Open Access Highly Accessed Research article

Speaking up for patient safety by hospital-based health care professionals: a literature review

Ayako Okuyama1*, Cordula Wagner23 and Bart Bijnen24

Author Affiliations

1 Department of Total Health Promotion Science, School of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita-shi 565-0871, Osaka, Japan

2 VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

3 NIVEL Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands

4 Foreest Medical School, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands

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BMC Health Services Research 2014, 14:61  doi:10.1186/1472-6963-14-61

Published: 8 February 2014

Abstract

Background

Speaking up is important for patient safety, but often, health care professionals hesitate to voice concerns. Understanding the influencing factors can help to improve speaking-up behaviour and team communication. This review focused on health care professionals’ speaking-up behaviour for patient safety and aimed at (1) assessing the effectiveness of speaking up, (2) evaluating the effectiveness of speaking-up training, (3) identifying the factors influencing speaking-up behaviour, and (4) developing a model for speaking-up behaviour.

Methods

Five databases (PubMed, MEDLINE, CINAHL, Web of Science, and the Cochrane Library) were searched for English articles describing health care professionals’ speaking-up behaviour as well as those evaluating the relationship between speaking up and patient safety. Influencing factors were identified and then integrated into a model of voicing behaviour.

Results

In total, 26 studies were identified in 27 articles. Some indicated that hesitancy to speak up can be an important contributing factor in communication errors and that training can improve speaking-up behaviour. Many influencing factors were found: (1) the motivation to speak up, such as the perceived risk for patients, and the ambiguity or clarity of the clinical situation; (2) contextual factors, such as hospital administrative support, interdisciplinary policy-making, team work and relationship between other team members, and attitude of leaders/superiors; (3) individual factors, such as job satisfaction, responsibility toward patients, responsibility as professionals, confidence based on experience, communication skills, and educational background; (4) the perceived efficacy of speaking up, such as lack of impact and personal control; (5) the perceived safety of speaking up, such as fear for the responses of others and conflict and concerns over appearing incompetent; and (6) tactics and targets, such as collecting facts, showing positive intent, and selecting the person who has spoken up.

Conclusions

Hesitancy to speak up can be an important contributing factor to communication errors. Our model helps us to understand how health care professionals think about voicing their concerns. Further research is required to investigate the relative importance of different factors.

Keywords:
Speaking up; Inter-professional relations; Patient care team; Patient safety; Communication