Physicians and nurses are afraid to speak up about unsafe medical practices, says a new study by University of Toronto and York University researchers, and this puts patients’ health at risk.
To the researchers’ surprise, the study of over 2,700 Canadian doctors and nurses showed that fear did not change with time on the job: older, more experienced clinicians were no less intimidated than their more junior colleagues when it came to reporting patient safety issues. Nor was fear tied to age or gender, as seen with other workplace behaviours. Instead, a supportive work environment makes all the difference when it comes to encouraging clinicians to report problems.
“Punishing staff merely encourages denial, fear and secrecy. We saw that safety leadership from the unit matters, but leadership from the larger hospital itself matters far more,” said Evan Castel, a PhD candidate in geography and public health policy at U of T and lead author of the study published in BMC Health Services Research last week.
The team surveyed 2,319 nurses and 386 physicians in Ontario, Manitoba and Nova Scotia in a wide variety of clinical settings and found surprising differences. While supportive leadership from their unit mattered to both nurses and physicians, support from the larger organization was far more important.
For physicians, this organization-level support was twice as influential as it was for nurses. Perceptions vary by unit as well: fear was particularly high in mental health and community care settings. The researchers were also surprised that staff in emergency departments, operating rooms and critical care units did not stand out for confidence in reporting safety issues, even though staff in these units have specialized safety training to cope with their high-risk setting.
“Overall, this study offers new insight into how different levels of safety leadership matter to nurses and physicians, and suggests that clinician education needs to be tailored to these differences. We need to leave the one-size-fits-all approach if we want to reduce the human and economic impact of errors and unsafe medical practices,” said Castel.
Besides Castel, the research team included Liane Ginsburg, Shahram Zaheer and Hala Tamim of York University.