The report investigates how the environment for speaking up in the healthcare and care services sector affects patient safety. It is based on concern reports from healthcare staff who feel unsafe speaking up about critical issues and believe that raising concerns is ineffective. A healthy speaking-up climate — characterized by psychological safety and effective communication — is essential to detect, learn from, and prevent adverse events.
Main findings include:
- Many employees fear retaliation or feel unsupported when they raise concerns.
- A poor speaking-up culture can lead to patient harm, delays in treatment, and increased sick leave.
- Managers often face intense pressure due to tight budgets, conflicting responsibilities, operational challenges, and staffing shortages. They may lack necessary support, both medically and in leadership. This weakens efforts to ensure quality and patient safety, and also negatively affects the work environment.
- Factors like harsh communication (incivility), confusion about loyalty versus freedom of expression, and reputation management concerns further undermine the ability to speak up.
The issue is complex and cannot be solved through quick fixes. However, improving the speaking-up culture is crucial — for both patients and staff. It is therefore valuable to prioritize this topic in public debate and at every workplace.
The report highlights factors that are important in this context:
- Strengthen leadership that promotes openness and a safe work atmosphere.
- Improve feedback systems by integrating measurements and loops around quality, patient safety, and the speaking-up culture.
- Increase awareness of legal rights related to freedom of expression.
- Promote kindness and respect as core values in the organizational culture.
The report is directed at both the specialist health services and municipal healthcare services, encouraging reflection and dialogue to help improve the culture for speaking up—for the benefit of both patients and staff.
The translation from Norwegian to English is based on AI. Ukom has reviewed, edited and quality assured the translation.