title: Predictors of likelihood of speaking up about safety concerns in labour and delivery.
abstract: BACKGROUND
  Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care.
  
  
  METHODS
  The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm. The authors embedded this scale in a survey with measures of safety climate, teamwork climate, disruptive behaviour, work stress, and personality traits of bravery and assertiveness. The survey was distributed to all registered nurses and obstetricians practising in two US Labour & Delivery units.
  
  
  RESULTS
  The response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7±11 years in specialty). A higher perception of harm, respondent role, specialty experience and site predicted the likelihood of speaking up when controlling for bravery and assertiveness. Physicians rated potential harm in common clinical scenarios lower than nurses did (7.5 vs 8.4 on 2-10 scale; p<0.001). Some participants (12%) indicated they were unlikely to speak up, despite perceiving a high potential for harm in certain situations.
  
  
  CONCLUSIONS
  This exploratory study found that nurses and physicians differed in their harm ratings, and harm rating was a predictor of speaking up. This may partially explain persistent discrepancies between physicians and nurses in teamwork climate scores. Differing assessments of potential harms inherent in everyday practice may be a target for teamwork intervention in maternity care.
authors.affiliation: Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA. audrey.lyndon@nursing.ucsf.edu
authors.forename: Audrey
authors.initials: A
authors.lastname: Lyndon
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
authors.forename: Kathleen Rice
authors.initials: KR
authors.lastname: Simpson
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenstein
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Lee
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
mesh_terms: D000328:Adult; D001242:Assertiveness; D003142:Communication; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000592:standards; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010121:Oxytocin / Q000008:administration & dosage; D059408:Pain Management / Q000379:methods; D061214:Patient Safety; D019555:Physician-Nurse Relations
chemical_list: D010121:Oxytocin