Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents.

Background Open communication between healthcare professionals about care concerns, also known as ‘speaking up’, is essential to patient safety. Objective Compare interns9 and residents9 experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats. Design Anonymous, cross-sectional survey. Setting Six US academic medical centres, 2013–2014. Participants 1800 medical and surgical interns and residents (47% responded). Measurements Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales. Results Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p Conclusions Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.