Journal article
Hierarchy and medical error: speaking up when witnessing an error
Safety Science, Vol.125(May), 104648
2020
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Source: InCites
Abstract
There exists a palpable influence from the Medical Hierarchy upon behaviour of both Junior and seniors medical doctors. An unwholesome submissiveness demonstrated by trainees to senior doctors is evident.There exists a difference in perceptions of senior and juniors when it comes to speaking up expectations.Continued research in this area is essential.Simulation training in speaking up does not translate into practice.Speaking up is required but listening down is essential. This review aims to identify and evaluate existing knowledge on speaking up within the context of medical hierarchy while witnessing medical error (ME). Specifically, this review explores evidence to answer the question: Within the medical hierarchy, what are the mechanisms influencing speaking up behaviours in the presence of witnessed ME? Systematic review of published articles that reported on studies relating to speaking up within the medical hierarchy. Medline, Psychinfo and Business Source Premier. The literature in this review suggested a palpable influence of the medical hierarchy upon the behaviours of both trainees and senior medical doctors. Within the context of ME this influence arguably sustains inadequate communication that contributes to compromised patient safety. The studies that expose hierarchies’ impact on speaking up lacked critical analysis toward the causative mechanisms influencing members of the hierarchy. Multiple studies in this review identified that seniors should encourage trainees to speak up, especially in the presence of witnessed error. It is long recognised that environments should be fostered in which trainees and seniors recognise each other’s opinions, value differences and prevent an ‘us versus them’ situation from developing. Despite many efforts attempting to achieve this, the problem remains. Patients continue to be harmed, with a death rate of approximately one Boeing 737 a day (approx. 174 passengers). Trainees and seniors must speak up and listen down in the presence of witnessed error to influence a culture of patient safety and especially to reduce harm to patients.
Details
- Title
- Hierarchy and medical error: speaking up when witnessing an error
- Creators
- Rodney (Rod) Peadon - Southern Cross UniversityJohn Hurley - Southern Cross UniversityMarie Hutchinson - Southern Cross University
- Publication Details
- Safety Science, Vol.125(May), 104648
- Publisher
- Elsevier
- Identifiers
- 991012834400402368
- Academic Unit
- School of Health and Human Sciences; Nursing; Faculty of Health
- Language
- English
- Resource Type
- Journal article