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Silence That Can Be Dangerous: A Vignette Study to Assess Healthcare Professionals’ Likelihood of Speaking up about Safety Concerns

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  • David L B Schwappach
  • Katrin Gehring

Abstract

Purpose: To investigate the likelihood of speaking up about patient safety in oncology and to clarify the effect of clinical and situational context factors on the likelihood of voicing concerns. Patients and Methods: 1013 nurses and doctors in oncology rated four clinical vignettes describing coworkers’ errors and rule violations in a self-administered factorial survey (65% response rate). Multiple regression analysis was used to model the likelihood of speaking up as outcome of vignette attributes, responder’s evaluations of the situation and personal characteristics. Results: Respondents reported a high likelihood of speaking up about patient safety but the variation between and within types of errors and rule violations was substantial. Staff without managerial function provided significantly higher levels of decision difficulty and discomfort to speak up. Based on the information presented in the vignettes, 74%−96% would speak up towards a supervisor failing to check a prescription, 45%−81% would point a coworker to a missed hand disinfection, 82%−94% would speak up towards nurses who violate a safety rule in medication preparation, and 59%−92% would question a doctor violating a safety rule in lumbar puncture. Several vignette attributes predicted the likelihood of speaking up. Perceived potential harm, anticipated discomfort, and decision difficulty were significant predictors of the likelihood of speaking up. Conclusions: Clinicians’ willingness to speak up about patient safety is considerably affected by contextual factors. Physicians and nurses without managerial function report substantial discomfort with speaking up. Oncology departments should provide staff with clear guidance and trainings on when and how to voice safety concerns.

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  • David L B Schwappach & Katrin Gehring, 2014. "Silence That Can Be Dangerous: A Vignette Study to Assess Healthcare Professionals’ Likelihood of Speaking up about Safety Concerns," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-8, August.
  • Handle: RePEc:plo:pone00:0104720
    DOI: 10.1371/journal.pone.0104720
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    References listed on IDEAS

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    1. Banja, John, 2010. "The normalization of deviance in healthcare delivery," Business Horizons, Elsevier, vol. 53(2), pages 139-148, March.
    2. Amy C. Edmondson, 2003. "Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interdisciplinary Action Teams," Journal of Management Studies, Wiley Blackwell, vol. 40(6), pages 1419-1452, September.
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    2. Martina Schmiedhofer & Christina Derksen & Franziska Maria Keller & Johanna Elisa Dietl & Freya Häussler & Reinhard Strametz & Ilona Koester-Steinebach & Sonia Lippke, 2021. "Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses," IJERPH, MDPI, vol. 18(3), pages 1-16, January.
    3. Stefan Bushuven & Markus Dettenkofer & Sonia Sippel & Sarah Koenig & Stefanie Bushuven & Wulf Schneider-Brachert, 2020. "Speaking up behavior and cognitive bias in hand hygiene: Competences of German-speaking medical students," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-17, September.
    4. Tedone, Archana Manapragada & Lanz, Julie J., 2024. "Staying silent during a crisis: How workplace factors influence safety decisions in U.S. nurses," Social Science & Medicine, Elsevier, vol. 341(C).
    5. Stefan Bushuven & Milena Trifunovic-Koenig & Michael Bentele & Stefanie Bentele & Reinhard Strametz & Victoria Klemm & Matthias Raspe, 2022. "Self-Assessment and Learning Motivation in the Second Victim Phenomenon," IJERPH, MDPI, vol. 19(23), pages 1-19, November.

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