Carien W Alingh1,2, Jeroen D H van Wijngaarden1, Karina van de Voorde2, Jaap Paauwe1,2, Robbert Huijsman1.
Abstract
BACKGROUND: Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers' behaviour and employees' perceptions about whether speaking up is safe and worthwhile is still lacking. AIM: To explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses' willingness to speak up.
METHODS: We conducted a cross-sectional survey study, resulting in a sample of 980 nurses and 93 nurse managers working in Dutch clinical hospital wards. To test our hypotheses, hierarchical regression analyses (at ward level) and multilevel regression analyses were conducted.
RESULTS: Significantly positive associations were found between nurses' perceptions of control-based safety management and climate for safety (β=0.74; p<0.001), and between the perceived levels of commitment-based management and team psychological safety (β=0.36; p<0.01). Furthermore, team psychological safety is found to be positively related to nurses' speaking up attitudes (B=0.24; t=2.04; p<0.05). The relationship between nurse-rated commitment-based safety management and nurses' willingness to speak up is fully mediated by team psychological safety.
CONCLUSION: Results provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses' perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
BACKGROUND: Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers' behaviour and employees' perceptions about whether speaking up is safe and worthwhile is still lacking. AIM: To explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses' willingness to speak up.
METHODS: We conducted a cross-sectional survey study, resulting in a sample of 980 nurses and 93 nurse managers working in Dutch clinical hospital wards. To test our hypotheses, hierarchical regression analyses (at ward level) and multilevel regression analyses were conducted.
RESULTS: Significantly positive associations were found between nurses' perceptions of control-based safety management and climate for safety (β=0.74; p<0.001), and between the perceived levels of commitment-based management and team psychological safety (β=0.36; p<0.01). Furthermore, team psychological safety is found to be positively related to nurses' speaking up attitudes (B=0.24; t=2.04; p<0.05). The relationship between nurse-rated commitment-based safety management and nurses' willingness to speak up is fully mediated by team psychological safety.
CONCLUSION: Results provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses' perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Entities:
Keywords:
management; nurses; patient safety
Mesh：
Year: 2018
PMID： 29954948 DOI： 10.1136/bmjqs-2017-007163
Source DB: PubMed Journal: BMJ Qual Saf ISSN： 2044-5415 Impact factor: 7.035