Speaking up about patient safety concerns: The influence of safety management approaches and climate on nurses' willingness to speak up

C.W. Alingh, J. van Wijngaarden, F.C. van de Voorde, J. Paauwe, R. Huijsman

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Abstract

Background 
Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers’ behaviour and employees’ perceptions about whether speaking up is safe and worthwhile is still lacking.
Aim 
To explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses’ willingness to speak up.
Methods 
We conducted a cross-sectional survey study, resulting in a sample of 980 nurses and 93 nurse managers working in Dutch clinical hospital wards. To test our hypotheses, hierarchical regression analyses (at ward level) and multilevel regression analyses were conducted.
Results 
Significantly positive associations were found between nurses’ perceptions of control-based safety management and climate for safety (β=0.74; p<0.001), and between the perceived levels of commitment-based management and team psychological safety (β=0.36; p<0.01). Furthermore, team psychological safety is found to be positively related to nurses’ speaking up attitudes (B=0.24; t=2.04; p<0.05). The relationship between nurse-rated commitment-based safety management and nurses’ willingness to speak up is fully mediated by team psychological safety.
Conclusion 
Results provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses’ perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable.
Original languageEnglish
Pages (from-to)39-48
JournalBMJ Quality & Safety
Volume28
Issue number1
DOIs
Publication statusPublished - 2019

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Nurses
Cross-Sectional Studies
Nurse Administrators
Delivery of Health Care

Keywords

  • ANTECEDENTS
  • ATTITUDES
  • BEHAVIOR
  • CARE
  • COMMITMENT
  • EMPLOYEE VOICE
  • LEADERSHIP
  • PERFORMANCE
  • PSYCHOLOGICAL SAFETY
  • QUALITY IMPROVEMENT
  • management
  • nurses
  • patient safety

Cite this

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title = "Speaking up about patient safety concerns: The influence of safety management approaches and climate on nurses' willingness to speak up",
abstract = "Background Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers’ behaviour and employees’ perceptions about whether speaking up is safe and worthwhile is still lacking.Aim To explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses’ willingness to speak up.Methods We conducted a cross-sectional survey study, resulting in a sample of 980 nurses and 93 nurse managers working in Dutch clinical hospital wards. To test our hypotheses, hierarchical regression analyses (at ward level) and multilevel regression analyses were conducted.Results Significantly positive associations were found between nurses’ perceptions of control-based safety management and climate for safety (β=0.74; p<0.001), and between the perceived levels of commitment-based management and team psychological safety (β=0.36; p<0.01). Furthermore, team psychological safety is found to be positively related to nurses’ speaking up attitudes (B=0.24; t=2.04; p<0.05). The relationship between nurse-rated commitment-based safety management and nurses’ willingness to speak up is fully mediated by team psychological safety.Conclusion Results provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses’ perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable.",
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author = "C.W. Alingh and {van Wijngaarden}, J. and {van de Voorde}, F.C. and J. Paauwe and R. Huijsman",
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Speaking up about patient safety concerns : The influence of safety management approaches and climate on nurses' willingness to speak up. / Alingh, C.W.; van Wijngaarden, J.; van de Voorde, F.C.; Paauwe, J.; Huijsman, R.

In: BMJ Quality & Safety, Vol. 28, No. 1, 2019, p. 39-48.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Speaking up about patient safety concerns

T2 - The influence of safety management approaches and climate on nurses' willingness to speak up

AU - Alingh, C.W.

AU - van Wijngaarden, J.

AU - van de Voorde, F.C.

AU - Paauwe, J.

AU - Huijsman, R.

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N2 - Background Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers’ behaviour and employees’ perceptions about whether speaking up is safe and worthwhile is still lacking.Aim To explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses’ willingness to speak up.Methods We conducted a cross-sectional survey study, resulting in a sample of 980 nurses and 93 nurse managers working in Dutch clinical hospital wards. To test our hypotheses, hierarchical regression analyses (at ward level) and multilevel regression analyses were conducted.Results Significantly positive associations were found between nurses’ perceptions of control-based safety management and climate for safety (β=0.74; p<0.001), and between the perceived levels of commitment-based management and team psychological safety (β=0.36; p<0.01). Furthermore, team psychological safety is found to be positively related to nurses’ speaking up attitudes (B=0.24; t=2.04; p<0.05). The relationship between nurse-rated commitment-based safety management and nurses’ willingness to speak up is fully mediated by team psychological safety.Conclusion Results provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses’ perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable.

AB - Background Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers’ behaviour and employees’ perceptions about whether speaking up is safe and worthwhile is still lacking.Aim To explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses’ willingness to speak up.Methods We conducted a cross-sectional survey study, resulting in a sample of 980 nurses and 93 nurse managers working in Dutch clinical hospital wards. To test our hypotheses, hierarchical regression analyses (at ward level) and multilevel regression analyses were conducted.Results Significantly positive associations were found between nurses’ perceptions of control-based safety management and climate for safety (β=0.74; p<0.001), and between the perceived levels of commitment-based management and team psychological safety (β=0.36; p<0.01). Furthermore, team psychological safety is found to be positively related to nurses’ speaking up attitudes (B=0.24; t=2.04; p<0.05). The relationship between nurse-rated commitment-based safety management and nurses’ willingness to speak up is fully mediated by team psychological safety.Conclusion Results provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses’ perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable.

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KW - ATTITUDES

KW - BEHAVIOR

KW - CARE

KW - COMMITMENT

KW - EMPLOYEE VOICE

KW - LEADERSHIP

KW - PERFORMANCE

KW - PSYCHOLOGICAL SAFETY

KW - QUALITY IMPROVEMENT

KW - management

KW - nurses

KW - patient safety

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DO - 10.1136/bmjqs-2017-007163

M3 - Article

VL - 28

SP - 39

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JO - BMJ Quality & Safety

JF - BMJ Quality & Safety

SN - 2044-5415

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ER -