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

BMC Health Services Research

Bart Bijnen¹  Cordula Wagner³  Ayako Okuyama² 

[1] Foreest Medical School, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands;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;NIVEL Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands

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

Others  :  1134138
DOI  :  10.1186/1472-6963-14-61

 received in 2013-04-30, accepted in 2014-02-07,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Okuyama et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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