title: [When silence is dangerous: "Speaking-up" about safety concerns].
abstract: BACKGROUND
  Open and direct communication ("speaking-up") about errors, bypassed safety rules and risky behaviours among hospital staff is required to avoid patient harm, and it is an essential characteristic of an established safety culture. In German-speaking countries, little is known about speaking-up behaviour among health care professionals (HCPs) in hospitals.
  
  
  METHODS
  Safety concerns and speaking-up behaviours among HCPs of nine oncological units of eight hospitals were assessed using a self-administered survey. A vignette was embedded to assess hypothetical speaking-up and its predictors. The association of hierarchical position and speaking-up was investigated. 1,013 physicians and nurses completed the survey (65 % response rate).
  
  
  RESULTS
  53 % of the HCPs reported having concerns about patient safety at their unit, "sometimes", "frequently", or "very frequently". Colleagues bypassing important safety rules at least "sometimes" were reported by 30 %. A considerable fraction of responders reported episodes of withholding of voice. Nearly 20 % said they did not communicate safety problems at their unit at least sometimes. 73 % of higher-ranking staff and 60 % among those at lower ranks said they had never withheld information which could have reduced threats to patients (OR=1.8, p≤0.001). Many responders felt that speaking-up is often difficult and challenging. 32 % responded that they would not speak-up about a missed hand disinfection towards a colleague assessing the wound of a recently operated oncological patient.
  
  
  CONCLUSIONS
  HCPs in hospital frequently experience safety concerns and often withhold them. An important resource for better patient safety is lost. The development of interventions to improve speaking-up culture is warranted.
authors: Swiss Patient Safety Foundation, Zurich, Switzerland; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. Electronic address: schwappach@patientensicherheit.ch.
authors: David L B
authors: DL
authors: Schwappach
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D005858:Germany; D006801:Humans; D061214:Patient Safety; D010564:Personnel, Hospital; D017751:Safety Management
keywords: Kommunikation; Medizinische Fehler; Onkologie; Patient safety; Patientensicherheit; Speaking-up; communication; medical errors; oncology; speaking-up