Speaking up about Bullying and Harassment in Healthcare: Reflections Following the Introduction of an Innovative “Speak Up” Role in NHS England

BackgroundLittle is known about patient/family comfort voicing care concerns in real time, especially in the intensive care unit (ICU) where stakes are high and time is compressed. Experts advocate patient and family engagement in safety, which will require that patients/families be able to voice concerns. Data on patient/family attitudes and experiences regarding speaking up are sparse, and mostly include reporting events retrospectively, rather than pre-emptively, to try to prevent harm. We aimed to (1) assess patient/family comfort speaking up about common ICU concerns; (2) identify patient/family-perceived barriers to speaking up; and (3) explore factors associated with patient/family comfort speaking up.MethodsIn collaboration with patients/families, we developed a survey to evaluate speaking up attitudes and behaviours. We surveyed current ICU families in person at an urban US academic medical centre, supplemented with a larger national internet sample of individuals with prior ICU experience.Results105/125 (84%) of current families and 1050 internet panel participants with ICU history completed the surveys. Among the current ICU families, 50%–70% expressed hesitancy to voice concerns about possible mistakes, mismatched care goals, confusing/conflicting information and inadequate hand hygiene. Results among prior ICU participants were similar. Half of all respondents reported at least one barrier to voicing concerns, most commonly not wanting to be a ‘troublemaker’, ‘team is too busy’ or ‘I don’t know how’. Older, female participants and those with personal or family employment in healthcare were more likely to report comfort speaking up.ConclusionSpeaking up may be challenging for ICU patients/families. Patient/family education about how to speak up and assurance that raising concerns will not create ‘trouble’ may help promote open discussions about care concerns and possible errors in the ICU.

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Becoming Active Citizens

Prophets and Patriots ◽

10.1525/california/9780520293649.003.0002 ◽

2017 ◽

Author(s):

Ruth Braunstein

Keyword(s):

Religious Discourse ◽

Active Citizenship ◽

American Democracy ◽

Speaking Up ◽

Standing Up ◽

Civil Discourse ◽

Waking Up ◽

Speak Up

Chapter 2 focuses on similarities in the ways in which members of Interfaith and the Patriots described their choice to become more active citizens, despite significant differences in their demographic compositions and policy demands. For members of both groups, this process involved waking up, standing up, and speaking up—acts that were described as democratic and sacred responsibilities alike. In justifying their choices and distinguishing them from alternatives, participants in both groups drew loosely on a “civil discourse” that valorized the qualities associated with active citizenship, while critiquing or distancing themselves from fellow citizens who chose not to wake up, stand up and speak up. In the process, they also drew on “civil religious discourse” that infused active citizenship and American democracy itself with sacred significance.

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Organisational empowerment and assertive communication behaviours: a survey of Jordanian newly qualified nurses

British Journal of Nursing ◽

10.12968/bjon.2020.29.7.419 ◽

2020 ◽

Vol 29 (7) ◽

pp. 419-425 ◽

Cited By ~ 1

Author(s):

Muhammad W Darawad ◽

Mansour Mansour ◽

Tahany Al-Niarat

Keyword(s):

Two Dimensions ◽

Early Years ◽

Cross Sectional Survey ◽

Speaking Up ◽

Structural Empowerment ◽

Cross Sectional ◽

Clinical Scenarios ◽

Communication Behaviours ◽

Speak Up ◽

The Impact

Background: Newly qualified nurses (NQNs) face several challenges in their early years of practice. Being empowered and able to speak up against unsafe practice are two important pillars for practising nursing safely and competently. Little research has examined the potential correlation between those two dimensions in the context of NQNs in Jordan. Aims: To investigate the correlation between NQNs' perceived structural empowerment in their work setting and their willingness to challenge unsafe practice in some hypothetical clinical scenarios. Methods: A cross-sectional survey involved 233 NQNs, who completed a self-administered questionnaire between January and March 2016. Findings: Participants reported moderate levels of both perceived structural empowerment and willingness to speak up against unsafe practice. There was a statistically significant positive correlation between the total structural empowerment score and the mean score for speaking up against unsafe practice. Conclusion: The findings highlight the impact of peer, managerial and overall organisational support on enabling NQNs to become more empowered and assertive. Concrete, collaborative and organisation-wide efforts must be considered to foster greater empowerment of NQNs, but also revisiting work priorities to include supporting and advocating assertive communication skills among the more vulnerable of the newly qualified cohort.

