1
Department of Healthcare Services Management, Faculty of Management, Islamic Azad University Electronic Campus (IAUEC), Tehran, Iran
2
Department of Healthcare Service Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran
Abstract
Aims: Improving the quality of patients' safety is one of the hospitals' priorities and the WHO has prioritized it as one of the basic health concerns. The purpose of the present study was to investigate the impact of the "SPEAK UP" program on strengthening patients' participation and safety referred to Babolsar hospitals.
Materials & Methods: This quasi-experimental interventional study was performed from June to December 2017. The selected patients referred to the clinic of Shafa Hospital were divided into two groups: control and experimental (50 participants in each). A pre-test was given to both samples, and then training was held for the intervention group through the educational brochure. A researcher-made questionnaire was used for collecting the data based on the "SPEAK UP brochure" (α=0.925). Wilcoxon and Mann-Whitney tests were used for testing the research hypotheses through SPSS 20.
Findings: The mean scores of participation, safety, learning, and asking skills in the post-test of the experimental group were higher than that of their pre-test scores. Implementation of the SPEAK UP program had a significant impact on participation, safety skills, learning skills, and the asking skills of the patients who referred to the hospital.
Conclusion: Promoting the implementation of the "SPEAK UP" program through using 7 educational rules has a significant impact on the free expression of opinions, enhancing the patients' participation level, and improving the safety of patients who referred to hospitals and others health centers.
References
1- Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J. 2014 Mar 1;90(1061):149-54. http://dx.doi.org/10.1136/postgradmedj-2012-131168
2- Crigger NJ. Always having to say you’re sorry: an ethical response to making mistakes in professional practice. Nurs Ethics. 2004 Nov;11(6):568-76. https://doi.org/10.1191/0969733004ne739oa
3- Williamson L. Patient and citizen participation in health: the need for improved ethical support. The Am J Bioeth. 2014 Jun 3;14(6):4-16. https://doi.org/10.1080/15265161.2014.900139
4- World Health Organization. Ata A. Declaration of Alma Ata: International conference on primary health care. In Alma Ata, USSR: International Conference on Primary Health Care 1978 Sep (Vol. 6).
5- Entwistle VA, Quick O. Trust in the context of patient safety problems. J Health Organ Manag. 2006 Sep 1;20(5):397-416. https://doi.org/10.1108/14777260610701786
6- Khammarnia M, Ravangard R, Jahromi M, Moradi A. Study on the Medical Errors in Public Hospitals of Shiraz, 2013. Hospital. 2014;13(3):17-24. http://jhosp.tums.ac.ir/article-1-5153-fa.html
7- Shamsaii M, FarajiO,Ramazani A, Hedaiati P. The viewpoints of Zabol’s General
Practitioners about medical errors in 2010. Hospital, 2012; 10(2): 21-30. [Farsi] Abstract retrieved from https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=279679
8- Rafiefar S. National Self-care Executive Regulations (for Ministry of Health and
Medical Education (MOHME). Tehran: Nashre-cheshmeh; 2016. [Farsi]
9- Bokaee M, Enjezab B, Fotouhi Z, Sarvari M, Farajkhoda T, Abbasi M. Exploring the
Extent of Patients’ Awareness of the Patients’ Rights Charter in ShahidSadoughi Hospital of
Yazd in 2000. Medical Ethics Journal. 2011;5(17):11-26. [Farsi]
10- Chiang HY, Pepper GA. Barriers to nurses' reporting of medication administration errors in Taiwan. J Nurs Scholarsh. 2006 Dec;38(4):392-9. https://doi.org/10.1111/j.1547-5069.2006.00133.x
11- Elwyn G, Edwards A, Mowle S, Wensing M, Wilkinson C, Kinnersley P, Grol R. Measuring the involvement of patients in shared decision-making: a systematic review of instruments. Patient Educ Couns. 2001 Apr 1;43(1):5-22. https://doi.org/10.1016/s0738-3991(00)00149-x
