BMA Cymru Wales survey on raising concerns in the workplace – key findings
The survey was sent electronically to 3,059 members in Wales working across secondary
care. It was conducted between 27 March and 16 May 2015. 526 responses were
received, representing a response rate of 17.2%. 60.9% of respondents identified as
consultants, 15.7% as junior doctors, 11.5% as staff/specialty doctors, 8.0% as associate
specialists and 2.0% as medical academics. Respondents were asked to complete the
survey on an anonymous basis.
1. 58.6% of respondents said they had raised a
concern about patient safety in the workplace over
the last three months.
2. Those who said they’d raised a concern over the
last three months also revealed that they had each
raised an average of 9.8 concerns in the last twelve
months.
3. Of those who had raised a concern over the last
three months, 69.8% had raised concerns verbally
to a manager; 53.4% had raised concerns in writing
to a manager; 52.2% had completed an incident
form; 58.1% had told a colleague; and 4.4% had
reported concerns to an external agency such as
HIW or the Ombudsman.1
4. When asked what action had been taken in relation
to the most recent concern raised, 18.6% of
respondents said the concern was investigated and
satisfactory remedial action taken; 20.4% said the
concern was investigated but the action taken was
not satisfactory; 17.5% said the concern was
investigated but no action was taken; 8.2% said
they were actively discouraged or told directly to
report the concern; and 39.8% said that no action
had been taken to the best of their knowledge.1
5. When asked what action had been taken in relation
to all concerns they had raised when there had
been more than one, 18.1% said that concerns had
been investigated and satisfactory remedial action
taken; 23.3% said that concerns had been
investigated but the action taken was not
satisfactory; 28.1% said concerns had been
investigated but no action was taken; 8.7% said
they were actively discouraged or told directly to
report the concerns; and 45.1% said that no action
had been taken to the best of their knowledge.1
6. When asked how they felt they were treated by
managers and people in authority after they had
reported concerns, 11.4% said extremely well,
11.1% said quite well, 46.0% said the same, 13.4%
said quite badly and 13.4% said extremely badly.
1
When individual responses are added together, the total reached may
exceed 100 % because some respondents may have selected more than
one option in answering this question.
7. When asked how they felt they were treated by
colleagues and co-workers after they had reported
concerns, 20.8% said extremely well, 19.1% said
quite well, 48.0% said the same, 4.0% said quite
badly and 3.4% said extremely badly.
8. When asked what, in their opinion, had caused the
most recent patient safety incident they had
reported, 32.5% pointed to unfilled staff vacancies;
25.9% to a higher than usual workload; 16.1% to
human error; 51.8% to systemic causes (e.g. drive
to meet targets/inadequate facilities); and 14.1% to
other causes.1
9. When asked what, in their opinion, had caused all
patient safety incidents they had reported when
there had been more than one, 49.8% pointed to
unfilled staff vacancies; 37.8% to a higher than
usual workload; 19.8% to human error; 65.7% to
systemic causes (e.g. drive to meet
targets/inadequate facilities); and 14.5% to other
causes.1
10. Those who said they hadn’t reported a patient
safety concern in the last three months were asked
whether, if they did have a concern, they would
agree with the statement ‘I would feel worried
about reporting the concern for fear of reprisal
(such as being victimised) or because it could have a
negative effect on my career or my relationship
with colleagues.’ 42.9% said they agreed with the
statement, whilst 57.1% said they disagreed.
11. When those who said they hadn’t reported a
patient safety concern in the last three months
were asked what was the reason they had not done
so, 70.7% said they had had no concerns to raise;
12.8% said the problem was widely known so they
felt no other action was needed; 7.4% said the
concern did not merit reporting; 5.3% said they
were worried about negative consequences for
them and their career if they raised concerns; 4.8%
said they did not feel sufficiently supported by their
superiors; 4.3% said their concerns were voiced by
other colleagues; 2.7% said they had no time to
raise it because their department is so busy; 2.1%
said they didn’t know how to raise their concern;
and 1.6% said they did not feel able to raise their
concern because it related directly to a manager.1
12. 14.4% of respondents said they had considered
leaving either their current job or the medical
profession at some point in the last twelve months
because they had concerns about patient safety
they felt unable to raise. 26.9% of respondents said
they had considered leaving either their current job
or the medical profession at some point in the last
twelve months because they had raised concerns
that were not dealt with. 24.1% of respondents said
they had considered leaving either their current job
or the medical profession at some point in the last
twelve months because they had suffered a
negative impact on their career or job satisfaction
as a result of raising concerns about patient safety.
13. As a direct result of having raised a concern about
patient safety, 60.2% of respondents said they had
experienced bullying or harassment; 46.4% said
they had experienced victimisation (they were
personally blamed after raising their concern);
37.6% said there had been a detrimental impact on
their career progression; 22.7% said they’d been
‘gagged’ (actively prevented from raising their
concern); and 24.3% said they had experienced
some other form of detriment.1
14. 31.3% of respondents disagreed with the view that
raising concerns about patient safety is encouraged
in their place of work.
21. 49.6% of respondents disagreed with the view that
there is a supportive culture in their organisation
where staff are encouraged to raise concerns.
22. 43.8% of respondents agreed with the view that
there is a blame culture within their organisation
where staff are fearful to raise concerns.
23. 30.6% of respondents agreed with the view that
there is a bullying culture within their organisation
where staff are discouraged to raise concerns.
24. 40.7% of respondents disagreed with the view that
there is a culture of learning within their
organisation where information is shared and
lessons learned following an adverse event.
25. 88.2% of respondents disagreed with the view that
there are enough staff in their workplace to handle
the workload.
26. 84.8% of respondents said there were long-term
unfilled staff vacancies in their workplace
27. 69.0% of respondents agreed with the view that
staff in their unit work longer hours than is best for
patient care.
28. 51.9% of respondents disagreed with the view that
their workplace has procedures and systems that
are good at preventing errors from happening.
29. 65.3% of respondents agreed there were patient
safety problems in their workplace.
15. 41.6% of respondents disagreed with the view that
their organisation has a clear and accessible policy
on supporting staff to raise concerns.
30. 55.3% of respondents agreed with the view that
staff in their workplace are used as ‘scapegoats’
when problems arise.
16. 56.4% of respondents said they were not confident
something appropriate would be done if they
reported concerns about patient safety to
somebody in their organisation.
31. 39.4% of respondents agreed with the view that
staff in their workplace are afraid to ask questions
when something does not seem right.
17. 36.9% of respondents said they would be wary
about reporting concerns about patient safety to
someone at their workplace because of possible
negative ramifications for their career.
18. 34.9% of respondents said they would be wary
about reporting concerns about patient safety to
someone at their workplace because of possible
negative ramifications on their relationship with
colleagues.
32. 71.7% of respondents disagreed with the view that
staff and managers in their workplace actively
discuss ways to prevent errors from happening.
33. 64.8% of respondents agreed with the view that it
is just by chance that serious mistakes don’t happen
in their workplace.
34. 59.0% of respondents disagreed with the view that
their hospital management seriously considers staff
suggestions for improving patient safety.
19. 52.8% of respondents disagreed with the view that
management in their organisation is serious about
protecting people who report concerns.
35. 65.4% of respondents disagreed with the view that
their hospital management provides clear
leadership on patient safety in their hospital.
20. 43.4% of respondents disagreed with the view that
there is an open culture in their organisation where
staff feel able to raise concerns.
36. 74.1% of respondents agreed with the view that
their hospital management only seems interested in
patient safety after an adverse event occurs.