Speaking Up about Patient Safety in Perioperative Care: Differences between Academic and Nonacademic Hospitals in Austria and Switzerland.

: In perioperative care, communication about patient safety concerns is both difficult and valuable. Research into speaking up has mostly been conducted in single countries; the aim of this study was to compare speaking up-related climate and behaviors in academic and nonacademic hospitals. : The study is based on two surveys conducted in Austria and Switzerland. The Swiss survey was conducted in five nonacademic hospitals, the Austrian survey in one university hospital. : 768 questionnaires were returned (nonacademic:  = 360; response rate: 37%; academic:  = 408; response rate: 32%). There were differences ( < 0.001) concerning speaking up episodes (at least one episode of speaking up in the past four weeks) between nonacademic hospitals (68%) and the academic hospital (96%). Withholding voice was reported by 32% of nonacademic and 43% of academic staff ( = 0.003). The speak up-related climate in the Swiss sample was more positive. Nurses compared to doctors scored higher on all items of the "resignation scale." Important differences emerged in ratings of a clinical scenario of missed hand disinfection: Nonacademic health-care workers perceived the risk of harm for patients higher compared to academic (5.3 vs. 2.5;  < 0.001). Responders higher in hierarchy felt better with speaking up in nonacademic hospitals. : The study is one of the first to address differences in academic and nonacademic hospitals in speaking up behaviors and demonstrated differences. This analysis helps to put local data in perspective and to target further activities for improvement.