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Organisational empowerment and speaking up against unsafe practice: the case for newly qualified nurses in Saudi Arabia

British Journal of Healthcare Management ◽

10.12968/bjhc.2019.0022 ◽

2020 ◽

Vol 26 (3) ◽

pp. 94-102 ◽

Cited By ~ 2

Author(s):

Mansour Mansour ◽

Maha Al-Madani ◽

Abdelrahman Al-Anati ◽

Aysar Jamama

Keyword(s):

Saudi Arabia ◽

Nurse Managers ◽

Speaking Up ◽

Eastern Province ◽

Staff Wellbeing ◽

Perceived Access ◽

Speak Up ◽

Support At Work ◽

Work Empowerment ◽

Spearman’S Correlation

Background/aims Nurses' sense of empowerment and ability to speak up against unsafe clinical practice are crucial to patient safety and staff wellbeing. However, research examining these attitudes among newly qualified nurses is lacking. This study aimed to investigate perceptions of organisational empowerment and willingness to speak up against perceived unsafe practice among newly qualified nurses in Saudi Arabia. Methods A questionnaire was completed by a convenient sample of 83 newly qualified nurses in the Eastern Province of Saudi Arabia. Descriptive statistics and Spearman's correlation coefficient (rho) were used for data analysis. Findings The nurses reported moderate levels of both empowerment and willingness to speak up against unsafe practice. There was a statistically significant correlation between the participants' total structured empowerment score and their speaking up score. Willingness to speak up against potentially unsafe practice was also correlated with participants' perceived access to support at work. Conclusions These findings highlight the need to support newly qualified nurses to develop their level of empowerment and assertive communication skills. Nurse managers, educators and peers must therefore consider practical strategies to help build and sustain newly qualified nurses' sense of work empowerment and assertiveness.

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Speaking up in the perioperative setting

Journal of Perioperative Practice ◽

10.1177/1750458920937947 ◽

2020 ◽

Vol 31 (1-2) ◽

pp. 11-14

Author(s):

Mark Dorrance

Keyword(s):

Health Care ◽

Patient Safety ◽

Health Care Workers ◽

Speaking Up ◽

Care Workers ◽

Speak Up

Patient safety is a key role for all staff who work in the perioperative environment. Being able to raise concerns and have these concerns listened to is a big part of maintaining patient safety. Freedom to Speak Up Guardians were introduced to assist health care workers in raising concerns; however, their access to perioperative areas may be restricted. This article therefore looks to explain the role of Freedom to Speak Up Guardians and how this new role impacts on how concerns should be raised.

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Why do employees speak up? Examining the roles of LMX, perceived risk and perceived leader power in predicting voice behavior

Journal of Managerial Psychology ◽

10.1108/jmp-11-2018-0534 ◽

2019 ◽

Vol 34 (8) ◽

pp. 560-572

Author(s):

Jinyun Duan ◽

Émilie Lapointe ◽

Yue Xu ◽

Sarah Brooks

Keyword(s):

Social Information Processing ◽

Perceived Risk ◽

Voice Behavior ◽

Speaking Up ◽

High Quality ◽

Content Type ◽

Social Information Processing Theory ◽

Processing Theory ◽

Member Exchange ◽

Speak Up

Purpose The purpose of this paper is to understand better why employees voice. Drawing on social information processing theory and insights derived from the literature on power, the authors suggest that leader–member exchange (LMX) fosters voice by reducing the perceived risk of voicing. The authors further contend that high perceived leader power will strengthen this mediated relationship. Design/methodology/approach The authors relied on a sample of 265 employee-supervisor dyads collected from Chinese organizations to test the study hypotheses. Findings Results indicated that perceived risk of voicing significantly mediated the positive LMX–voice behavior relationship. In addition, perceived leader power strengthened the effect of LMX on voice behavior via perceived risk of voicing. The relationship of LMX to perceived risk of voicing was more negative, and the indirect effect of LMX on voice behavior was more positive when employees perceived that leader power was high. Practical implications Organizations seeking to promote voice behaviors should support leaders to develop high-quality relationships with employees. Organizations should also ensure that leaders are sufficiently empowered to fulfill their roles, and ensure that employees are aware of their leaders’ influence. Originality/value Findings suggest that, in the context of high quality leader–member relationships, employees’ perceptions of their leaders’ power may help to overcome barriers associated with speaking up. Thus, this study helps explain the conditions that encourage employees to voice.

