In the intricate world of healthcare, where patient safety is paramount, the ability to speak up is a crucial component of a culture of safety. However, the complexities surrounding voicing concerns or challenging the status quo in a healthcare environment can be extremely daunting. Speaking up to those who are respected, who are perceived as more powerful or more influential is not easy. Even asking questions, let alone questioning others can create tension or even risk relationships. We are too often silenced by others or are purposefully silent ourselves because it is the easier thing to do.
Barriers to Speaking Up:
- Hierarchy and Power Dynamics:
- The traditional hierarchy in healthcare is still alive and well. Decision-making often follows a top-down approach. This makes it difficult for staff of ‘lower banding’ or status or even those that are ‘younger’ or have not been around for as long as others to speak up. I often have really enthusiastic staff who are fairly new saying they are dismissed because they have not had the experience of those they are trying to talk to. We are missing out on not only giving our staff a chance to learn but for us all to learn from other peoples ideas. Wisdom comes with age, but wisdom also means listening to others no matter how much or how little experience they have.
- Fear of Retaliation:
- The number one dynamic for a high performing team is psychological safety. Psychological safety, where individuals feel they belong to the team, feel comfortable asking questions and expressing their opinions without fear of judgment, is a must within healthcare. Without this, healthcare professionals may, and sadly often do, choose silence over voicing concerns.Speaking out, especially when you witness something that is about to go wrong or has gone wrong is a risky business. Healthcare professionals fear looking stupid, fear they may have it wrong themselves, or they fear retaliation or damage to their professional reputation if they speak up against a colleague or challenge a decision. This fear can discourage open communication and obviously hinder the identification of potential risks or actual harm.
- Cultural norms:
- Long-standing cultural norms in healthcare may discourage questioning authority or deviating from established practices. The “this is how we’ve always done it” mentality can stifle innovation and improvement. Crucially, a multicultural society and workforce may also have cultural norms and behaviours that inhibit speaking up to those of authority or other professions.
What can we do:
- Promoting a restorative just culture:
- Establishing a culture that is fair, proportionate and respective helps create an environment where individuals feel safe reporting concerns without fear of severe consequences. Creating one that has healing at its heart helps restore relationships and provide the comfort that people need, especially when things have gone wrong.
- Training and education:
- We all need help. Learning how to effectively coach and mentor, how to communicate, how to do conflict resolution, and raising awareness of the importance of speaking up – all these can equip healthcare professionals with the skills and confidence needed to voice their concerns constructively or listen to those that do.
- Provide opportunity and permission:
- All of us play a pivotal role in providing the opportunity and permission for people to share, ask questions, contribute and challenge. People who actively encourage and value open communication contribute to a culture where speaking up is seen as a responsibility rather than a challenge. Our response really matters.
The Impact on Patient Safety: The reluctance to speak up can have profound consequences for patient safety. Errors may go unaddressed, potential risks undiscovered, and suboptimal practices unchallenged. Equally amazing ideas, innovations and improvements are lost. Creating an environment where healthcare professionals feel empowered to speak up is essential for preventing patient safety incidents and improving the working lives of staff.
Patient Safety Now 