Three Ways To Combat the Fear of Speaking Up in Healthcare from LifeWings

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The two biggest barriers to hospitals ensuring patient safety are nurses' fear of retribution if they speak up and poor communication during handoffs. Find out what the experts know and learn three steps you can take to fix one of them.

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Telling is NOT training! Training means you have told them how, shown them how, given them an opportunity to practice through role play or simulation, and given them expert feedback on their practice.

What are the two biggest barriers to hospitals ensuring patient safety?

Hospital C-suite executives and risk managers surveyed this year by American International Group Inc. (AIG) identified the top two issues: nurses fearing retribution for raising patient safety issues, and patients being handed off multiple times to different hospital staffers and departments, which don't always coordinate or communicate well.

Regarding the fear of speaking up for safety, the AIG survey agrees with the research of the National Association for Healthcare Quality (NAHQ). The NAHQ finds that despite 20 years of quality and safety improvements, healthcare providers still hold back from speaking up, fearing retaliation and intimidation.

Physicians agree, even though they are often the reason nurses are fearful of speaking up. Peter Angood, M.D., CEO of the American College of Physician Executives says the fear of retaliation is so "very distinct and quite palpable" that some hospital staff are afraid to mention a threat to patient safety exists.

Steve Harden, CEO of LifeWings a patient safety training company, states "As a result of my own work with 140 healthcare organizations over the last 13 years, I have come to the conclusion that if we could get staff to speak up without fail when they perceive a problem with patient care, we could fix 85% of patient harm." Mr. Harden goes on to say that LifeWings believes the following are the three steps to changing the fear of speaking up:

1. Train staff to speak up. Mr. Harden says, " Telling is not training! Training means you have told them how, shown them how (with a demonstration), given them an opportunity to practice through role play and/or simulation, and given them expert feedback on their practice. If you haven't done this you haven't "trained." (Go to this link for more resources on how to do training.)

Here is a free training resource on speaking up that can be used during educational sessions or staff meetings. One case study could be covered in less than five minutes during a shift briefing or morning report.

2. Put an Escalation Policy in place.

Staff must absolutely know whom to call to escalate an issue to get a satisfactory resolution. The number one reason trained nurses don't speak up is that there is no mechanism in place to give them immediate support at the bedside. If you are not willing to do this, don't bother to do assertion training.

3. Put a "No Retribution Policy" in place.

The second most often cited reason for not speaking up is captured in this comment recently received from a nurse. "Sure, administration will support me when I speak up. They'll even come to the bedside if I need them to. But later, for the next three months, that physician will make my life a living hell. And no one will do anything about it."

(Go to this link for even more information on steps you can take to overcome the barriers to speaking up.)

LifeWings CEO, Steve Harden, believes these three items go hand-in-hand. Train. Escalate. Stop retribution. Three legs of a three-legged stool. Without all of them you will not overcome one of the two biggest barriers to patient safety today.

About LifeWings Partners LLC:

LifeWings Partners was founded by a former U.S. Navy Top Gun instructor, a commercial airline pilot, and two physicians who are former NASA astronauts. LifeWings’ practical and effective teamwork training programs are highly effective in reducing human error and currently involve the training of more than 13,000 high-performance medical team members per year. Measurable results are found in all LifeWings’ initiatives. To find out more, please visit or or follow Steve Harden on Twitter @SaferPatients.

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Stephen Harden
Lifewings Partners, LLC
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Angela Myers
LifeWings Partners, LLC
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