Improving safety through speaking up: An ethical and financial imperative

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Culture
• Health Economics

Background:

• Fostering a culture of open communication regarding patient care quality and safety is ethically and economically imperative.
• The Michigan Health & Hospital Association (MHA) Keystone Center implemented the Speak-Up! Award program to recognize frontline healthcare staff for identifying and reporting safety concerns.
• The program aimed to enhance patient safety through measurable improvements in organizational safety culture.

Purpose of the Study:

• To evaluate the impact of the Speak-Up! Award program on patient safety culture within MHA Keystone Center member organizations.
• To quantify the cost savings associated with staff speaking up about potential patient harm.
• To demonstrate the link between a culture of speaking up and improved patient safety outcomes.

Main Methods:

• Speak-Up! Award nominations were collected via an electronic form, capturing data on harm type, severity, and the decision-making process involved in speaking up.
• A cost-savings framework, adapted from existing models, was applied to estimate the financial impact of prevented harm.
• Safety culture was assessed using the Safety, Communication, Operational Reliability, and Engagement (SCORE) instrument.

Main Results:

• The Speak-Up! Award program received 416 nominations over two years, with 62% detailing specific harm types prevented, most commonly adverse drug events.
• An estimated $13,000 in expenses were avoided for each instance of staff speaking up, aligning with external economic impact reports.
• Safety culture survey results showed a 6% improvement between 2015 and 2017, coinciding with the award program's implementation.

Conclusions:

• The Speak-Up! Award program effectively recognizes staff vigilance and contributes to a safer healthcare environment.
• Evidence suggests that cultivating a psychologically safe culture where staff feel empowered to speak up yields significant financial and humanistic benefits.
• Further research is needed to precisely correlate improvements in safety culture with specific cost savings.