1. Section Editor(s): Palatnik, AnneMarie MSN, APN, ACNS-BC

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Ineffective communication is one of the most frequently identified root causes of sentinel events and contributes to the 400,000 deaths that occur each year due to preventable medical errors.1,2 Ineffective communication includes failure of staff to speak up when they know something is wrong that could potentially cause harm to the patient.

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While it might seem like speaking up to prevent harm is easy, it is not. Only 49% of the 447,584 respondents to the Hospital Survey on Patient Safety Culture felt free to question the decisions or actions of those with more authority.3 Further, 65% of those respondents were afraid to ask questions when something did not seem right.3


Nurses have reported fear of retaliation, being reprimanded, how others will respond, and appearing incompetent as reasons for not speaking up. Nurses have also reported that they do not feel that anything will change as a result of their intervention.4


This is not a new issue. A 2005 study collected data from more than 1,700 healthcare employees, including 1,143 nurses. The participants in the study reported frequent observation of colleagues making mistakes, appearing critically incompetent, or taking dangerous shortcuts-but less than 1 in 10 spoke up about their concerns.5


This is so concerning because as nurses, we are the patient's advocate and we are the patient's voice. This communication breakdown can only be corrected by creating a nonpunitive environment where individuals feel empowered to speak up.


As a starting point for improving communication, the Agency for Healthcare Research and Quality offers two free comprehensive tool kits that can help enhance or create a culture of safety.6,7 The Comprehensive Unit-based Safety Program (CUSP) combines best practices and the science of safety, and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is designed to integrate teamwork principles into all areas of a healthcare system. These two tool kits include lecture notes, handouts, videos, and other great resources that provide direction and support for individuals and teams to improve communication and prevent errors.6,7


Even though it is not easy, each and every one of us has the responsibility to speak up for patient safety.


AnneMarie Palatnik, MSN, APN, ACNS-BC

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1. The Joint Commission. Sentinel event data: root cause by event type 2004-2014. 2015. [Context Link]


2. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122-128. [Context Link]


3. Agency for Healthcare Research and Quality. Hospital survey on patient safety culture: 2016 user comparative database report. 2016. [Context Link]


4. Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Serv Res. 2014;14:61. [Context Link]


5. Maxfield D, Grenny J, McMillan R, Patterson K, Switzler A. Silence kills: the seven crucial conversations for healthcare. 2005. [Context Link]


6. Agency for Healthcare Research and Quality. CUSP toolkit. [Context Link]


7. Agency for Healthcare Research and Quality. TeamSTEPPS: strategies and tools to enhance performance and patient safety. 2016. [Context Link]