Chan attributed to Sayre et al —A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. This definition does not require a specific response or outcome from the speaking up and therefore is an individual action solely in the control of the speaker.
Kane, J., Munn, L., Kane, S. F., & Srulovici, E. (2023). Defining Speaking Up in the Healthcare System: a Systematic Review. Journal of general internal medicine, 38(15), 3406–3413. https://doi.org/10.1007/s11606-023-08322-0
Psychologically safe environments facilitate speaking up.
The term psychological safety is defined as an individual’s “sense of being able to show and employ oneself without fear of negative consequences to self-image, status or career” and at the group level as “a shared belief that the team is safe for interpersonal risk taking.”The term embodies individual confidence in the belief that speaking up will not result in embarrassment, rejection, criticism, or punishment from others.
Kingston MB, Dowell P, Mossburg SE, et al. Annual Perspective: Psychological Safety of Healthcare Staff. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022.
Kingston et al (2022) identified four barriers (with examples) for psychological safety.
- Hierarchy: higher ranking physicians were valued more (organizational level)
- Lack of knowledge: lack of awareness of cases being discussed (team level)
- Authoritarian leadership: leaders devaluing ideas from team members (team level)
- Personality: dominant personalities overpowering conversations, or overly shy team members (individual level)
Let’s discuss speaking up and patient safety tonight at the #HealthXPH chat on Bluesky 9 pm, Manila time.
T1. What prevents healthcare professionals from speaking up about errors or safety concerns?
T2. How can we create psychologically safe environments where staff can voice concerns?
T3. What’s the balance between respecting hierarchy and advocating for patient safety?