Predictors of likelihood of speaking up about safety concerns in labour and delivery

Audrey Lyndon, J. Bryan Sexton, Kathleen Rice Simpson, Alan Rosenstein, Kathryn A. Lee, Robert M. Wachter

Research output: Contribution to journalArticle

Abstract

Background: Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care. Methods: The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm. The authors embedded this scale in a survey with measures of safety climate, teamwork climate, disruptive behaviour, work stress, and personality traits of bravery and assertiveness. The survey was distributed to all registered nurses and obstetricians practising in two US Labour & Delivery units. Results: The response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7611 years in specialty). A higher perception of harm, respondent role, specialty experience and site predicted the likelihood of speaking up when controlling for bravery and assertiveness. Physicians rated potential harm in common clinical scenarios lower than nurses did (7.5 vs 8.4 on 2-10 scale; p<0.001). Some participants (12%) indicated they were unlikely to speak up, despite perceiving a high potential for harm in certain situations. Discussion: This exploratory study found that nurses and physicians differed in their harm ratings, and harm rating was a predictor of speaking up. This may partially explain persistent discrepancies between physicians and nurses in teamwork climate scores. Differing assessments of potential harms inherent in everyday practice may be a target for teamwork intervention in maternity care.

Original languageEnglish (US)
Pages (from-to)791-799
Number of pages9
JournalBMJ Quality and Safety
Volume21
Issue number9
DOIs
StatePublished - Sep 1 2012

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Safety
Climate
Nurses
Assertiveness
Physicians
Patient Safety
Caregivers
Personality
Cross-Sectional Studies
Communication
Surveys and Questionnaires
Courage

ASJC Scopus subject areas

  • Health Policy

Cite this

Lyndon, A., Sexton, J. B., Simpson, K. R., Rosenstein, A., Lee, K. A., & Wachter, R. M. (2012). Predictors of likelihood of speaking up about safety concerns in labour and delivery. BMJ Quality and Safety, 21(9), 791-799. https://doi.org/10.1136/bmjqs-2010-050211

Predictors of likelihood of speaking up about safety concerns in labour and delivery. / Lyndon, Audrey; Sexton, J. Bryan; Simpson, Kathleen Rice; Rosenstein, Alan; Lee, Kathryn A.; Wachter, Robert M.

In: BMJ Quality and Safety, Vol. 21, No. 9, 01.09.2012, p. 791-799.

Research output: Contribution to journalArticle

Lyndon, A, Sexton, JB, Simpson, KR, Rosenstein, A, Lee, KA & Wachter, RM 2012, 'Predictors of likelihood of speaking up about safety concerns in labour and delivery', BMJ Quality and Safety, vol. 21, no. 9, pp. 791-799. https://doi.org/10.1136/bmjqs-2010-050211
Lyndon, Audrey ; Sexton, J. Bryan ; Simpson, Kathleen Rice ; Rosenstein, Alan ; Lee, Kathryn A. ; Wachter, Robert M. / Predictors of likelihood of speaking up about safety concerns in labour and delivery. In: BMJ Quality and Safety. 2012 ; Vol. 21, No. 9. pp. 791-799.
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