What causes less “speaking up” for patient safety among healthcare workers? – A cross sectional study in Malaysia

Abstract

Abstract Background In healthcare, “speaking up” refers to when healthcare workers raise concern regarding patient safety through questions, sharing information, or expressing their opinion to prevent harmful incidents and ensure patient safety. Conversely, withholding voice is an act of not voicing or raising concerns, which could be beneficial in certain situations. Factors associated with speaking up and withholding healthcare workers’ voices are not fully understood, especially in strongly hierarchical countries, such as Malaysia. This study aimed to examine the factors associated with speaking up and withholding the voices of healthcare workers in Malaysia, thus providing suggestions that can be used in other countries facing similar patient safety challenges. Methods This cross-sectional study was conducted in a tertiary hospital in Sarawak State, Malaysia. Data were collected from 474 healthcare workers from 43 departments using a self-administered questionnaire for speaking up and withholding voice measures in the 4 weeks prior to data analysis as well as socio-demographic factors of healthcare workers (gender, age, profession, department, weekly work hours for patient care, years of employment in the hospital, and the hierarchical level) and speaking up related climate of the working environment were recorded. Data were analyzed using descriptive statistics. Logistic regression was performed to find out (adjusted) odds ratio of speaking up and withholding voice. Results Nurse, long years of employment, high hierarchical levels, and an encouraging environment for speaking up were positively associated with frequent speaking up. Emergency and intensive care department, long weekly work hours for patient were negatively associated with frequent speaking up. An environment in which healthcare workers avoid speaking up was positively associated with frequent withholding of voice. Conclusions Working long hours for patient care and with healthcare workers from different disciplines where hierarchical structure does not work, as seen in emergency and intensive care department, cause less speaking up. Our study has unearthed the necessity of establishing an encouraging environment that promotes speaking up and prevents withholding of voices, especially in circumstances where multiple types of healthcare workers with various socio-demographics work together across hierarchical structure, to ensure patient safety and prevent harm.