SPEAK

Posted on March 14, 2023

When it comes to health care safety in hospitals, urgent care centers, clinics and other related settings, there should be little to be concerned about. After all, patients are surrounded by and cared for nurses, doctors, technicians and others with specialized education and training specific to patient care. Turns out, that is not necessarily the case. . .

While doing a bit of background information in preparation for an upcoming presentation on the topic of those instances and situations where it is important – imperative actually to SPEAK UP in many types of health care situations. There is little guiding literature for patients or their care partners.

Nine out of ten times, the information I did find is geared for health care professionals - for good reason. When it comes to health care safety in hospitals, urgent care centers, clinics and other related settings, there should be little to be concerned about. After all, patients are surrounded by and cared for nurses, doctors, technicians and others with specialized education and training specific to patient care.

Turns out, that is not necessarily the case. As a patient advocate this is worrisome. Raising concerns by health care professionals for the benefit of patient safety and quality of care tends to not happen - more often than you might expect. This means during those situations . . . upon seeing or becoming aware of risky or inadequate actions of health care teams, that result in mistakes, failure to follow standard protocols, lapses, even rule breaking, health care professionals hesitate to Speak Up and voice concerns.[i]

What Is SPEAKING UP?

Speaking up is defined as “the raising of concerns by health care professionals for the benefit of patient safety and care quality upon recognizing or becoming aware of the risky or deficient actions of others within health care teams in a hospital environment.”

Safety concerns that require SPEAKING UP include:

· Mistakes such as missed diagnoses

· Violating hygiene protocol

· Rule breaking

· Medication errors

· Administration errors

· Patient management decisions such as delayed transfer to intensive care unit

· Outdated safety protocols [ii]

Speaking Up is important for patient safety. In the health care system, it is designed as a quick-time out, too question or review an order or action. It should have an immediate preventive effect to prevent human errors or to improve technical and system deficiencies.

Even patient safety experts find it hard to SPEAK UP

No matter their position or specialty, most medical and nursing professionals have had some experience in hesitating with speaking up when they see a safety risk. Even when the medical professional is fully aware of the potential hazard to the patient, staying silent can be seen as a “safe’ option.

It has been shown that those who are aware of a problem often either speak up and are ignored or choose the ‘safe’ response of silence, withholding input that could be valuable to others.[iii] While it might seem like speaking up to prevent harm is easy, it is not. Only 49% of the 447,584 respondents to a Hospital Survey on Patient Safety Culture felt free to question the decisions or actions of those with more authority.3 Further, 65% of those respondents were afraid to ask questions when something did not seem right.

Nurses have reported fear of retaliation, being reprimanded, concerned how others will respond, and appearing incompetent as reasons for not speaking up. Nurses have also reported that they do not feel that anything will change as a result of their intervention. [iv]

Hesitancy to speak up is considered to be an important contributing factor to communication errors.[v] Errors causing harm, albeit unintentional harm, to the patient. All the more reason for the almost urgent reason for care partners in the form of a spouse, other family members, trusted friends and other professionals to assume the responsibility of advocating on behave of the patient.

SILENCE ISN’T “SAFE”. SPEAKING UP IS.

You know those moments when you realize just how complicated the healthcare industry can be, especially when someone you love requires medical attention. Many find themselves in the position of being a care partner for a beloved parent, spouse, child or friend.

With exception, it is extremely difficult any patient to advocate for themselves. Distracted by concern and fear, while lacking the energy caused by the illness or other circumstance resulting in a concerning health situation. This is why it is advised that family members or trusted friends, who know and will respect their loved one’s decisions about the care desired, should be by his or her side for advice and support.

Recognize is this is going to be uncomfortable. The care partner is going to have to be alert. Finally, knowing that professionals may be hesitate to speak up, the most important thing, and often the most difficult to do is to SPEAK UP FOR OR ABOUT YOUR OR A LOVED ONE’s CARE.

With a bit of knowledge, instinct and common sense, who better to advocate the someone knows the person laying or an emergency room or urgent care stretcher or hospital bed. Beginning this moment with SPEAK UP basics, then continuing during the following four blogs, I will highlight those instances when to SPEAK UP.

To begin with, and on behalf of your loved on as a patient, SPEAK UP if or when:

· You need medical forms explained.

· Any and every time you understand something or if something doesn’t seem right.

· You think your loved one is being confused with another patient.

· You or your loved one is not getting the medication or treatment when you should.

· If you don’t recognize a medicine or think you or your loved one is about to get the wrong medicine.

· You speak or read another language.[vi]

In all instances, recognize this is going to be hard. Give yourself grace.

One final word, during any circumstance or situation where you may feel overwhelmed and uncertain in the unfamiliar space of any aspect of our fragmented and complicated, there is always to option to consult with or utilize the services of a professional (board certified) patient advocate.

[i] Speaking up for patient safety by hospital-based health care professionals: a literature review
Ayako Okuyama, Cordula Wagner, and Bart Bijnen. BMC Health Serv Res. 2/8/14. doi: 10.1186/1472-6963-14-61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016383/
[ii] SILENCE ISN’T “SAFE”. SPEAKING UP IS. https://www.qlicksmart.com/speaking-up-safe-silence-not/?v=7516fd43adaa.
[iii] Speaking up for patient safety by hospital-based health care professionals: a literature review
Ayako Okuyama, Cordula Wagner, and Bart Bijnen. BMC Health Serv Res. 2/8/14. doi: 10.1186/1472-6963-14-61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016383/
[iv] DEPARTMENT: GUEST EDITORIAL: Speak up for patient safety. Editor(s): Palatnik, AnneMarie MSN, APN, ACNS-BC. Author Information: Nursing Critical Care 11(6):p 4, November 2016. DOI: 10.1097/01.CCN.0000503425.05594.02
[v] Ibid
[vi] Speak Up About Your Care - The Joint Commission. https://www.jointcommission.org/resources/for-consumers/speak-up-campaigns/about-your-care/