Deliberate practices of speaking up and responding skills: the Speak-PREP e-learning module for healthcare professionals

PurposeSpeaking up and responding to others’ concerns promotes patient safety. We describe health professionals’ utilisation of these important skills.MethodWe developed an interactive e-learning module, Speak-PREP, to train healthcare professionals in speaking up and responding strategies. Participants completed interactive video-based exercises that engaged them with entering speaking up and responding statements, augmenting strategies from a list of prompting phrases and responding to a pushback. We report strategy utilisation.ResultsA total of 101 health professionals completed Speak-PREP training. Most frequently used speaking up strategies were: brainstorming to explore solutions (50%), showing consideration of others (45%) and encouraging others’ opinions through invitations (43%). Responding strategies included reflecting the concern expressed by colleagues, discussing next steps and expressing gratitude (70%, 67% and 50%, respectively). When prompted, participants augmented their statements with reframing concerns, asking questions to deepen understanding, using how or what to start questions and expressing curiosity (p<0.00001, p=0.003, p=0.0002 and p<0.0001, respectively). Pushbacks lead to increased use of reflecting the concern and decreasing consideration, curiosity, empathy, expressing gratitude and encouraging others’ opinions (p<0.05 for all).ConclusionsThe Speak-PREP module targeted deliberate practice in speaking up and responding skills. Future work should examine the application of these strategies in the clinical environment.

A Critical Textual Analysis of Gender Disparities in Reneilwe Malatji’s Selected Short Stories

This article demonstrates the abstractness of the gender theory of motherism posited by Nigerian scholar Catherine Acholonu, showing its weakness as a theory by which to gauge rural women’s experiences in Africa. Using the short stories of South African writer Reneilwe Malatji as literary data, the article argues that gender works in conspiracy with culture, age, marital status and ethnicity to constrain rural women from exiting abusive marriages, speaking up against their husbands’ infidelities, ending dissatisfactory marriages, and fighting poverty. At the same time, Malatji’s short stories highlight the agency of rural women in resisting gender constraints to attain self-empowerment. The article proposes ultimately that a re-theorization of motherism must reflect the harsh realities in rural women’s lives and simultaneously show that alongside the debilitating experiences of patriarchal oppression women are also acting as agents of their own transformation.

Enhancing intergroup communication in healthcare: The role of the receiver

This paper explores how the communication behaviour of another can have significant personal and professional impact and, in turn, put others in harm’s way. In healthcare, in a continual attempt to address known barriers to communication, such as fear, hierarchy and power differentials, significant human and financial resources are deployed to develop and teach new and existing methods of how to speak up. Despite the effort, speaking up remains difficult, and as a result, patients are still being harmed. The author’s personal story highlights the fact that maybe, until now, we have not been addressing the whole issue.

A behavioural study of obedience in health professional students

Interprofessional Education and Collaborative Practice (IPECP) is a field of study suggested to improve team functioning and patient safety. However, even interprofessional teams are susceptible to group pressures which may inhibit speaking up (positive deviance). Obedience is one group pressure that can inhibit positive deviance leading to negative patient outcomes. To examine the influence of obedience to authority in an interprofessional setting, an experimental simulated clinical scenario was conducted with Respiratory Therapy (RT) (n = 40) and Advanced Care Paramedic (ACP) (n = 20) students. In an airway management scenario, it was necessary for students to challenge an authority, a senior anesthesiologist, to prevent patient harm. In a 2 × 2 design cognitive load and an interventional writing task designed to increase positive deviance were tested. The effect of individual characteristics, including Moral Foundations, and displacement of responsibility were also examined. There was a significant effect for profession and cognitive load: RT students demonstrated lower levels of positive deviance in the low cognitive load scenario than students in other conditions. The writing task did not have a significant effect on RT or ACP students’ behaviour. The influence of Moral Foundations differed from expectations, In Group Loyalty was selected as a negative predictor of positive deviance while Respect for Authority was not. Displacement of responsibility was influential for some participants thought not for all. Other individual variables were identified for further investigation. Observational analysis of the simulation videos was conducted to obtain further insight into student behaviour in a compliance scenario. Individual differences, including experience, should be considered when providing education and training for positive deviance. Simulation provides an ideal setting to use compliance scenarios to train for positive deviance and for experimentation to study interprofessional team behaviour.