Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents.

Autor:	Martinez W; Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Lehmann LS; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.; National Center for Ethics in Health Care, Veterans Health Administration, Washington DC, USA., Thomas EJ; Memorial Hermann Center for Healthcare Quality and Safety, The University of Texas Medical School at Houston, Houston, Texas, USA., Etchegaray JM; The RAND Corporation, Santa Monica, California, USA., Shelburne JT; Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas, USA., Hickson GB; Quality, Safety & Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Brady DW; Office of Graduate Medical Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Schleyer AM; Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA., Best JA; Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA., May NB; Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA., Bell SK; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2017 Nov; Vol. 26 (11), pp. 869-880. Date of Electronic Publication: 2017 Apr 25.
DOI:	10.1136/bmjqs-2016-006284
Abstrakt:	Background: Open communication between healthcare professionals about care concerns, also known as 'speaking up', is essential to patient safety. Objective: Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats. Design: Anonymous, cross-sectional survey. Setting: Six US academic medical centres, 2013-2014. Participants: 1800 medical and surgical interns and residents (47% responded). Measurements: Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales. Results: Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50). Conclusions: Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment. Competing Interests: Competing interests: None declared. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
Databáze:	MEDLINE
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