How Johns Hopkins encourages employees to voice patient safety concerns

Researchers led by Baltimore-based Johns Hopkins Medicine and the University of Cambridge in the U.K. identified measures healthcare organizations can use to encourage employees to speak up about patient safety concerns.

The study, published in Academic Medicine, looked at what stopped employees from raising patient safety concerns. To encourage employee voice, Johns Hopkins leadership first identified barriers by interviewing 67 administrators and front-line staff members about raising patient safety issues at the Johns Hopkins Hospital in Baltimore.

Some staff members said they didn't know how to report their concerns, and others worried about hostile responses or being labeled a bad team player. Even when they did speak up, nothing appeared to happen in response, employees said.

Many employees also expressed concern about senior staff members who engaged in poor conduct but did not face consequences, leading employees to think raising concerns would go nowhere.

To address these concerns, Johns Hopkins leaders implemented interventions from fall 2014 through summer 2016, including clear definitions of acceptable and unacceptable behavior, well-coordinated reporting mechanisms, leadership training on difficult conversations and consistent consequences for unacceptable behaviors.

Johns Hopkins leaders designed Safe at Hopkins, a program to address and investigate concerns, to make everyone feel comfortable, the researchers said. As opposed to relying on individual accounts of events that may be disputed, Johns Hopkins leadership will investigate an entire clinical unit.

During the study period, employees made 382 individual reports of disruptive behavior that led to 55 investigations in which officials interviewed an entire clinical unit.

"It's not enough just to say you're committed to employee voice. Healthcare staff must genuinely feel comfortable speaking up if organizations are going to provide safe, high quality care," said lead study author Mary Dixon-Woods. "Even when reporting mechanisms are in place, employees may not report disruptive behaviors if they don't feel safe in doing so and don't think their concerns will be addressed."

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