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Predictors of likelihood of speaking up about safety concerns in labour and delivery.

Publication ,  Journal Article
Lyndon, A; Sexton, JB; Simpson, KR; Rosenstein, A; Lee, KA; Wachter, RM
Published in: BMJ Qual Saf
September 2012

BACKGROUND: Despite 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. METHODS: The 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. RESULTS: The 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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Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

September 2012

Volume

21

Issue

9

Start / End Page

791 / 799

Location

England

Related Subject Headings

  • Physician-Nurse Relations
  • Patient Safety
  • Pain Management
  • Oxytocin
  • Organizational Culture
  • Middle Aged
  • Male
  • Likelihood Functions
  • Labor, Induced
  • Humans
 

Citation

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Lyndon, A., Sexton, J. B., Simpson, K. R., Rosenstein, A., Lee, K. A., & Wachter, R. M. (2012). Predictors of likelihood of speaking up about safety concerns in labour and delivery. BMJ Qual Saf, 21(9), 791–799. https://doi.org/10.1136/bmjqs-2010-050211
Lyndon, Audrey, J Bryan Sexton, Kathleen Rice Simpson, Alan Rosenstein, Kathryn A. Lee, and Robert M. Wachter. “Predictors of likelihood of speaking up about safety concerns in labour and delivery.BMJ Qual Saf 21, no. 9 (September 2012): 791–99. https://doi.org/10.1136/bmjqs-2010-050211.
Lyndon A, Sexton JB, Simpson KR, Rosenstein A, Lee KA, Wachter RM. Predictors of likelihood of speaking up about safety concerns in labour and delivery. BMJ Qual Saf. 2012 Sep;21(9):791–9.
Lyndon, Audrey, et al. “Predictors of likelihood of speaking up about safety concerns in labour and delivery.BMJ Qual Saf, vol. 21, no. 9, Sept. 2012, pp. 791–99. Pubmed, doi:10.1136/bmjqs-2010-050211.
Lyndon A, Sexton JB, Simpson KR, Rosenstein A, Lee KA, Wachter RM. Predictors of likelihood of speaking up about safety concerns in labour and delivery. BMJ Qual Saf. 2012 Sep;21(9):791–799.

Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

September 2012

Volume

21

Issue

9

Start / End Page

791 / 799

Location

England

Related Subject Headings

  • Physician-Nurse Relations
  • Patient Safety
  • Pain Management
  • Oxytocin
  • Organizational Culture
  • Middle Aged
  • Male
  • Likelihood Functions
  • Labor, Induced
  • Humans