Kanwal Noreen, Isha Ahmad Shahrul Nizam, Al-Mekhlafi Al-Baraa Abdulrahman, Haider Rao Irfan Ali
Department of Management, Sunway Business School, Sunway University, Subang Jaya, Selangor, 47500, Malaysia.
Department of Management and Humanities, University Technology PETRONAS, Persiaran UTP, 32610, Seri Iskandar, Perak, Malaysia.
BMC Health Serv Res. 2025 Jan 6;25(1):32. doi: 10.1186/s12913-024-11782-7.
Voice barriers among frontline healthcare workers hinder safety related to work and patients. Understanding these barriers and practices is crucial to improve voice behavior in healthcare settings. Therefore, this study aims to identify the voice barriers and practices among healthcare workers in Pakistan.
The study has adopted a mixed-method research design. Data was collected from 15 frontline healthcare workers through semi-structured interviews to achieve study objectives. Descriptives and content analysis were conducted to explore voice barriers and alternative practices to solve their concerns. After that, a quantitative study was conducted to determine the statistical significance of the identified voice barriers and the magnitude of their effect. For this purpose, data was collected from 480 frontline healthcare workers in the primary, secondary, and territory healthcare units. A questionnaire survey was used for data collection. Then, multistage hierarchical regression analysis was employed for data analysis.
Study findings highlight the determinants of two key factors: withholding patient safety concerns and withholding worker safety concerns. First, the study identifies several factors that increase the likelihood of healthcare workers withholding concerns about patient safety. These factors include professional designation, work experience, blackmailing, overconfidence, longer work tenure, feelings of insult, early career stage, fear of patient reactions, bad past experiences, job insecurity, and uncooperative management. Fear of increased workload also plays a significant role. Second, when it comes to work-related safety concerns, factors such as gender, shyness, lack of confidence, fear of duty changes, management issues, interpersonal conflicts, and resource shortages contribute to the withholding of concerns. To navigate these challenges, healthcare workers often resort to strategies such as seeking political connections, personal settlements, transfers, union protests, quitting, using social media, engaging in private practice, or referring patients to other hospitals.
Findings demonstrates that healthcare workers in Pakistan often withhold safety concerns due to hierarchical pressures, personal insecurities, and fear of repercussions. Their reliance on external mechanisms, such as political influence or social media, underscores the need for significant reforms to improve safety culture and management support. Addressing these issues is crucial for ensuring both patient and worker safety.
一线医护人员之间的发声障碍阻碍了与工作和患者相关的安全。了解这些障碍和做法对于改善医疗环境中的发声行为至关重要。因此，本研究旨在确定巴基斯坦医护人员中的发声障碍和做法。
本研究采用了混合方法研究设计。通过半结构化访谈从15名一线医护人员收集数据以实现研究目标。进行描述性分析和内容分析以探索发声障碍和解决他们担忧的替代做法。之后，进行了一项定量研究以确定所识别的发声障碍的统计显著性及其影响程度。为此，从初级、二级和地区医疗单位的480名一线医护人员收集数据。使用问卷调查进行数据收集。然后，采用多阶段分层回归分析进行数据分析。
研究结果突出了两个关键因素的决定因素：隐瞒患者安全问题和隐瞒工作人员安全问题。首先，该研究确定了几个增加医护人员隐瞒患者安全担忧可能性的因素。这些因素包括专业职称、工作经验、敲诈勒索、过度自信、工作任期长、受辱感、职业生涯早期、对患者反应的恐惧、过去的不良经历、工作不安全感和不合作的管理层。对工作量增加的恐惧也起着重要作用。其次，在与工作相关的安全问题方面，性别、害羞、缺乏自信、对职责变化的恐惧、管理问题、人际冲突和资源短缺等因素导致担忧被隐瞒。为了应对这些挑战，医护人员经常诉诸于寻求政治关系、私下解决、调动、工会抗议、辞职、使用社交媒体、从事私人执业或将患者转诊到其他医院等策略。
研究结果表明，由于层级压力、个人不安全感和对后果的恐惧，巴基斯坦的医护人员经常隐瞒安全问题。他们对政治影响或社交媒体等外部机制的依赖凸显了进行重大改革以改善安全文化和管理支持的必要性。解决这些问题对于确保患者和工作人员的安全至关重要。
