Influences of leadership, organizational culture and hierarchy on raising concerns about patient deterioration: A qualitative study (August 2024)

Summary

Raising concerns is essential to quickly detect and respond to patient deterioration. However, factors such as hierarchy, leadership and organisational culture can impact negatively on people's willingness to raise concerns. This qualitative study in the Journal of Patient Safety investigated how these factors influence healthcare workers, patients and caregivers in raising concerns about patient deterioration.

The results showed that positive leadership that challenges traditional professional hierarchies by embracing multidisciplinary teamwork, valuing the input of all stakeholders and championing person-centred practice fosters a positive working culture. This culture has the potential to empower clinical staff, patients, caregivers and family members to confidently raise concerns. Staff development, clinical supervision and access to feedback—all underpinned by psychological safety—were viewed as facilitating the escalation of concerns and have the potential to improve patient safety.