Speaking Up is Hard to Do

When you feel that something is not quite right, it takes a commitment to say so. And when others ignore or speak over your comment, it takes actual assertiveness to insist that they pay attention.

A lot of things influence whether people speak up when things don’t seem right:

  • individual self-confidence,
  • the power of the other person’s convictions,
  • the quality of the relationship between the people involved, and
  • the workgroup’s culture of respect.

The influences can be quite subtle, but the consequences can be considerable.

The Wrong Patient is an article from a few years ago in the Annals of Internal Medicine.

The article recites a chronology of interactions among health care providers that resulted in the wrong patient undergoing an invasive procedure. The authors noted 17 errors along the way; none were devastating in on its own, but the whole chain of events led to an adverse outcome.

At a number of those erroneous interactions, someone had doubts about whether this patient was scheduled for that procedure. Some even expressed those doubts but then backed off when others were dismissive of their concerns.

It wasn’t until an hour and a half into the procedure that an attending physician noticed a missing patient, tracked her down to the operating room, and pointed out the error. At first his objections were dismissed, but he persisted in his statements until others recognized the error.

Patient safety in health care and high quality outcomes in other sectors depend upon effective communication among colleagues.

Workgroups gain a lot from a culture of respect and civility. Individuals hesitate to challenge others, especially when they anticipate some form of incivility as a response.

Building and sustaining such a culture is a core leadership responsibility.

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