Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

• Published in: BMJ quality & safety Vol. 26; no. 11; pp. 869 - 880
• Main Authors: Martinez, William, Lehmann, Lisa Soleymani, Thomas, Eric J, Etchegaray, Jason M, Shelburne, Julia T, Hickson, Gerald B, Brady, Donald W, Schleyer, Anneliese M, Best, Jennifer A, May, Natalie B, Bell, Sigall K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2017
• Subjects: Academic Medical Centers; Attitude of Health Personnel; Attitudes; Communication; Core curriculum; Courage; Cross-Sectional Studies; Female; Health administration; Humans; Internal medicine; Internship and Residency; Internships; Male; Medical personnel; Medical research; Patient Safety; Physicians; Polls & surveys; Professional Misconduct - psychology; Professional relationships; Professionalism; Safety engineering; Safety Management; Surgery; Threats; United States; Safety culture; Graduate medical education; Communication
• ISSN: 2044-5415; 2044-5423
• DOI: 10.1136/bmjqs-2016-006284

BackgroundOpen communication between healthcare professionals about care concerns, also known as ‘speaking up’, is essential to patient safety.ObjectiveCompare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.DesignAnonymous, cross-sectional survey.SettingSix US academic medical centres, 2013–2014.Participants1800 medical and surgical interns and residents (47% responded).MeasurementsAttitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.ResultsRespondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).ConclusionsInterns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.