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“Speaking up requires deliberation and, usually, a degree of courage.”
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The Many Ways to Speak Up for Patient Safety

By Tejal Gandhi | Wednesday, September 11, 2019


Photo by Israel Palacio | Unsplash

When I saw results of recent patient surveys at eight hospitals in Maryland and Washington, DC, I was not surprised. Nearly half of the patients who responded said they had experienced a problem during their hospital stay, and 30 percent of those who experienced a problem did not always feel comfortable speaking up about it.

As a physician and safety leader, I have long counseled health professionals, patients, and leaders about the importance of speaking up when something seems not right. In my own life, both personally and professionally, I’ve been in the position of overseeing another’s care and needing to speak up in uncomfortable situations. I know it’s not easy.

With World Patient Safety Day approaching on September 17, I’ve been reflecting on the World Health Organization (WHO) challenge to “Speak Up for Patient Safety” and how broadly it applies to improvement work. Although the call to speak up often refers to situations that require immediate action, I’ve come to believe that it’s also essential to many of the stories we hear about safety initiatives around the world. Speaking up is not necessarily about a “stop the line” moment; it also applies when a situation builds to a point where someone is moved to act.

A recent example is work being done in Brazil to reduce infections. A number of philanthropic hospitals , in collaboration with the Ministry of Health, have taken up the challenge to reduce infections in intensive care units by 50 percent over 18 months. The Health in Our Hands project has so far shown amazing results, with general infections down by more than one-third only a year into the work. The teams involved estimate that some 978 lives have been saved as a result.

But beyond the technical details of preventing infections, speaking up, in a sense, has been a key factor in the program’s success. Francisco de Assis Figueiredo, the Ministry’s Secretary of Health Care, recently said that Brazil must overcome a “culture of non-dissemination of knowledge.” By working together and sharing what they’ve learned, these hospitals and the Ministry are collectively speaking up to identify problems as well as effective solutions.

Similarly, a project in a South African clinic shows how speaking up about a problem is at the heart of improvement work and keeping patients safe. The clinic staff found that, fairly frequently, patients newly diagnosed with HIV would come to the clinic, but leave before they saw a nurse. The clinic manager brought all of the stakeholders together to map the process and identify gaps that kept patients from receiving care. As part of this work, a community committee identified concerns from the patients’ perspective, giving voice to those who are often reluctant to speak up. The team developed a more streamlined process from diagnosis to treatment and have sustained the work in part through improvements in communication with patients.

How is speaking up different than simply communicating? Speaking up requires deliberation and, usually, a degree of courage. That courage takes different forms, whether it’s a patient questioning the need for a test, a nurse flagging a medication contraindication, or a safety manager bringing below-benchmark data to a leader’s attention.

Speaking up also enables learning. This is the philosophy behind the Learn Not Blame campaign in the United Kingdom. A group of doctors — moved to speak up after a colleague was severely penalized following a medical error — started the campaign to spark culture change within the National Health Service. They are seeking a just culture, removing the threat of punishment and instead enabling clinicians to learn when something goes wrong.

By calling patient safety a global health priority, and creating World Patient Safety Day, the WHO and member states are speaking up to acknowledge that — even as we make important progress in safety around the world — there is much that still needs to be addressed to eliminate harm in health care.

How do you speak up for patient safety?

Tejal K. Gandhi, MD, MPH, CPPS, is IHI’s Chief Clinical and Safety Officer.

You might also be interested in:

IHI’s World Patient Safety Day resources

Patient Safety at IHI’s National Forum this December

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