Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study

Area of Science:

• Healthcare communication
• Patient safety
• Organizational behavior

Background:

• Speaking up about concerns is vital for ensuring patient safety in hospitals.
• The impact of different response civility levels (civil, pseudo-civil, rude) to staff speaking up on future speaking up behavior was investigated.

Purpose of the Study:

• To determine if witnessing a civil response to speaking up increases subsequent speaking up by hospital staff compared to pseudo-civil or rude responses.
• To explore the relationship between psychological safety and speaking up behavior in a healthcare setting.

Main Methods:

• A randomized controlled trial (RCT) was conducted in a large academic teaching hospital.
• A simulated basic life support scenario elicited standardized speaking up opportunities.
• Participants (n=125 interprofessional hospital staff) were randomized into three conditions manipulating response civility. Speaking up was assessed via video recording and behavior coding; data were analyzed using multilevel modeling.

Main Results:

• Participants were more likely to speak up when they felt psychologically safe (P=0.017).
• Contrary to expectations, participants spoke up more frequently in the rude response condition compared to the other conditions (P=0.019).
• The most common forms of speaking up included structuring inquiry, proactive and reactive instruction statements, and gestures.

Conclusions:

• The study findings challenge conventional beliefs regarding the role of civility in encouraging speaking up behavior within healthcare.
• The results suggest that a rude response, rather than a civil one, may paradoxically increase speaking up in certain healthcare contexts.