Risk Management and Healthcare Policy (Aug 2024)
Improving Patient Safety and Care Quality Through a “Speaking-Up” Climate: The Mediating Role of Situation Monitoring
Abstract
Ja Kyung Seo,1 Seung Eun Lee2 1Psychological Science Innovation Institute, Department of Psychology, Yonsei University, Seoul, South Korea; 2College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South KoreaCorrespondence: Seung Eun Lee, Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea, Tel +82-2-2228-3254, Fax +82-2-2227-8303, Email [email protected]: In healthcare settings, a climate that encourages speaking up among staff is believed to enhance patient safety and quality of care. However, the specific mechanisms of this relationship remain underexplored. Particularly, there is a need to understand how components of teamwork, such as situation monitoring, can be linked to the impact of a speaking-up climate on relevant outcomes. This study aimed to investigate the direct and indirect effects of a speaking-up climate on patient safety and quality of care using situation monitoring as a potential mediator.Patients and Methods: This cross-sectional study used survey data from 380 staff nurses who provided direct patient care at three Korean hospitals. Structural equation modeling was utilized to test a hypothesized mediation model using Mplus 7.0.Results: Our data analysis confirmed the partial mediation model. As hypothesized, a speaking-up climate directly improved patient safety (β = 0.384, p < 0.001) and quality of care (β = 0.393, p < 0.001). Also, we found that indirect effects of a speaking-up climate on patient safety (β = 0.224, p < 0.001) and quality of care (β = 0.186, p = 0.005) through situation monitoring were significant. These results indicate that situation monitoring was found to significantly mediate the relationship between a speaking-up climate, patient safety, and quality of care.Conclusion: Our study demonstrates that the positive impact of a speaking-up climate extends beyond improving nurses’ speaking up. Further, fostering a speaking-up climate can significantly improve patient safety and quality of care, and situation monitoring has a critical role in this relationship. These findings contribute to understanding how encouraging a speaking-up climate could benefit patient safety and care quality in healthcare organizations.Keywords: healthcare, nurse, nursing, organizational climate, teamwork
