Speaking up about patient safety in psychiatric hospitals - a cross-sectional survey study among healthcare staff.
David L B Schwappach, Andrea Niederhauser
PMID 31609065WHAT IT FOUND
Sixty-five percent of psychiatric hospital staff had patient safety concerns in the last four weeks.
Nurses reported concerns and speaking up more often than doctors, but also withheld concerns more often. Lower-ranking staff felt less safe speaking up than managers.
Key findings
01Nurses reported significantly higher frequencies of perceiving safety concerns, withholding voice, and speaking up compared to psychologists and doctors.
02Staff of lower hierarchical level reported less positive speaking up climate scores and higher frequencies of withholding voice compared to staff of higher hierarchical level.
03Nurses were more likely than other groups to report perceived ineffectiveness of speaking up as a major barrier to voicing concerns.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The response rate was low (23%), raising concerns about selection bias and the representativeness of the sample. The study was cross-sectional and relied on self-reported behaviors over a four-week period, which may be subject to recall bias. The survey instrument (SUPS-Q-PSYCH) was adapted for this study and showed mixed results in confirmatory factor analysis, suggesting the three-factor structure of climate data was not fully supported. Participants self-selected hospitals, which may have influenced the willingness of staff to participate or the baseline safety culture.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that a high self-reported likelihood to speak up in a hypothetical vignette translates to actual behavior in real clinical emergencies. The study found that while staff anticipated speaking up, nurses still reported withholding voice more often than other groups, and the vignette was rated as not very realistic by respondents.