My hand was trembling as I reached up for the white telephone receiver. I slowly pushed the soft keys on the pad to dial the number. “What are you doing?! Put that down!”. I turned to face the voice of instruction I disagreed so intensely with. I caved, I put the phone back down. Then, it all began... ​​

When a moment is recognised where potential harm is about to occur, you must speak up, not just for your patients, but for your own sake. Self compassion also includes thinking about your future self as a practitioner. Living with regret or uncertainty makes for poor confidence in future practitioners. When we work in an arena that requires trust in ourselves, we have to lead by example and create a culture where colleagues can voice concerns. Reassuring them by demonstrating supportive discussion will ensue not punitive statements.

What... Needs To Change

You will find yourself in a situation when you are faced with the decision to speak up or stay silent. It’s just a matter of time. In our profession, our days are filled with facing constant decisions, many of which determine whether a patient endures further pain or discomfort, even lives or dies.

How do you feel about the idea of challenging a colleague, to prevent potential harm to a patient? Yes, its about patient care, as they are in a position of vulnerability and we are in a position of responsibility. However, we are not only responsible for the patient immediately before us, but also to ourselves.

There is currently a wonderful, long overdue push in todays climate for health professionals to prioritise self-care and self-compassion, along side patient care. However, I haven’t heard anyone speak or write on the topic of why speaking up in patient safety is important, from the healthcare worker’s position.

Forgiveness. A commonly used term in the arena of psychology and self help, however not a term I’ve heard used within the current wellness shift in medicine. From the moment I put the phone down that night, it took me twenty years to forgive myself for not speaking up. Although it has been a trying process, it has lead me to where I am today, a passionate advocate and an example for the cause.

There is an additional reason for speaking up on behalf of patient safety. That reason is you. So that you as the professional can go on living and working, caring for future patients. Knowing that you have done all that you could have in those pivotal moments to be the best for your patients, and yourselves. It’s the ability and confidence of the future practitioner that is also at stake.

Why... Do We Need To Change

Being right. Another heavily loaded term. As healthcare professionals we spend the majority of our day earning our patients and colleagues trust in us. All the care we deliver is right, right according to current best practice standards and training (1). So what happens when we doubt this?

The reason why we should speak up and voice our concern, is not just for our patients, it is also for ourselves. Ourselves as individuals and ourselves as practitioners. If you choose to quit healthcare after a significant error occurs, it’s a different thing to battle self-forgiveness away from the workplace in which it occurred. It’s even more of a challenge when you have to wake up the next day and face constant reminders of a missed opportunity and deal with the self doubt of future practice which often ensues.

At the end of the day if we choose to come back to the next shift, it is the patients of our future that will test us again and again. Whether we improve our performance during the next opportune moment is yet to be determined. I am proposing, doing it for the good of ourselves stands along side doing it for the good of the patient.

How... Can We Change

A pivotal moment for me when I heard of @MartinBromiley and his families story, was when he said “You will be pleased to know they all returned to work eventually after the incident, and that is exactly what I wanted to happen, they will go on to lead by example”. Those in leadership roles need to be proactive and transparent in creating an environment where speaking up is supported and not discouraged. This must be demonstrated daily, to lead by example. Leadership is not just to say at the start of the shift “if you feel uncomfortable about anything come and see me”. My suggestion, take it one step further and say what your approach will be if that opportunity arises. If one is more informed regarding the approach one might receive from their superior if criticised, this may be of more reassurance considering the superior’s approach is patient focused and won’t result in a punitive outcome.

Studies have demonstrated that one of the largest barriers to speaking up when concerned, was the fear of retaliation (1, 2). However, after participants were provided informative educational session on encouraging speaking up culture, individuals felt more secure to do so (3).

Occasionally, when someone does speak up and questions a treatment option or lack of treatment, it comes from a place of knowledge deficit. This then lends itself to an opportunity to discuss the rationale behind choices of care, to open discussion for learning and further understanding.

Just as psychological safety is not created at the start of a simulation activity by just stating “this is a safe place”, a culture of speaking up is the same. It needs to be followed through by behavioural example and explanation.

References

1. Schwappach, D., & Gehring, K. (2014). Trade-offs between voice and silence: a qualitative exploration of oncology staff’s decisions to speak up about safety concerns. BMC Health Services Research, 14(1). doi: 10.1186/1472-6963-14-303

2. Reid, J. Bromley, M. (2012). Clinical human factors: the need to speak up to improve patient safety. Nursing Standard, 26(35), 35-40. doi: 10.7748/ns2012.05.26.35.35.c9084

3. Okayama, A., Wagner, C., & Bijnen, B. (2014). Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Service Research, 14(1). doi: 10.1186/1472-6963-14-61