'Speaking up' about patient safety concerns and unprofessional behaviour among residents: validation of two scales.

Martinez W, Etchegaray JM, Thomas EJ, Hickson GB, Lehmann LS, Schleyer AM, Best JA, Shelburne JT, May NB, Bell SK
BMJ Qual Saf. 2015 24 (11): 671-80

PMID: 26199427 · DOI:10.1136/bmjqs-2015-004253

OBJECTIVE - To develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.

METHOD - Residents from six large US academic medical centres completed an anonymous, electronic survey containing questions regarding safety culture and speaking up about safety and professionalism concerns.

RESULTS - Confirmatory factor analysis supported two separate, one-factor speaking up climates (SUCs) among residents; one focused on patient safety concerns (SUC-Safe scale) and the other focused on unprofessional behaviour (SUC-Prof scale). Both scales had good internal consistency (Cronbach's α>0.70) and were unique from validated safety and teamwork climate measures (r<0.85 for all correlations), a measure of discriminant validity. The SUC-Safe and SUC-Prof scales were associated with participants' self-reported speaking up behaviour about safety and professionalism concerns (r=0.21, p<0.001 and r=0.22, p<0.001, respectively), a measure of concurrent validity, while teamwork and safety climate scales were not.

CONCLUSIONS - We created and provided evidence for the reliability and validity of two measures (SUC-Safe and SUC-Prof scales) associated with self-reported speaking up behaviour among residents. These two scales may fill an existing gap in residency and safety culture assessments by measuring the openness of communication about safety and professionalism concerns, two important aspects of safety culture that are under-represented in existing metrics.

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MeSH Terms (16)

Academic Medical Centers Adult Attitude of Health Personnel Factor Analysis, Statistical Female Humans Internship and Residency Male Organizational Culture Patient Safety Physicians Professional Misconduct Psychometrics Reproducibility of Results Surveys and Questionnaires United States

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