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Investigating Physicians' Views on Soft Signals in the Context of Their Peers' Performance

van den Goor, Myra; Silkens, Milou; Heineman, Maas Jan; Lombarts, Kiki

doi: 10.1097/JHQ.0000000000000120
Original Article

Background: Physicians are responsible for delivering high quality of care. In cases of underperformance, hindsight knowledge indicates forewarning being potentially available in terms of concerns, signs, or signals. It is not known how the physicians involved perceive such signals.

Purpose: To openly explore how physicians perceive soft signals and react on them.

Methods: In-depth interviews with 12 hospital-based physicians from various specialties and institutions following the interpretative phenomenological analysis approach.

Results: Physicians perceive soft signals as an observable deviation from a colleague's normal behavior, appearance, or communication. Once observed, they evaluate the signal by reflecting on it personally and/or by consulting others, resulting in either an active (i.e., speaking up) or passive (i.e., avoidance) reaction. Observer sensitivity, closeness to the peer, and cohesion of the physician group influence this observation–evaluation–reaction process.

Conclusions and Implications: Physicians perceive soft signals as indicators of well-being and collegiality, not as concerns about performance or patient safety. They feel it is their responsibility to be sensitive to and deal with expressed signals. Creating a psychological safe culture could foster such an environment. Because a threat to physicians' well-being may indirectly affect their professional performance, soft signals require serious follow-up.

For more information on this article, contact Myra van den Goor at

The authors declare no conflicts of interest.

The authors declare that they have participated and contributed sufficiently in the intellectual content, analyses of the data, and writing of this manuscript. All authors reviewed the final version and approved it for submission.

Ethical Adherence: The Ethical Review Board of our Academic Medical Center waived ethical approval fort his study.

© 2018 National Association for Healthcare Quality
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