• Antonia Rich, Rowena Viney, and Ann Griffin.
• Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK.
• J R Soc Med. 2019 Oct 1; 112 (10): 428-437.

ObjectivesTo investigate doctors' intentions to raise a patient safety concern by applying the socio-psychological model 'Theory of Planned Behaviour'.DesignQualitative semi-structured focus groups and interviews.SettingTraining venues across England (North West, South East and South West).ParticipantsSampling was purposeful to include doctors from differing backgrounds and grades.Main Outcome MeasuresPerceptions of raising a patient safety concern.ResultsWhile raising a concern was considered an appropriate professional behaviour, there were multiple barriers to raising a concern, which could be explained by the Theory of Planned Behaviour. Negative attitudes operated due to a fear of the consequences, such as becoming professionally isolated. Disapproval for raising a concern was encountered at an interpersonal and organisational level. Organisational constraints of workload and culture significantly undermined the raising of a concern. Responses about concerns were often side-lined or not taken seriously, leading to demotivation to report. This was reinforced by high-profile cases in the media and the negative treatment of whistle-blowers. While regulator guidance acted as an enabler to justify raising a concern, doctors felt disempowered to raise a concern about people in positions of greater power, and ceased to report concerns due to a perceived lack of action about concerns raised previously.ConclusionsIntentions to raise a concern were complex and highly contextual. The Theory of Planned Behaviour is a useful model to aid understanding of the factors which influence the decision to raise a concern. Results point to implications for policymakers, including the need to publicise positive stories of whistle-blowers and providing greater support to doctors.

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