12- Florin D, Dixon J. Public involvement in health care. BMJ. 2004 Jan 15;328(7432):159-61. https://doi.org/10.1136/bmj.328.7432.159
13- Sabahi Beedgoli M, Shahri S, Kebriaee A, Seyedi HR, Sarafraz Z. Patient safety climate in medical centers of Kashan. JHPM. 2012; 1 (1) :62-72 URL: http://jhpm.ir/article-1-29-en.html
14- Jabbari, Alireza; RAISI, Ahmadreza; RostamI, Vahideh. Patient safety status in Selected
Training hospitals Affiliated with Isfahan University of medical sciences. Health Information
Management, Feb. 2015: 99-108. Available at: https://www.sid.ir/en/journal/ViewPaper.aspx?id=577967
15- Asefzade S, Mehrabian F, Nikpey A, Kianmehr S. Assessment of Patient Safety Based on
Standards of Patient Safety Friendly Hospitals in Education and Treatment Centers of Rasht
City in 2013. RME. 2013; 5 (1):36-44. https://dx.doi.org/10.18869/acadpub.rme.5.1.36
16- Cahill JO. Patient participation--a review of the literature. J Clin Nurs. 1998 Mar 1;7(2):119-28. https://doi.org/10.1111/j.1365-2702.1998.00132.x
17- Amini M, Nazarimanesh L, Mahmoudi Majdabadi Farahani M. Study of Nurses' Willingness to Patient Participation in Patient Safety in Hospitals Affiliated to Tehran University of Medical Sciences Using PaCT-HCW Questionnaire. Payavard. 2019; 12 (6) :458-466
URL: http://payavard.tums.ac.ir/article-1-6670-en.html
18- Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. In Mayo Clin Proc. 2010 Jan 1 (Vol. 85, No. 1, pp. 53-62). Elsevier. https://dx.doi.org/10.4065%2Fmcp.2009.0248
19- Brennan PF, Safran C. Patient safety: remember who it’s really for. Int J Med Inform. 2004 Aug 1;73(7-8):547-50. https://doi.org/10.1016/j.ijmedinf.2004.05.005
20- Coulter A. Patient engagement—what works?. J Ambul Care Manage. 2012 Apr 1;35(2):80-9. https://doi.org/10.1097/jac.0b013e318249e0fd
21- Peters E, Slovic P, Hibbard JH, Tusler M. Why worry? Worry, risk perceptions, and willingness to act to reduce medical errors. Health Psychol. 2006 Mar;25(2):144. https://doi.org/10.1037/0278-6133.25.2.144
22- James J. Patient engagement. Health Affairs Health Policy Brief. 2013;14(10.1377). https://www.healthaffairs.org/do/10.1377/hpb20130214.898775/full/
23- O’leary KJ, Sehgal NL, Terrell G, Williams MV. High Performance Teams and the Hospital of the Future Project Team. Interdisciplinary teamwork in hospitals: a review and practical recommendations for improvement. J Hosp Med. 2012 Jan;7(1):48-54. https://doi.org/10.1002/jhm.970
24- Riga M, Vozikis A, Pollalis Y, Souliotis K. MERIS (Medical Error Reporting Information System) as an innovative patient safety intervention: A health policy perspective. Health Policy. 2015 Apr 1;119(4):539-48. https://doi.org/10.1016/j.healthpol.2014.12.006
25- Fassier T, Azoulay E. Conflicts and communication gaps in the intensive care unit. Curr Opin Crit Care. 2010 Dec 1;16(6):654-65. https://doi.org/10.1097/mcc.0b013e32834044f0
26- Shakerinia I. Physician-patient relationship and patient's satisfaction. IJME. 2009; 2 (3):9-
16. http://ijme.tums.ac.ir/article-1-268-fa.html
27- SPEAK UPTM: Facts about Speak Up [Internet]. Jointcommission.org. 2020 [cited 4
February 2020]. Available from: https://www.jointcommission.org/en/resources/forconsumers/speak-up-campaigns/facts-about-speak-up/
28- Rainey, H., Ehrich, K., Mackintosh, N., & Sandall, J. (2015). The role of patients and their relatives in ‘speaking up’ about their own safety–a qualitative study of acute illness. Health Expect. 18(3), 392-405. https://dx.doi.org/10.1111%2Fhex.12044
29- Strull, W. M., Lo, B., & Charles, G. (1984). Do patients want to participate in medical decision making?. JAMA 252(21), 2990-2994. h ttps://doi.org/10.1001/jama.1984.03350210038026
30- Ginsburg L. ‘Speaking up’ climate: a new domain of culture to measure and explore.
BMJ Publishing Group Ltd; 2015. http://dx.doi.org/10.1136/bmjqs-2015-004598
31- Entwistle, V. A., McCaughan, D., Watt, I. S., Birks, Y., Hall, J., Peat, M., . . . Wright, J. (2010). Speaking up about safety concerns: multi-setting qualitative study of patients' views and experiences. Qual Saf Health Care. 19(6), e33-e33.
32- Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Serv Res. 2014 Dec;14(1):1-8. https://doi.org/10.1186/1472-6963-14-61
33- Nacioglu A. As a critical behavior to improve quality and patient safety in health care: speaking up!. Safety in Health. 2016 Dec 1;2(1):10. https://doi.org/10.1186/s40886-016-0021-x
34- Sayre MM, McNeese-Smith D, Leach LS, Phillips LR. An educational intervention to increase “speaking-up” behaviors in nurses and improve patient safety. J Nurs Care Qual. 2012 Apr 1;27(2):154-60. https://doi.org/10.1097/ncq.0b013e318241d9ff
35- Seale H, Chughtai AA, Kaur R, Crowe P, Phillipson L, Novytska Y, Travaglia J. Ask, speak up, and be proactive: empowering patient infection control to prevent health care–acquired infections. Am J Infect Control. 2015 May 1;43(5):447-53. https://doi.org/10.1016/j.ajic.2015.01.007
36- Schwappach D, Richard A. Speak up-related climate and its association with healthcare workers’ speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland. BMJ Qual Saf. 2018 Oct 1;27(10):827-35. https://dx.doi.org/10.1136%2Fbmjqs-2017-007388
Weller J, Boyd M, Cumin D. Teams, tribes, and patient Safety: Overcoming barriers to effective teamwork in healthcare. Postgrad Med J. 2014;90:149-54. [Link] [DOI:10.1136/postgradmedj-2012-131168]
Crigger NJ. Always having to say you're sorry: An ethical response to making mistakes in professional practice. Nurs Ethics. 2004;11(6):568-76. [Link] [DOI:10.1191/0969733004ne739oa]
Williamson L. Patient and citizen participation in health: The need for improved ethical support. Am J Bioeth. 2014;14(6):4-16. [Link] [DOI:10.1080/15265161.2014.900139]
World Health Organization. Declaration of Alma Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12, September 1978. Geneva: World Health Organization; 1978. [Link]
Entwistle VA, Quick O. Trust in the context of patient safety problems. J Health Organ Manag. 2006;20(5):397-416. [Link] [DOI:10.1108/14777260610701786]
Khammarnia M, Ravangard R, Ghabari Jahromi M, Moradi A. A study on the medical errors in public hospitals of Shiraz: 2013. J Hosp. 2014;13(3):17-24. [Link] [DOI:10.17795/jhealthscope-15096]
Shamsaii M, Faraji O, Ramazani A, Hedaiati SP. The viewpoints of Zabol's general practitioners about medical errors in 2010. J Hosp. 2010;10(4):21-30. [Persian] [Link]
Rafiefar S. National Self-care Executive Regulations (for Ministry of Health and Medical Education (MOHME)). Tehran: Nashre-Cheshmeh; 2016. [Persian] [Link]
Bokaee M, Enjezab B, Fotouhi Z, Sarvari M, Farajkhoda T, Abbasi M. Exploring the extent of patients' awareness of the patients' rights charter in ShahidSadoughi Hospital of Yazd in 2000. J Med Eth. 2011;5(17):11-26. [Persian] [Link]
Chiang HY, Pepper GA. Barriers to nurses' reporting of medication administration errors in Taiwan. J Nurs Scholarsh. 2006;38(4):392-9. [Link] [DOI:10.1111/j.1547-5069.2006.00133.x]
Elwyn G, Edwards A, Mowle S, Wensing M, Wilkinson C, Kinnersley P, et al. Measuring the involvement of patients in shared decision-making: A systematic review of instruments. Patient Educ Couns. 2001;43(1):5-22. [Link] [DOI:10.1016/S0738-3991(00)00149-X]
Sabahi Beedgoli M, Shahri S, Kebriaee A, Seyedi HR, Sarafraz Z. Patient safety climate in medical centers of Kashan. J Health Promot Manag. 2012;1(1):62-72. [Link]
Jabbari A, Raisi A, Rostami V. Patient safety status in selected training hospitals affiliated with Isfahan University of medical sciences. Health Inf Manag. 2015;12(1):99-108. [Link]
Asefzade S, Mehrabian F, Nikpey A, Kianmehr S. Assessment of patient Safety based on standards of patient Safety friendly hospitals in education and treatment centers of Rasht city in 2013. Res Med Educ. 2013;5(1):36-44. [Link] [DOI:10.18869/acadpub.rme.5.1.36]
