• William Martinez, Lisa Soleymani Lehmann, Eric J Thomas, Jason M Etchegaray, Julia T Shelburne, Gerald B Hickson, Donald W Brady, Anneliese M Schleyer, Jennifer A Best, Natalie B May, and Sigall K Bell.
• Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
• BMJ Qual Saf. 2017 Nov 1; 26 (11): 869-880.

BackgroundOpen communication between healthcare professionals about care concerns, also known as 'speaking up', is essential to patient safety.ObjectiveCompare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.DesignAnonymous, cross-sectional survey.SettingSix US academic medical centres, 2013-2014.Participants1800 medical and surgical interns and residents (47% responded).MeasurementsAttitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.ResultsRespondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).ConclusionsInterns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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