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

Robbins, Julie

Abstract Details

2013, Doctor of Philosophy, Ohio State University, Public Health.
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.
Ann McAlearney, Sc.D. (Advisor)
Raymond Noe, Ph.D. (Committee Member)
Sharon Schweikhart, Ph.D. (Committee Member)
Thomas Wickizer, Ph.D. (Committee Member)

Recommended Citations

Citations

  • Robbins, J. (2013). Speaking Up is Hard to Do: What Can Management Do to Help When Patient Safety is on the Line? [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1365424400

    APA Style (7th edition)

  • Robbins, Julie. Speaking Up is Hard to Do: What Can Management Do to Help When Patient Safety is on the Line? . 2013. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1365424400.

    MLA Style (8th edition)

  • Robbins, Julie. "Speaking Up is Hard to Do: What Can Management Do to Help When Patient Safety is on the Line? ." Doctoral dissertation, Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1365424400

    Chicago Manual of Style (17th edition)