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Development and Psychometric Evaluation of the Speaking Up About Patient Safety Questionnaire

Richard, Aline, PhD*; Pfeiffer, Yvonne, PhD*; Schwappach, David D.L., PhD*†

doi: 10.1097/PTS.0000000000000415
Original Article: PDF Only

Objective Speaking up about safety concerns by staff is important to prevent medical errors. Knowledge about healthcare workers' speaking up behaviors and perceived speaking up climate is useful for healthcare organizations (HCOs) to identify areas for improvement. The aim of this study was to develop a short questionnaire allowing HCOs to assess different aspects of speaking up among healthcare staff.

Methods Healthcare workers (n = 523) from 2 Swiss hospitals completed a questionnaire covering various aspects of speak up–related behaviors and climate. Psychometric testing included descriptive statistics, correlations, reliabilities (Cronbach α), principal component analysis, and t tests for assessing differences in hierarchical groups.

Results Principal component analysis confirmed the structure of 3 speaking up behavior-related scales, that is, frequency of perceived concerns (concern scale, α = 0.73), withholding voice (silence scale, α = 0.76), and speaking up (speak up scale, α = 0.85). Concerning speak up climate, principal component analysis revealed 3 scales (psychological safety, α = 0.84; encouraging environment, α = 0.74; resignation, α = 0.73). The final survey instrument also included items covering speaking up barriers and a vignette to assess simulated behavior. A higher hierarchical level was mostly associated with a more positive speak up–related behavior and climate.

Conclusions Patient safety concerns, speaking up, and withholding voice were frequently reported. With this questionnaire, we present a tool to systematically assess and evaluate important aspects of speaking up in HCOs. This allows for identifying areas for improvement, and because it is a short survey, to monitor changes in speaking up—for example, before and after an improvement project.

From the *Swiss Patient Safety Foundation, Zurich; and †Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.

Correspondence: Aline Richard, PhD, Asylstrasse 77, 8032 Zurich, Switzerland (e-mail:

The authors disclose no conflict of interest.

The study was funded by the federal office of public health (FOPH) (Nr. 15.002825).

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