Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety
Autoři:
David Schwappach aff001; Gerald Sendlhofer aff003; Lars-Peter Kamolz aff004; Wolfgang Köle aff005; Gernot Brunner aff004
Působiště autorů:
Swiss Patient Safety Foundation, Zurich, Switzerland
aff001; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
aff002; Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
aff003; Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
aff004; Department of General Otorhinolaryngology, Medical University of Graz, Graz, Austria
aff005; Medical Directorate, University Hospital Graz, Graz, Austria
aff006
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222461
Souhrn
Background
Speaking up behavior is a manifestation the culture of safety in an organization; however, withholding voice is commonly observed. Within one academic teaching hospital, it was the aim to assess students’ speaking up behaviors and perceived culture in order to stimulation of the academic development in terms of patient safety.
Methods
Survey amongst medical students using a validated questionnaire. Data were analysed using descriptive statistics.
Results
326 individuals completed the questionnaire (response rate 24%). 37% of responders were in their 5th- 6th clinical term, 32% were in their 7th-8th term and 31% were in the 9th-12th term. 69% of students had a specific safety concern in the past four weeks, 48% had observed an error and 68% noticed the violation of a patient safety rule. Though students perceived specific patient safety concerns, 56% did not speak up in a critical situation. All predefined barriers seemed to play an important role in inhibiting students’ voicing concerns. The scores on the psychological safety scale were overall moderately favourable. Students felt little encouraged by colleagues and, in particular, by supervisors to speak up.
Conclusion
Speaking up behaviour of students was assessed for the first time in an Austrian academic teaching hospital. The higher the term the more frequent students reported perceived patient safety concerns or rule violations and withholding voice. These results suggest the need to adapt the curriculum concept of the faculty in order to address patient safety as a relevant topic.
Klíčová slova:
Medicine and health sciences – Health care – Patients – Health care providers – Nurses – Medical humanities – Research and analysis methods – Research design – Survey research – Surveys – Mathematical and statistical techniques – Statistical methods – Analysis of variance – Regression analysis – People and places – Population groupings – Professions – Medical personnel – Supervisors – Biology and life sciences – Psychology – Behavior – Social sciences – Sociology – Education – Medical education – Physical sciences – Mathematics – Statistics
Zdroje
1. Schwappach D, Richard A. Speak up-related climate and its association with healthcare workers’ speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland. BMJ Qual Saf [Internet]. 2018 [cited 2018 Jul 23];0:1–9. Available from: http://dx.doi.org/10.1136/bmjqs-2017-007388
2. 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 [Internet]. 2012 Sep [cited 2017 Nov 4];21(9):791–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22927492 doi: 10.1136/bmjqs-2010-050211
3. Morrow KJ, Gustavson AM, Jones J. Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies. Int J Nurs Stud [Internet]. 2016 Dec [cited 2017 Nov 4];64:42–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27684321 doi: 10.1016/j.ijnurstu.2016.09.014
4. Beament T, Mercer SJ. Speak up! Barriers to challenging erroneous decisions of seniors in anaesthesia. Anaesthesia [Internet]. 2016 Nov [cited 2017 Nov 4];71(11):1332–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27734483 doi: 10.1111/anae.13546
5. Schwappach DL, Gehring K. Trade-offs between voice and silence: a qualitative exploration of oncology staff’s decisions to speak up about safety concerns. [cited 2017 Oct 29]; Available from: https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/1472-6963-14-303?site=bmchealthservres.biomedcentral.com
6. Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: a literature review. [cited 2017 Oct 29]; Available from: https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/1472-6963-14-61?site=bmchealthservres.biomedcentral.com
7. Schwappach DLB, Gehring K. “Saying it without words”: a qualitative study of oncology staff’s experiences with speaking up about safety concerns. BMJ Open [Internet]. 2014 May 16 [cited 2017 Dec 2];4(5):e004740. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24838725 doi: 10.1136/bmjopen-2013-004740
8. Schwappach D, Sendlhofer G, Häsler L, Gombotz V, Leitgeb K, Hoffmann M, et al. Speaking up behaviors and safety climate in an Austrian university hospital. Int J Qual Heal Care [Internet]. 2018 Apr 26 [cited 2018 Jul 23]; Available from: https://academic.oup.com/intqhc/advance-article/doi/10.1093/intqhc/mzy089/4987045
9. der Vossen MM, van Mook W, Croiset G, Kusurkar R. Simulated Patient’s Perspective on Speaking up about Unprofessional Behavior: Qual Prim Care [Internet]. 2018 Feb 15 [cited 2018 May 6];26(1). Available from: http://primarycare.imedpub.com/simulated-patients-perspective-on-speaking-up-about-unprofessional-behavior-training-theresponding-muscles-is-key.php?aid=21890
10. Samuel R, Shuen A, Dendle C, Kotsanas D, Scott C, Stuart RL. Hierarchy and Hand Hygiene: Would Medical Students Speak Up to Prevent Hospital-Acquired Infection? Infect Control Hosp Epidemiol [Internet]. 2012 Aug 2 [cited 2018 May 20];33(08):861–3. Available from: https://www.cambridge.org/core/product/identifier/S0195941700031428/type/journal_article
