Speaking up behaviours (safety voices) of healthcare workers: a metasynthesis of qualitative research studies.
A key aspect of positive safety culture is the perception that all team members should speak up about safety concerns. This review of studies identified hierarchy and role expectations as barriers to nurses speaking up and found that nurse managers play a central role in determining the extent to which speaking up is valued. These results suggest that speaking up about safety remains aspirational for nurses and other health care workers.
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