Barriers to reporting clinical deterioration - and how to remove them
Clinical deterioration is a key risk for any organisation providing clinical care. This qualitative study investigates how three organisational influences - leadership, culture and hierarchies - impact healthcare professionals' readiness to raise concerns about patient deterioration.
The study, conducted through in-depth interviews with clinical staff across various healthcare settings, sheds light on systemic barriers and enablers for fostering the culture of open communication that is crucial for reporting deterioration, as follows:
1. leadership influence
The study underscores the pivotal role of leadership in shaping communication practices. Supportive and visible leaders who prioritize patient safety and actively encourage feedback were identified as instrumental in empowering staff to voice concerns. Conversely, leaders perceived as disengaged or overly authoritative often inhibited communication, creating an atmosphere of hesitation and fear.
2. organisational culture
The research highlights that a positive culture, characterised by openness, trust, and a commitment to continuous improvement, is essential for raising concerns. Staff reported being more willing to speak up in environments where mistakes were viewed as learning opportunities rather than grounds for punishment. Conversely, cultures emphasising blame and punishment discouraged reporting, fostering silence even in critical situations.
3. hierarchical barriers
Hierarchies within healthcare teams emerged as a significant barrier, with junior staff often feeling intimidated by senior colleagues. This fear of reprisal or judgment discouraged them from voicing concerns. The study found that rigid hierarchies stifled communication and impeded the timely escalation of critical issues.
4. personal and professional confidence
The participants also highlighted individual factors such as experience, self-confidence, and communication skills. Less experienced staff often lacked the confidence to challenge authority, further compounding the issue in hierarchical settings.
In response to the findings, the authors recommend several actions to improve reporting of deterioration:
- Foster Leadership Engagement:
Develop leadership programs that emphasize visibility, active listening, and responsiveness. Leaders should model openness by seeking and addressing staff concerns transparently. - Build a Just Culture:
The shift from blame-oriented practices to systems that value learning and transparency. Encourage regular safety reviews and celebrate improvements stemming from reported concerns. - Reduce Hierarchical Barriers:
Promote team-based approaches and flatten power structures by involving all team members in decision-making. Structured interdisciplinary rounds can facilitate inclusive communication. - Enhance Training Opportunities:
Equip staff with assertiveness and communication training, particularly focusing on junior and less experienced employees. Scenario-based exercises can build confidence to address and escalate concerns effectively.
Any health or human service organisation providing clinical care will benefit from applying these findings and recommendations to improve clinical deterioration reporting.
All accessed 14/11/24: