Simulation Centre, University Hospital Zurich, Zurich, Switzerland.
Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
Br J Anaesth. 2022 Nov;129(5):776-787. doi: 10.1016/j.bja.2022.07.050. Epub 2022 Sep 6.
Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response.
In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling.
The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%).
Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.
表达关切对于患者安全至关重要。我们研究了与目睹不礼貌（即礼貌、尊重）的回应相比，目睹礼貌（即模糊且略带轻视）或粗鲁的回应是否会增加医院工作人员进一步表达意见的可能性。
在单一大教学医院进行的这项 RCT 中，设计了一个单一的基本生命支持模拟场景，以引出标准化的发言机会。由两名或三名成员组成的团队被随机分配到三个实验条件之一，在这些条件中，对发言的回应礼貌程度通过嵌入的模拟人员进行操纵。通过应用 10 个代码使用 The Observer XT 14.1 对团队互动的视频记录进行行为编码来评估发言行为。使用多级模型进行数据分析。
样本包括 125 名跨专业医院工作人员（82 名[66%]女性，43 名[34%]男性）。当参与者感到心理安全时，他们更有可能发言（γ=0.47；标准误差 [se]=0.19；95%置信区间 [CI]，0.09-0.85；P=0.017）。与其他条件相比，参与者在粗鲁条件下更有可能发言（γ=0.28；se=0.12；95%CI，0.05-0.52；P=0.019）。在各种条件下，参与者最常通过提问结构（n=289，31.52%）、主动（n=240，26.17%）和反应（n=148，16.14%）指令语句以及手势（n=139，15.16%）发言。
我们的研究挑战了当前关于医疗保健中礼貌和发言行为相互作用的假设。
