Fear of Speaking Up is Pervasive

By Chris Hermann

Let’s say you’re visiting your mother in the hospital. You see a doctor or nurse enter the room, shake her hand, and then start to inspect stitches from her surgery without cleaning their hands. Would you say anything? Would you speak up and remind the clinician to perform hand hygiene first?

A scenario similar to this was posed to healthcare professionals in a study, published recently by the American Journal of Infection Control. Results were troubling, but not surprising. A full 43% of clinicians reported that they would feel uncomfortable speaking up if they saw a colleague fail to clean their hands.

While this part of the survey was hypothetical – about a possible future situation – another question addressed past history. And results were even worse. Over 61% of respondents reported that they had actually failed to speak up at least once during the past four weeks even though they had a concern about patient safety.

Likelihood of speaking up was impacted by the respondent’s place in the organization, with those with lower hierarchical status being considerably less likely to speak up than those at the top of the org chart.

Clearly, this is a problem. With tens of thousands of hand hygiene opportunities in a typical hospital every month, it’s only natural that some providers will forget to clean their hands sometimes. They’re busy, they’re rushing around, their hands are full, etc. If their colleagues are often afraid to speak up and remind them to sanitize, then patient safety is compromised, and a whole series of bad outcomes could follow.

What’s a hospital to do? Of course, it’s important to foster a culture that provides psychological safety to its employees and that encourages clinicians to speak up. But the research found that those factors did not impact results here.

It appears that, despite hospitals’ best intentions and even in supportive cultures, human beings are, well, human. So, if many of them won’t speak up even under the best circumstances, it may be time to turn to technology to do what people can’t or won’t.

Our electronic hand hygiene reminder system uses an automated human voice to remind providers to sanitize when they forget. There’s no judgment call, there’s no discomfort, there’s no risk. It’s all technology, and it works. Hand hygiene typically doubles or more once our voice is turned on. This frees up doctors and nurses from having to face the dilemma of speaking up and feeling uncomfortable, or not speaking up and feeling guilty.

If you’d like to explore how our system typically doubles hand hygiene performance rates and reduces HAIs by up to 75-80%, here’s a brief video about how it works. Or here’s a white paper on How the New Joint Commission Hand Hygiene Standards Could Impact Your Hospital.

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