Speaking Up is Hard to Do:What Can Management Do to Help When Patient Safety is on the Line?

In healthcare organizations, employees are often reluctant to speak up about errors and opportunities for improvement. This reluctance is a widely-recognized barrier to healthcare quality and a threat to patient safety. Although previous studies have identified factors that influence employees’ decisions to speak up or not, few have considered how organizations can influence this behavior. In this dissertation, I present findings from three qualitative case study analyses that identify management practices that can be implemented to facilitate, or remove barriers to, speaking up in healthcare organizations. In the first study, I present conceptual and qualitative evidence to support the use of high-performance work practices (HPWP), a set of complementary human resource practices that align the workforce to support the achievement of organizational goals, as a strategy to facilitate speaking up in five healthcare organizations. In the second and third studies, I identify specific ways in which six case study hospitals address speaking up as part of their efforts to prevent and reduce central line-associated bloodstream infections (CLABSIs). Collectively, these studies find that healthcare organizations can successfully facilitate speaking up by implementing organizational and management practices that 1) emphasize the importance of speaking up with respect to improving patient safety outcomes, and 2) ensure that this behavior is expected and rewarded, rather than punished. Specific practices for accomplishing this include: clear leadership communication regarding the importance of speaking up, inclusion of speaking up as an expected behavior for employees, including physicians in initiatives designed to promote speaking up, formal and informal training to enhance employee communication skills, and robust use of error and event reporting systems to support patient safety improvement efforts.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Public Health

Grantor dc:publisher

The Ohio State University

Year dc:date

2013

Author dc:creator

• Robbins, Julie

Contributors dc:contributor

• McAlearney, Ann

• Public Health
• Health
• Health Care Management
• Health Care
• Healthcare quality
• patient safety
• employee voice

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=osu1365424400

OAI identifier oai:identifier

oai:etd.ohiolink.edu:osu1365424400