Speak-up culture in an intensive care unit in Hong Kong: A cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

George Wing Yiu Ng, Jack Kwok Hung Pun, Eric Hang Kwong So, Wendy Wai Hang Chiu, Avis Siu Ha Leung, Yuk Han Stone, Chung Ling Lam, Sarah Pui Wa Lai, Rowlina Pui Wah Leung, Hing Wah Luk, Anne Kit Hung Leung, Kin Wah Au Yeung, Kang Yiu Lai, Diana Slade, Engle Angela Chan

Research output: Journal article publicationJournal articleAcademic researchpeer-review

11 Citations (Scopus)


No commercial use is permitted unless otherwise expressly granted. Objectives Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. Design A mixed-methods design with quantitative and sequential qualitative components was used. Setting and participants Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. Results The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. Conclusions Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.
Original languageEnglish
Article numbere015721
JournalBMJ Open
Issue number8
Publication statusPublished - 1 Aug 2017


  • Chinese
  • clinicians
  • communication openness
  • intensive care unit
  • speaking up

ASJC Scopus subject areas

  • Medicine(all)

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