Abstract
Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up‐related behaviour and climate for the first time in psychiatric hospitals. A cross‐sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up‐related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up‐related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%–65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13–25% of HCWs, and speaking up was reported by 53%–72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self‐reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure.
Highlights
IntroductionMedical errors and adverse events occur frequently in psychiatric hospitals
We focused on mental health treatment provided in psychiatric hospitals
Encouraging Environment for Speaking up (Cronbach’s alpha = 0.8) In my unit/clinical area, I observe others speaking up about their patient safety concerns I am encouraged by my colleagues to speak up about patient safety concerns I am encouraged by my supervisors to speak up about patient safety concerns
Summary
Medical errors and adverse events occur frequently in psychiatric hospitals. A study in psychiatric units from medical centres in the Veterans Health Administration (VHA) hospital system identified a patient safety event in 28% of all discharges reviewed (Marcus et al, 2018). A recent review of 4,371 medical charts from 14 inpatient psychiatric units identified adverse events in 14.5% and medical errors in 9% of hospitalizations (Vermeulen et al, 2018). Experts have identified medication and diagnostic errors, harm from use of restraints and seclusion, errors in treating suicidal or self-harm tendencies, and
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