Citation

Schwappach DL. Z. Evid. Fortbild. Qual. Gesundhwes. 2016; 114: 5-12.

Vernacular Title

Wenn Schweigen gefährlich ist: "Speaking-up" bei Sicherheitsbedenken.

Affiliation

Swiss Patient Safety Foundation, Zurich, Switzerland; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. Electronic address: schwappach@patientensicherheit.ch.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.zefq.2016.05.011

PMID

27566265

Abstract

BACKGROUND: Open and direct communication ("speaking-up") about errors, bypassed safety rules and risky behaviours among hospital staff is required to avoid patient harm, and it is an essential characteristic of an established safety culture. In German-speaking countries, little is known about speaking-up behaviour among health care professionals (HCPs) in hospitals.

METHOD: Safety concerns and speaking-up behaviours among HCPs of nine oncological units of eight hospitals were assessed using a self-administered survey. A vignette was embedded to assess hypothetical speaking-up and its predictors. The association of hierarchical position and speaking-up was investigated. 1,013 physicians and nurses completed the survey (65 % response rate).

RESULTS: 53 % of the HCPs reported having concerns about patient safety at their unit, "sometimes", "frequently", or "very frequently". Colleagues bypassing important safety rules at least "sometimes" were reported by 30 %. A considerable fraction of responders reported episodes of withholding of voice. Nearly 20 % said they did not communicate safety problems at their unit at least sometimes. 73 % of higher-ranking staff and 60 % among those at lower ranks said they had never withheld information which could have reduced threats to patients (OR=1.8, p≤0.001). Many responders felt that speaking-up is often difficult and challenging. 32 % responded that they would not speak-up about a missed hand disinfection towards a colleague assessing the wound of a recently operated oncological patient.

CONCLUSIONS: HCPs in hospital frequently experience safety concerns and often withhold them. An important resource for better patient safety is lost. The development of interventions to improve speaking-up culture is warranted.

Copyright © 2016. Published by Elsevier GmbH.

Language: de