Z. Alawadi3,4, L. R. Putnam3,4, R. Landgren5, J. Etchegaray2,5, E. Thomas1,2, K. Tsao3,4, L. Kao3,4 1University Of Texas Health Science Center At Houston,Department Of Internal Medicine,Houston, TX, USA 2The University Of Texas At Houston-Memorial Hermann Center For Healthcare Quality And Safety,Houston, Texas, USA 3University Of Texas Health Science Center At Houston,Department Of General Surgery,Houston, TX, USA 4Center For Surgical Trials And Evidence-based Practice, University Of Texas Medical School At Houston,Houston, TX, USA 5University Of Texas Medical School At Houston,Hosuton, TX, USA
Introduction: Communication breakdown is a major threat to patient safety. Studies show that surgical, compared to non-surgical, residents are less likely to speak up when there is a patient safety concern. We hypothesized that surgery residents have worse perceptions of safety culture and different reasons for not speaking up than pediatric residents.
Methods: Surgery (SR) and Pediatric residents (PR) at the University of Texas-Houston were asked to complete a 2 part web-based survey. The first part consisted of a validated survey evaluating 5 domains of safety culture within their work environment. Data are presented as the percent of respondents who slightly or strongly agreed with the items within each domain. Negatively-worded questions are reverse coded. Chi-square analysis was used to compare responses. The second part was an open-ended question asking residents to list 3 reasons that would prevent them from speaking up when there is a patient safety concern. Participation was anonymous. Responses were independently analyzed for thematic content by multiple coders. Coding differences were discussed until consensus was reached.
Results: Response rates were 85% and 80% for SR, and 57% and 28% for PR for the first and second parts of the survey, respectively. PR scored significantly higher than SR on all 5 domains of the survey, especially in regard to communication openness (71% vs 8%, Table). However, both groups reported similar barriers to speaking up: fear of consequences/intimidation, hierarchical system, feeling powerless, and lack of confidence in self-decisions. Excessive workload was an additional barrier reported frequently by SR, while lack of adequate training in patient safety and reporting processes was reported more frequently among PR.
Conclusion: Despite better perceptions of safety culture among pediatric residents, similar reasons prevent residents from speaking up regardless of their specialty. Although changes in safety culture are needed, they may not be sufficient to empower residents to speak up. Effective methods for overcoming communication barriers within the medical hierarchy and for educating residents about patient safety and reporting processes are necessary to provide safer patient care.
