The DOI matches its Crossref record; 4 of the 4 references it cites were found in a registry or an index.
Speak up-related climate and its association with healthcare workers’ speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland
Open accessAbstract
Objectives: To determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice. Design: Cross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression models Setting: 4 hospitals with a total of nine sites from the German, French and Italian speaking part of Switzerland. Participants: Survey data were collected from 979 nurses and doctors. Main outcome measures: Frequencies of perceived patient safety concerns, of withholding voice and of speaking up behaviour. Speak up-related climate measures included psychological safety, encouraging environment and resignation. Results: Perceived patient safety concerns were frequent among doctors and nurses (between 62% and 80% reported at least one safety concern during the last 4 weeks depending on the single items). Withholding voice was reported by 19%–39% of HCWs. Speaking up was reported by more than half of HCWs (55%–76%). The frequency of perceived concerns during the last 4 weeks was positively associated with both speaking up (OR=2.7, p<0.001) and withholding voice (OR=1.6, p<0.001). An encouraging environment was related to higher speaking up frequency (OR=1.3, p=0.005) and lower withholding voice frequency (OR=0.82, p=0.006). Resignation was associated with withholding voice (OR=1.5, p<0.001). The variance in both voicing behaviours attributable to the hospital-site level was marginal. Conclusions: Our results strengthen the importance of a speak up-supportive safety climate for staff safety-related communication behaviours, specifically withholding voice. This study indicates that a poor climate, in particular high levels of resignation among HCWs, is linked to frequent ‘silence’ of HCWs but not inversely associated with frequent speaking up. Interventions addressing safety-related voicing behaviours should discriminate between withholding voice and speaking up.
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Employee voice behavior is best conceptualized as two distinct concepts: speaking up and withholding voice.
“Our results also support the conceptualization of employee voice behavior as two distinct concepts: speaking up and withholding voice.”
From Psychological Safety as a Mediator of the Relationship Between Inclusive Leadership and Nurse Voice Behaviors and Error Reporting (2021) · cites this paper as Schwappach & Richard, 2018
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Metadata
- Authors
- Schwappach, D., & Richard, A.
- Affiliations
- University of Bern (CH)
- Stiftung Patientensicherheit Schweiz (CH)
- Corresponding author
- Schwappach, David
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2018-03-23
- Volume
- 27
- Issue
- 10
- Pages
- 827-835
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- PMC
- PMC6166598
- OpenAlex
- W2791370670
- Cited by
- 172
- References
- 4
- Citations by year
- 2026: 17 · 2025: 22 · 2024: 30 · 2023: 21 · 2022: 14 · 2021: 50 · 2020: 9 · 2019: 9
- FWCI
- 25.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Quality & Safety (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Open Access CRIS of the University of Bern
- Funders
- federal office of public health, Switzerland
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Workplace Violence and Bullying
- Social Sciences › Safety Research › Occupational Health and Safety Research
- Keywords
- speaking up, safety climate, psychological safety, resignation, patient safety concerns, healthcare workers, nurses, physicians, hospital safety culture
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Male, Medical Staff, Hospital, Middle Aged, Surveys and Questionnaires, Switzerland, Truth Disclosure, Organizational Culture, Safety Management, Patient Safety
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