• David Schwappach, Gerald Sendlhofer, Lynn Häsler, Veronika Gombotz, Karina Leitgeb, Magdalena Hoffmann, Lydia Jantscher, and Gernot Brunner.
• Swiss Patient Safety Foundation, Zurich, Switzerland.
• Int J Qual Health Care. 2018 Nov 1; 30 (9): 701-707.

ObjectiveTo analyze speaking up behavior and safety climate with a validated questionnaire for the first time in an Austrian university hospital.DesignSurvey 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.SettingThe survey was conducted in 2017.ParticipantsAbout 2.149 HCW from three departments were asked to participate.InterventionTo measure speaking up behavior and safety climate.Main Outcome MeasureTo explore psychological safety, encouraging environment and resignation towards speaking up.ResultsAbout 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.ConclusionsWe 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.

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