Speaking up behaviors and safety climate in an Austrian university hospital.

Schwappach, David; Sendlhofer, Gerald; Häsler, Lynn; Gombotz, Veronika; Leitgeb, Karina; Hoffmann, Magdalena; Jantscher, Lydia; Brunner, Gernot (2018). Speaking up behaviors and safety climate in an Austrian university hospital. International journal for quality in health care, 30(9), pp. 701-707. Oxford University Press 10.1093/intqhc/mzy089

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Objective To analyze speaking up behavior and safety climate with a validated questionnaire for the first time in an Austrian university hospital. Design Survey amongst healthcare workers (HCW). Data were analyzed using descriptive statistics, Cronbach's alpha was calculated as a measure of internal consistencies of scales. Analysis of variance and t-tests were used. Setting The survey was conducted in 2017. Participants About 2.149 HCW from three departments were asked to participate. Intervention To measure speaking up behavior and safety climate. Main Outcome Measure To explore psychological safety, encouraging environment and resignation towards speaking up. Results About 859 evaluable questionnaires were returned (response rate: 40%). More than 50% of responders perceived specific concerns about patient safety within the last 4 weeks and observed a potential error or noticed rule violations. For the different items, between 16% and 42% of HCW reported that they remained silent though concerns for safety. In contrast, between 96% and 98% answered that they did speak up in certain situations. The psychological safety for speaking up was lower for HCW with a managerial function (P < 0.001). HCW with managerial functions perceived the environment as less encouraging to speak up (P < 0.05) than HCW without managerial function. Conclusions We identified speaking up behaviors for the first time in an Austrian university hospital. Only moderately frequent concerns were in conflict with frequent speaking up behaviors. These results clearly show that a paradigm shift is needed to increase speaking up culture.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Schwappach, David


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Oxford University Press




Tanya Karrer

Date Deposited:

16 May 2018 14:56

Last Modified:

10 Nov 2019 06:51

Publisher DOI:


PubMed ID:






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