title: 'Speaking up' about patient safety concerns and unprofessional behaviour among residents: validation of two scales.
abstract: OBJECTIVE
  To develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.
  
  
  METHODS
  Residents from six large US academic medical centres completed an anonymous, electronic survey containing questions regarding safety culture and speaking up about safety and professionalism concerns.
  
  
  RESULTS
  Confirmatory factor analysis supported two separate, one-factor speaking up climates (SUCs) among residents; one focused on patient safety concerns (SUC-Safe scale) and the other focused on unprofessional behaviour (SUC-Prof scale). Both scales had good internal consistency (Cronbach's α>0.70) and were unique from validated safety and teamwork climate measures (r<0.85 for all correlations), a measure of discriminant validity. The SUC-Safe and SUC-Prof scales were associated with participants' self-reported speaking up behaviour about safety and professionalism concerns (r=0.21, p<0.001 and r=0.22, p<0.001, respectively), a measure of concurrent validity, while teamwork and safety climate scales were not.
  
  
  CONCLUSIONS
  We created and provided evidence for the reliability and validity of two measures (SUC-Safe and SUC-Prof scales) associated with self-reported speaking up behaviour among residents. These two scales may fill an existing gap in residency and safety culture assessments by measuring the openness of communication about safety and professionalism concerns, two important aspects of safety culture that are under-represented in existing metrics.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: William
authors.initials: W
authors.lastname: Martinez
authors.affiliation: The RAND Corporation, Santa Monica, California, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Etchegaray
authors.affiliation: Memorial Hermann Center for Healthcare Quality and Safety, The University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Quality, Safety & Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Hickson
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Lisa Soleymani
authors.initials: LS
authors.lastname: Lehmann
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Anneliese M
authors.initials: AM
authors.lastname: Schleyer
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Best
authors.affiliation: Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Julia T
authors.initials: JT
authors.lastname: Shelburne
authors.affiliation: Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Natalie B
authors.initials: NB
authors.lastname: May
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Sigall K
authors.initials: SK
authors.lastname: Bell
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D015279:Organizational Culture; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D028743:Professional Misconduct; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014481:United States
keywords: Communication; Graduate medical education; Patient safety; Safety culture; Statistics