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Associations of form and function of speaking up in anaesthesia: a prospective observational study


Lemke, Rahel; Burtscher, Michael J; Seelandt, Julia C; Grande, Bastian; Kolbe, Michaela (2021). Associations of form and function of speaking up in anaesthesia: a prospective observational study. British Journal of Anaesthesia, 127(6):971-980.

Abstract

Background: Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up.

Methods: Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding.

Results: Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018).

Conclusion: Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions.

Keywords: assertiveness; group processes; interaction; patient safety; responding; speaking up.

Abstract

Background: Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up.

Methods: Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding.

Results: Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018).

Conclusion: Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions.

Keywords: assertiveness; group processes; interaction; patient safety; responding; speaking up.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Anesthesiology and Pain Medicine
Uncontrolled Keywords:Anesthesiology and Pain Medicine
Language:English
Date:2021
Deposited On:03 Dec 2021 05:00
Last Modified:27 May 2024 01:44
Publisher:Elsevier
ISSN:0007-0912
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.bja.2021.08.014
Related URLs:https://www.zora.uzh.ch/id/eprint/229481/
PubMed ID:34511257
Project Information:
  • : FunderSNSF
  • : Grant ID10001C_169785
  • : Project TitleSpeaking Up for patient safety: Investigating the social dynamics of voice behavior in healthcare
  • Content: Published Version
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)