‘Speaking up’ about patient safety concerns and unprofessional behaviour among residents: validation of two scales

• Published in: BMJ quality & safety Vol. 24; no. 11; pp. 671 - 680
• Main Authors: Martinez, William, Etchegaray, Jason M, Thomas, Eric J, Hickson, Gerald B, Lehmann, Lisa Soleymani, Schleyer, Anneliese M, Best, Jennifer A, Shelburne, Julia T, May, Natalie B, Bell, Sigall K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2015
• Subjects: Academic Medical Centers; Adult; Attitude of Health Personnel; Curricula; Factor analysis; Factor Analysis, Statistical; Female; Health administration; Humans; Internship and Residency; Male; Organizational Culture; Patient Safety; Physicians; Physicians - psychology; Professional Misconduct; Psychometrics; Reproducibility of Results; Safety; Safety management; Surveys and Questionnaires - standards; United States; United States > US; Patient safety; Safety culture; Statistics; Graduate medical education; Communication
• ISSN: 2044-5415; 2044-5423
• DOI: 10.1136/bmjqs-2015-004253

ObjectiveTo develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.MethodResidents from six large US academic medical centres completed an anonymous, electronic survey containing questions regarding safety culture and speaking up about safety and professionalism concerns.ResultsConfirmatory factor analysis supported two separate, one-factor speaking up climates (SUCs) among residents; one focused on patient safety concerns (SUC-Safe scale) and the other focused on unprofessional behaviour (SUC-Prof scale). Both scales had good internal consistency (Cronbach's α>0.70) and were unique from validated safety and teamwork climate measures (r<0.85 for all correlations), a measure of discriminant validity. The SUC-Safe and SUC-Prof scales were associated with participants’ self-reported speaking up behaviour about safety and professionalism concerns (r=0.21, p<0.001 and r=0.22, p<0.001, respectively), a measure of concurrent validity, while teamwork and safety climate scales were not.ConclusionsWe created and provided evidence for the reliability and validity of two measures (SUC-Safe and SUC-Prof scales) associated with self-reported speaking up behaviour among residents. These two scales may fill an existing gap in residency and safety culture assessments by measuring the openness of communication about safety and professionalism concerns, two important aspects of safety culture that are under-represented in existing metrics.