ArticleBMJ quality & safety2018
Speak up-related climate and its association with healthcare workers' speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland.
Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 4 of them syntheses that pooled it.
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Who cites it
59 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Essential elements and outcomes of psychological safety in the healthcare practice setting: A systematic review.Applied nursing research : ANR · 2025Pooled it
- Classification of influencing factors of speaking-up behaviour in hospitals: a systematic review.BMC health services research · 2024Pooled it
- The Relationship between Negative Leadership Behaviours and Silence among Nurses.Journal of nursing management · 2024Pooled it
- Defining Speaking Up in the Healthcare System: a Systematic Review.Journal of general internal medicine · 2023Pooled it
- Feeling better informed and more confident to speak up in the operating room: team effects of a structured intraoperative briefing intervention - a before-after study.BMJ open quality · 2026Article
- 'If You Don't Speak Up, It Will Eat You Up': A Critical Discourse Analysis of Voice and Silence in a Multicultural Clinical Healthcare System.Nursing inquiry · 2026Article
- A meta-ethnography of staff experiences of raising concerns about quality and safety in residential aged care.The Gerontologist · 2026Review
- Breaking the safety barrier: Risk factors for unjustified non-acceptance of pharmaceutical interventions in the PICU and their association with mortality.Exploratory research in clinical and social pharmacy · 2026Article
- Bias and discrimination in healthcare through the eyes of future professionals: a qualitative study of student observations.BMC medical education · 2026Article
- Factors influencing hand hygiene speak-up as perceived by nursing students with clinical practice experience: an application of the theory of planned behavior.BMC nursing · 2026Article
- The relationship between nurses' speaking up about patient safety and nursing work environment in Saudi Arabia: A cross-sectional study.Belitung nursing journal · 2026Article
- The Impact of Compulsory Citizenship Behavior on Organizational Silence in Nurses: The Roles of Presenteeism and Psychological Inflexibility.Journal of nursing management · 2026Article
- Development and Evaluation of a "Speak-Up" Program for Patient Safety: A Virtual Reality-Based Intervention for Nursing Students.Healthcare (Basel, Switzerland) · 2025Article
- Core competencies and training needs of specialist-nurse clinical educators: a latent profile analysis.BMC nursing · 2025Article
- Network analysis of the relationships between voice behavior and team psychological safety climate among Chinese nurses.BMC nursing · 2025Article
- Individual and unit-level predictors of promotive voice in nursing: a multilevel analysis.BMC nursing · 2025Article
- Examining the effects of despotic leadership on nurses in the face of emotional exhaustion, organizational silence, and revanchist behaviors.BMC nursing · 2025Article
- Assertiveness in Nursing: A Systematic Review of Its Role and Impact in Healthcare Settings.Nursing reports (Pavia, Italy) · 2025Review
- Assessing employee silence about patient safety and its association with environmental factors among nurses in Ardabil: a cross-sectional study.BMC health services research · 2025Article
- The relationship between affective leadership and the voice behavior of nurses: a cross-level moderated mediation model.BMC nursing · 2025Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice.
designCross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression models
setting4 hospitals with a total of nine sites from the German, French and Italian speaking part of Switzerland.
participantsSurvey data were collected from 979 nurses and doctors.
main outcome measuresFrequencies of perceived patient safety concerns, of withholding voice and of speaking up behaviour. Speak up-related climate measures included psychological safety, encouraging environment and resignation.
resultsPerceived patient safety concerns were frequent among doctors and nurses (between 62% and 80% reported at least one safety concern during the last 4 weeks depending on the single items). Withholding voice was reported by 19%-39% of HCWs. Speaking up was reported by more than half of HCWs (55%-76%). The frequency of perceived concerns during the last 4 weeks was positively associated with both speaking up (OR=2.7, p<0.001) and withholding voice (OR=1.6, p<0.001). An encouraging environment was related to higher speaking up frequency (OR=1.3, p=0.005) and lower withholding voice frequency (OR=0.82, p=0.006). Resignation was associated with withholding voice (OR=1.5, p<0.001). The variance in both voicing behaviours attributable to the hospital-site level was marginal.
conclusionsOur results strengthen the importance of a speak up-supportive safety climate for staff safety-related communication behaviours, specifically withholding voice. This study indicates that a poor climate, in particular high levels of resignation among HCWs, is linked to frequent 'silence' of HCWs but not inversely associated with frequent speaking up. Interventions addressing safety-related voicing behaviours should discriminate between withholding voice and speaking up.
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