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Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

BMJ Open ◽

10.1136/bmjopen-2016-015721 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015721 ◽

Cited By ~ 8

Author(s):

George Wing Yiu Ng ◽

Jack Kwok Hung Pun ◽

Eric Hang Kwong So ◽

Wendy Wai Hang Chiu ◽

Avis Siu Ha Leung ◽

...

Keyword(s):

Intensive Care Unit ◽

Hong Kong ◽

Intensive Care ◽

Chinese Culture ◽

Speaking Up ◽

Open Communication ◽

Staff Members ◽

Communication Openness ◽

Speak Up ◽

Doctors And Nurses

ObjectivesDespite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up.DesignA mixed-methods design with quantitative and sequential qualitative components was used.Setting and participantsEighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices.ResultsThe participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases.ConclusionsCreating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.

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Speaking Up and Activism Among Frontline Employees: How Professional Coping Influences Work Engagement and Intent to Leave Among Teachers

The American Review of Public Administration ◽

10.1177/0275074016682313 ◽

2016 ◽

Vol 48 (4) ◽

pp. 318-328 ◽

Cited By ~ 4

Author(s):

Nina M. van Loon ◽

Madelon Heerema ◽

Marit Weggemans ◽

Mirko Noordegraaf

Keyword(s):

Work Engagement ◽

Intent To Leave ◽

Service Providers ◽

Coping Behavior ◽

Active Coping ◽

Frontline Employees ◽

Speaking Up ◽

Primary School Teachers ◽

Professional Norms ◽

Speak Up

Demands that exceed time and resources place pressure on public professionals, resulting in coping behavior. This study aims to provide insight in the prevalence and consequences of taking a more active strategy, professional coping. Next to traditional forms of coping studied in public administration, studying active coping can result in more insight in when and with what consequences frontline employees speak up and resist pressures. We explore to what degree teachers use speaking out using professional norms as a way to tackle the pressures they face. Moreover, we analyze the relationship between professional coping, work engagement, and intent to leave as important indicators of how immersed frontline employees are in their work. Using survey data ( n = 1,270) from primary school teachers, we conclude that professional coping is in general regularly but not very often applied, but that professional coping is related to higher work engagement and lower intent to leave. We conclude that studying active coping strategies can not only be important for street-level literature in gaining insight in all types of behavior and their consequences but also for public service providers aiming for an engaged workforce.

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Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses’ willingness to speak up

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-007163 ◽

2018 ◽

Vol 28 (1) ◽

pp. 39-48 ◽

Cited By ~ 17

Author(s):

Carien W Alingh ◽

Jeroen D H van Wijngaarden ◽

Karina van de Voorde ◽

Jaap Paauwe ◽

Robbert Huijsman

Keyword(s):

Patient Safety ◽

Safety Management ◽

Psychological Safety ◽

Regression Analyses ◽

Speaking Up ◽

Safety Concerns ◽

Management Approaches ◽

Nurses Perceptions ◽

Speak Up ◽

The Relationship

BackgroundSpeaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers’ behaviour and employees’ perceptions about whether speaking up is safe and worthwhile is still lacking.AimTo explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses’ willingness to speak up.MethodsWe conducted a cross-sectional survey study, resulting in a sample of 980 nurses and 93 nurse managers working in Dutch clinical hospital wards. To test our hypotheses, hierarchical regression analyses (at ward level) and multilevel regression analyses were conducted.ResultsSignificantly positive associations were found between nurses’ perceptions of control-based safety management and climate for safety (β=0.74; p<0.001), and between the perceived levels of commitment-based management and team psychological safety (β=0.36; p<0.01). Furthermore, team psychological safety is found to be positively related to nurses’ speaking up attitudes (B=0.24; t=2.04; p<0.05). The relationship between nurse-rated commitment-based safety management and nurses’ willingness to speak up is fully mediated by team psychological safety.ConclusionResults provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses’ perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable.

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