BACKGROUND: Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care. METHODS: The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm. The authors embedded this scale in a survey with measures of safety climate, teamwork climate, disruptive behaviour, work stress, and personality traits of bravery and assertiveness. The survey was distributed to all registered nurses and obstetricians practising in two US Labour & Delivery units. RESULTS: The response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7±11 years in specialty). A higher perception of harm, respondent role, specialty experience and site predicted the likelihood of speaking up when controlling for bravery and assertiveness. Physicians rated potential harm in common clinical scenarios lower than nurses did (7.5 vs 8.4 on 2-10 scale; p<0.001). Some participants (12%) indicated they were unlikely to speak up, despite perceiving a high potential for harm in certain situations. DISCUSSION: This exploratory study found that nurses and physicians differed in their harm ratings, and harm rating was a predictor of speaking up. This may partially explain persistent discrepancies between physicians and nurses in teamwork climate scores. Differing assessments of potential harms inherent in everyday practice may be a target for teamwork intervention in maternity care.
BACKGROUND: Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care. METHODS: The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm. The authors embedded this scale in a survey with measures of safety climate, teamwork climate, disruptive behaviour, work stress, and personality traits of bravery and assertiveness. The survey was distributed to all registered nurses and obstetricians practising in two US Labour & Delivery units. RESULTS: The response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7±11 years in specialty). A higher perception of harm, respondent role, specialty experience and site predicted the likelihood of speaking up when controlling for bravery and assertiveness. Physicians rated potential harm in common clinical scenarios lower than nurses did (7.5 vs 8.4 on 2-10 scale; p<0.001). Some participants (12%) indicated they were unlikely to speak up, despite perceiving a high potential for harm in certain situations. DISCUSSION: This exploratory study found that nurses and physicians differed in their harm ratings, and harm rating was a predictor of speaking up. This may partially explain persistent discrepancies between physicians and nurses in teamwork climate scores. Differing assessments of potential harms inherent in everyday practice may be a target for teamwork intervention in maternity care.
Authors: J B Sexton; C G Holzmueller; P J Pronovost; E J Thomas; S McFerran; J Nunes; D A Thompson; A P Knight; D H Penning; H E Fox Journal: J Perinatol Date: 2006-06-15 Impact factor: 2.521
Authors: Caprice C Greenberg; Scott E Regenbogen; David M Studdert; Stuart R Lipsitz; Selwyn O Rogers; Michael J Zinner; Atul A Gawande Journal: J Am Coll Surg Date: 2007-04 Impact factor: 6.113
Authors: Stephen D Pratt; Susan Mann; Mary Salisbury; Penny Greenberg; Ronald Marcus; Barbara Stabile; Patricia McNamee; Peter Nielsen; Benjamin P Sachs Journal: Jt Comm J Qual Patient Saf Date: 2007-12
Authors: John B Sexton; Robert L Helmreich; Torsten B Neilands; Kathy Rowan; Keryn Vella; James Boyden; Peter R Roberts; Eric J Thomas Journal: BMC Health Serv Res Date: 2006-04-03 Impact factor: 2.655
Authors: Thomas A D'Agostino; Philip A Bialer; Chasity B Walters; Aileen R Killen; Hrafn O Sigurdsson; Patricia A Parker Journal: AORN J Date: 2017-10 Impact factor: 0.676
Authors: Abdulrahman Y Sabbagh; Hala M Alzaid; Abdullah A Almarshed; Amani A Azizalrahman; Shady Elmasry; Claudia A Rosu; Usamah Alzoraigi; Abdulrahman Alzahrani; Ameera A Cluntun Journal: J Clin Med Res Date: 2022-09-29