11. Schwappach DLB. Speaking up about hand hygiene failures: A vignette survey study among healthcare professionals. Am J Infect Control [Internet]. 2018 Apr 9 [cited 2018 Jul 23]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/29650487
12. Martinez W, Lehmann LS, Thomas EJ, Etchegaray JM, Shelburne JT, Hickson GB, et al. Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents. BMJ Qual Saf [Internet]. 2017 Nov 1 [cited 2018 Sep 2];26(11):869–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28442609 doi: 10.1136/bmjqs-2016-006284
13. Reeves SA, Denault D, Huntington JT, Ogrinc G, Southard DR, Vebell R. Learning to Overcome Hierarchical Pressures to Achieve Safer Patient Care. Nurse Educ [Internet]. 2017 [cited 2018 May 6];42:S27–31. Available from: http://insights.ovid.com/crossref?an=00006223-201709001-00007 28832459
14. Rees CE, Monrouxe LV., McDonald LA. ‘My mentor kicked a dying woman’s bed…’ Analysing UK nursing students’ ‘most memorable’ professionalism dilemmas. J Adv Nurs [Internet]. 2015 Jan [cited 2018 Jul 23];71(1):169–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24916272 doi: 10.1111/jan.12457
15. Bickhoff L, Sinclair PM, Levett-Jones T. Moral courage in undergraduate nursing students: A literature review. Collegian [Internet]. 2017 Feb 1 [cited 2018 May 6];24(1):71–83. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1322769615000761 29218965
16. Doyle P, Vandenkerkhof EG, Edge DS, Ginsburg L, Goldstein DH. Self-reported patient safety competence among Canadian medical students and postgraduate trainees: a cross-sectional survey. [cited 2019 May 1]; Available from: http://dx.doi.org/10.1136/bmjqs-2014-003142
17. American Nurses Association., Kent State University. School of Nursing. Online journal of issues in nursing. [Internet]. Kent State University School of Nursing in partnership with the American Nurses’ Association; 1996 [cited 2018 Jul 23]. http://ojin.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Courage-and-Distress/Moral-Courage-and-Risk.html
18. Bradbury-Jones C, Sambrook S, Irvine F. The meaning of empowerment for nursing students: a critical incident study. J Adv Nurs [Internet]. 2007 Aug [cited 2018 Jul 23];59(4):342–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17543007 doi: 10.1111/j.1365-2648.2007.04331.x
19. Human Medicine. cited 2019 Sep 4. Available from: https://www.medunigraz.at/en/studying/range-of-studies/human-medicine/
20. Burns KEA, Duffett M, Kho ME, Meade MO, Adhikari NKJ, Sinuff T, et al. A guide for the design and conduct of self-administered surveys of clinicians. Can Med J 2008; 179(3): 245–252.
21. Richard A, Pfeiffer Y, Schwappach DDL. Development and Psychometric Evaluation of the Speaking Up About Patient Safety Questionnaire. J Patient Saf [Internet]. 2017 Aug 28 [cited 2018 Sep 1];1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28858000
22. Cuzick J. 1985. A Wilcoxon-type test for trend. Statistics in Medicine 4: 87–90 doi: 10.1002/sim.4780040112 3992076
23. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ [Internet]. 2016 May 3 [cited 2017 Nov 4];353:i2139. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27143499 doi: 10.1136/bmj.i2139
24. Walton M, Woodward H, Van Staalduinen S, Lemer C, Greaves F, Noble D, et al. The WHO patient safety curriculum guide for medical schools. BMJ Qual Saf [Internet]. 2010 Dec 1 [cited 2018 Sep 9];19(6):542–6. Available from: http://qualitysafety.bmj.com/lookup/doi/10.1136/qshc.2009.036970
25. Coleman DL, Wardrop RM, Levinson WS, Zeidel ML, Parsons PE. Strategies for Developing and Recognizing Faculty Working in Quality Improvement and Patient Safety. Acad Med [Internet]. 2017 Jan [cited 2018 Sep 2];92(1):52–7. Available from: http://insights.ovid.com/crossref?an=00001888-201701000-00020 doi: 10.1097/ACM.0000000000001230 27191838
26. Patient Safety Curriculum Guide Multi-professional Edition [Internet]. 2011 [cited 2018 Sep 2]. www.who.int
27. Sandars J, Bax N, Mayer D, Wass V, Vickers R. Educating undergraduate medical students about patient safety: Priority areas for curriculum development. Med Teach [Internet]. 2007 Jan 3 [cited 2018 Sep 9];29(1):60–1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17538837 doi: 10.1080/01421590601087546
28. Anderson E, Thorpe L, Heney D, Petersen S. Medical students benefit from learning about patient safety in an interprofessional team. Med Educ [Internet]. 2009 Jun [cited 2018 Sep 9];43(6):542–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19493178 doi: 10.1111/j.1365-2923.2009.03328.x
29. Dao DK, Goss AL, Hoekzema AS, Kelly LA, Logan AA, Mehta SD, et al. Integrating Theory, Content, and Method to Foster Critical Consciousness in Medical Students. Acad Med [Internet]. 2017 Mar [cited 2018 Sep 2];92(3):335–44. Available from: http://insights.ovid.com/crossref?an=00001888-201703000-00025 27680318
30. Escher C, Creutzfeldt J, Meurling L, Hedman L, Kjellin A, Felländer-Tsai L. Medical students’ situational motivation to participate in simulation based team training is predicted by attitudes to patient safety. BMC Med Educ [Internet]. 2017 Dec 10 [cited 2018 Sep 2];17(1):37. Available from: http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0876-5 doi: 10.1186/s12909-017-0876-5 28183316
31. Ogunlayi F, Britton P. Achieving a "top-down" change agenda by driving and supporting a collaborative "bottom-up" process: case study of a large enhanced revovery programme. BMJ Open Quality 2017;6:e000008. doi: 10.1136/bmjoq-2017-000008 29450260
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