Objective: To analyze speaking up behavior and safety climate with a validated questionnaire for the first time in an Austrian university hospital.
Design: Survey amongst healthcare workers (HCW). Data were analyzed using descriptive statistics, Cronbach's alpha was calculated as a measure of internal consistencies of scales. Analysis of variance and t-tests were used.
Setting: The survey was conducted in 2017.
Participants: About 2.149 HCW from three departments were asked to participate.
Intervention: To measure speaking up behavior and safety climate.
Main outcome measure: To explore psychological safety, encouraging environment and resignation towards speaking up.
Results: About 859 evaluable questionnaires were returned (response rate: 40%). More than 50% of responders perceived specific concerns about patient safety within the last 4 weeks and observed a potential error or noticed rule violations. For the different items, between 16% and 42% of HCW reported that they remained silent though concerns for safety. In contrast, between 96% and 98% answered that they did speak up in certain situations. The psychological safety for speaking up was lower for HCW with a managerial function (P < 0.001). HCW with managerial functions perceived the environment as less encouraging to speak up (P < 0.05) than HCW without managerial function.
Conclusions: We identified speaking up behaviors for the first time in an Austrian university hospital. Only moderately frequent concerns were in conflict with frequent speaking up behaviors. These results clearly show that a paradigm shift is needed to increase speaking up culture.