'Speaking Up' Shows A Commitment to Patient Safety

By Judith Fine, Vitalacy Clinical Consultant

My husband has been in and out of hospitals the last few years. He would tell me, regardless of whether he was in the emergency room or on an inpatient unit, to not say anything to the staff. He would give me the stink eye if he thought I was going to discuss infection prevention standards with anyone who came into the room. He knew how I would look over the room for the personal protective equipment (PPE), alcohol hand sanitizer, needle disposal unit, and other required supplies or equipment.

He was afraid that I would “speak up,” and he would be labeled as a problem patient.

This unfair labeling happens often, unfortunately. It happens not only to patients but to health care workers, as well. It happens even though those who speak up are providing us with valuable safety information that can help prevent infections and other adverse events.

Patients and family members have the right to speak up and respectfully remind staff to comply with infection prevention and control standards, especially hand hygiene. Health care workers have a right and a duty to speak up, as well.


'Speaking up' is a tenet of safety culture

In a Joint Commission "Speak Up" video about infection prevention, the main character, Diego, is a young man visiting his grandmother in the hospital. On his way to her room, he washes his hands after encountering an individual with a runny nose in an elevator. Later, in his grandmother's room, he hears coughing coming from a visitor of the patient sharing the room with his grandmother. He leaves the room and finds a nurse and asks her to provide a mask to the visitor. The nurse says, "OK, thanks for letting me know. I'll bring them a mask to wear and ask them to keep it on until they leave the hospital. You are doing a great job taking care of your grandma."

The Joint Commission published 11 tenets of a safety culture a few years ago. The tenets relating to speaking up are:

  • Apply a transparent, nonpunitive approach to reporting and learning from adverse events, close calls and unsafe conditions. (In other words, don't shoot the messenger and punish or label those who speak up!)

  • Develop policies that support this reporting and communicate these policies to all team members.

  • Recognize care team members who report adverse events and close calls, who identify unsafe conditions, or who have good suggestions for safety improvements. Share these "free lessons" with all team members.

Encouraging "speaking up" without fear of being labeled as a problem empowers patients, family members and co-workers and helps to ensure the safety of everyone within a hospital.

My father was a resident of a nursing home in New York. What do you say to a 91-year-old proud, obstinate and forceful man who has benign prostate hyperplasia and needs to go to the bathroom during the night shift when only one nursing assistant is covering 25 patients?

He didn’t want to hear that he wasn’t the only resident on the unit and needed to wait. He fell out of the bed almost every night trying to climb out. He was labeled in his chart as a "problem" and wasn’t placed into his bed unit until 10 or 11 each night. My brother waited every night until then for the staff to ensure that he was safe in his bed.

He shouldn’t have been labeled. The nursing home should have identified reasonable solutions to his situation and discussed them with the family members as partners in his ongoing care.

We shouldn’t label any patient or resident. We should listen with respect and kindness. My father could be your father.

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