Learning effective communication and teamwork skills
is crucial to improving patient safety for health care
professionals [1]. The frontline staff, such as medical residents
and nurses, is well positioned to observe early
signs of unsafe conditions in care delivery and bring
them to the attention of the organisation [2,3]. ‘Speaking
up’ is defined as the raising of concerns by health care
professionals for the benefit of patient safety and care
quality upon recognising or becoming aware of the risky
or deficient actions of others within health care teams in
a hospital environment [4,5]. Such actions include mistakes
(e.g. missed diagnoses, poor clinical judgement),
lapses, rule breaking, and failure to follow standardised
protocols. Speaking up is expected to have an immediate
preventive effect on human errors or to improve technical
and system deficiencies. Organisational research
illustrates that, in many cases, people choose the ‘safe’
response of silence, withholding input that could be
valuable to others or thoughts that they wish they could