van Dongen Dimmy, Guldenmund Frank, Grossmann Irene, Groeneweg Jop
Centre for Safety in Healthcare, at the Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, Delft, 2628 BX, the Netherlands.
BMC Health Serv Res. 2024 Dec 28;24(1):1657. doi: 10.1186/s12913-024-12138-x.
Speaking up among healthcare professionals plays an essential role in improving patient safety and quality of care, yet it remains complex and multifaceted behaviour. Despite awareness of potential risks and adverse outcomes for patients, professionals often hesitate to voice concerns due to various influencing factors. This complexity has encouraged research into the determinants of speaking-up behaviour in hospital settings. This review synthesises these factors into a multi-layered framework. It aims to provide a more comprehensive perspective on the influencing factors, which provides guidance for interventions aimed at fostering environments contributing to speaking up in hospitals.
A systematic review was conducted in November 2024, searching databases: PubMed, Scopus and Web of Science. Following PRISMA guidelines and the three stages for thematic synthesis, we developed the classification of influencing factors. Out of 1,735 articles identified articles, 413 duplicates were removed, 1,322 titles and abstracts were screened, and 152 full texts (plus six additional articles) were assessed. Ultimately, 45 articles met the inclusion criteria.
The review categorised influencing factors into four categories: individual (29 articles, 64%), relational (21 articles, 47%), contextual (19 articles, 42%), and organisational (26 articles, 58%). These categories encompass motivating, hindering and trade-off factors affecting speaking up among healthcare professionals in hospitals.
The multi-layered framework highlights the dynamic interplay of factors influencing speaking up among healthcare professionals. A systems approach is essential for identifying barriers and enablers and designing effective speaking up interventions. This framework serves as a foundation for more focused research and practical guidance, enabling healthcare leaders to address barriers across all categories. By fostering environments that support open communication, organisations can enhance patient safety and quality of care.
在医疗保健专业人员中直言不讳对于提高患者安全和护理质量起着至关重要的作用，但这仍然是一种复杂且多方面的行为。尽管意识到患者可能面临的风险和不良后果，但由于各种影响因素，专业人员往往对表达担忧犹豫不决。这种复杂性促使人们对医院环境中直言行为的决定因素进行研究。本综述将这些因素综合成一个多层次框架。其目的是提供一个关于影响因素的更全面视角，为旨在营造有利于在医院直言的环境的干预措施提供指导。
2024年11月进行了一项系统综述，检索了以下数据库：PubMed、Scopus和科学网。遵循PRISMA指南和主题综合的三个阶段，我们制定了影响因素分类。在识别出的1735篇文章中，删除了413篇重复文章，筛选了1322篇标题和摘要，并评估了152篇全文（外加6篇其他文章）。最终，45篇文章符合纳入标准。
该综述将影响因素分为四类：个人因素（29篇文章，64%）、关系因素（21篇文章，47%）、背景因素（19篇文章，42%）和组织因素（26篇文章，58%）。这些类别涵盖了影响医院医疗保健专业人员直言的激励、阻碍和权衡因素。
多层次框架突出了影响医疗保健专业人员直言的因素之间的动态相互作用。采用系统方法对于识别障碍和促进因素以及设计有效的直言干预措施至关重要。该框架为更有针对性的研究和实践指导奠定了基础，使医疗保健领导者能够解决所有类别的障碍。通过营造支持开放沟通的环境，组织可以提高患者安全和护理质量。
