ArticleBMJ quality & safety2012
Predictors of likelihood of speaking up about safety concerns in labour and delivery.
Article in BMJ quality & safety, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 44 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Classification of influencing factors of speaking-up behaviour in hospitals: a systematic review.BMC health services research · 2024Pooled it
- Defining Speaking Up in the Healthcare System: a Systematic Review.Journal of general internal medicine · 2023Pooled it
- Family centered nursing practices towards women and their families in the birthing context: A qualitative systematic review.Nursing open · 2023Pooled it
- Snitches Get Stitches and End Up in Ditches: A Systematic Review of the Factors Associated With Whistleblowing Intentions.Frontiers in psychology · 2021Pooled it
- To Speak Up or Not to Speak Up, Organisational and Individual Antecedents That Undergird This Behaviour in Resource Constrained Region.Journal of advanced nursing · 2025Article
- Exploring Physician-Nurse Relations Through the Lens of Intersectionality: A Scoping Review.Cureus · 2025Review
- Factors associated with assertiveness among Japanese community pharmacists: a cross-sectional study.Journal of pharmaceutical health care and sciences · 2025Article
- Healthcare professionals' perception of the World Health Organization Surgical Safety Checklist and psychological safety: a cross-sectional survey.BMJ open quality · 2024Article
- What inhibits "speaking up" for patient safety among healthcare workers? A cross-sectional study in Malaysia.Human resources for health · 2024Article
- Associations between medical students' stress, academic burnout and moral courage efficacy.BMC psychology · 2024Article
- Evaluation of a new patient safety educational programme to reduce adverse events by encouraging staff to speak up: application of the trigger tool methodology.BMJ open quality · 2024Article
- Identification of the barriers and enablers for receiving a speaking up message: a content analysis approach.Advances in simulation (London, England) · 2023Article
- South Korean Nurses' Experiences of Speaking up for Patient Safety and Incident Prevention.Healthcare (Basel, Switzerland) · 2023Article
- Moving beyond teamwork in the operating room to facilitating mutual professional respect.Proceedings (Baylor University. Medical Center) · 2023Article
- Nurses' perceptions of their role in antimicrobial stewardship within the hospital environment. An integrative literature review.Journal of clinical nursing · 2022Review
- A Newly Developed InterprofessionalJournal of clinical medicine research · 2022Article
- Speaking up or remaining silent about patient safety concerns in rehabilitation: A cross-sectional survey to assess staff experiences and perceptions.Health science reports · 2022Article
- Nursing Resources by Type of Maternity Unit Across Regions of the United States.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2022Article
- Do trained nurses feel more psychologically safe?-Results from a multi-level modelling approach.Nursing open · 2021Article
- The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis.BMC health services research · 2021Article
Corrections and comments
- Erratum issued
Authors and funding
6 authors.
Funding
Abstract
backgroundDespite 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.
methodsThe 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.
resultsThe response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7±11 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.
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