Why is it so hard for doctors to speak up when they see an error occurring?

BackgroundThe ability of doctors to ‘speak up’ when a medical error occurs is a cornerstone of patient safety. Hand hygiene (HH) is one of the simplest methods of reducing patient harm and represents a behavioural model in which to observe medical staff interaction. Our hypothesis is that the hierarchical structure amongst doctors prevents them from speaking up, which in turn contributes to poor HH compliance.MethodsAnanonymous survey was administered to doctors employed in a health service in Melbourne, Australia. Questions included: willingness to prompt doctors to perform HH, reasons for not speaking up, perceived reactions of a doctor being prompted to perform HH and perceived reaction if they were asked to perform HH.ResultsOne hundred and sixty-three doctors completed the questionnaire. Willingness to prompt a doctor to perform HH decreased as the questioned doctor's seniority increased, with 88.5% willing to ask an intern but only 40.4% willing to ask a consultant. The main reason for not asking a senior doctor was not wanting to speak up to a superior.ConclusionsOur study highlights a steep medical hierarchy, with less than half of the doctors willing to question seniors, even when they noticed an error occurring.Wesuggest that if acquired, the skills needed to respectfully prompt HH are transferrable to many other patient safety initiatives.