Embracing or relinquishing sources of power in interprofessional communication: implications for patient-centered speaking up.

Health professionals working in an interprofessional work environment are entrusted to speak up on behalf of patients. However, that environment is comprised of dynamic intra- and interprofessional hierarchies, characterized by power differentials that affect speaking up behaviors. Drawing on the social bases of power and on power/interaction theory, we analyzed focus group and interview transcripts of 62 health professionals' accounts of speaking up. We focused on their primary sources of power, and described factors associated with health professionals' embracing power to speak up for patient safety, as well as those associated with relinquishing power and remaining silent. Nurses primarily employed direct patient information as a source of power to advocate for patients. Senior nurses and attending physicians exercised their legitimate power through titles or expertise, and when embracing that power, often influenced the healthcare team's speaking up behaviors and the team environment. Physician trainees perceived to have limited sources of power. Participants reported using hospital policies, relationships, and humor for engaging in speaking up behavior. Relinquishing power and remaining silent were associated with fear, anxiety, and lack of confidence. Given the complex, hierarchical environment in healthcare, leaders' inclusive behaviors for setting a culture for speaking up, including modeling speaking up, are critical.