Amini M, Nazarimanesh L, Mahmoudi Majdabadi Farahani M. Study of nurses' willingness to patient participation in patient safety in hospitals affiliated to Tehran University of Medical Sciences Using PaCT-HCW questionnaire. J PAYAVARD SALAMAT. 2019;12(6):458-66 [Link]
Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: Current knowledge and applicability to patient safety. Mayo Clin Proc. 2010;85(1):53-62. [Link] [DOI:10.4065/mcp.2009.0248]
Peters E, Slovic P, Hibbard JH, Tusler M. Why worry? Worry, risk perceptions, and willingness to act to reduce medical errors. Health Psychol. 2006;25(2):144-52. [Link] [DOI:10.1037/0278-6133.25.2.144]
James J. Patient engagement. Health Affairs Health Policy Brief. 2013;14(10.1377). [Link]
O'leary KJ, Sehgal NL, Terrell G, Williams MV, High Performance Teams and the Hospital of the Future Project Team. Interdisciplinary teamwork in hospitals: A review and practical recommendations for improvement. J Hosp Med. 2012;7(1):48-54. [Link] [DOI:10.1002/jhm.970]
Riga M, Vozikis A, Pollalis Y, Souliotis K. MERIS (Medical Error Reporting Information System) as an innovative patient safety intervention: A health policy perspective. Health Policy. 2015;119(4):539-48. [Link] [DOI:10.1016/j.healthpol.2014.12.006]
Fassier T, Azoulay E. Conflicts and communication gaps in the intensive care unit. Curr Opin Crit Care. 2010;16(6):654-65. [Link] [DOI:10.1097/MCC.0b013e32834044f0]
Shakerinia I. Physician-patient relationship and patient's satisfaction. Med Eth History Med. 2009;2(3):9-16. [Link]
Rainey H, Ehrich K, Mackintosh N, Sandall J. The role of patients and their relatives in 'speaking up' about their own safety-a qualitative study of acute illness. Health Expect. 2015;18(3):392-405. [Link] [DOI:10.1111/hex.12044]
Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making?. JAMA. 1984;252(21):2990-4.
https://doi.org/10.1001/jama.252.21.2990 [Link] [DOI:10.1001/jama.1984.03350210038026]
Ginsburg L. 'Speaking up' climate: A new domain of culture to measure and explore. BMJ Qual Saf. 2015;24(11):661-3. [Link] [DOI:10.1136/bmjqs-2015-004598]
Entwistle VA, McCaughan D, Watt IS, Birks Y, Hall J, Peat M, et al. Speaking up about safety concerns: Multi-setting qualitative study of patients' views and experiences. Qual Saf Health Care. 2010;19(6):e33. [Link] [DOI:10.1136/qshc.2009.039743]
Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: A literature review. BMC Health Serv Res. 2014;14:1-8. [Link] [DOI:10.1186/1472-6963-14-61]
Nacioglu A. As a critical behavior to improve quality and patient Safety in health care: Speaking up!. Saf Health. 2016;2:10. [Link] [DOI:10.1186/s40886-016-0021-x]
Sayre MM, McNeese-Smith D, Leach LS, Phillips LR. An educational intervention to increase "speaking-up" behaviors in nurses and improve patient safety. J Nurs Care Qual. 2012;27(2):154-60. [Link] [DOI:10.1097/NCQ.0b013e318241d9ff]
Seale H, Chughtai AA, Kaur R, Crowe P, Phillipson L, Novytska Y, et al. Ask, speak up, and be proactive: Empowering patient infection control to prevent health care-acquired infections. Am J Infect Control. 2015;43(5):447-53. [Link] [DOI:10.1016/j.ajic.2015.01.007]
Schwappach D, Richard A. Speak up-related climate and its association with healthcare workers' speaking up and withholding voice behaviours: A cross-sectional survey in Switzerland. BMJ Qual Saf. 2018;27(10):827-35. [Link] [DOI:10.1136/bmjqs-2017-007388]
Mousavi,S. and Rezai-Rad,M. (2025). Impact of SPEAK UP™ on Patients' Participation and Safety among People Referring to Babolsar Hospitals. Health Education and Health Promotion, 8(4), 181-188.
MLA
Mousavi,S. , and Rezai-Rad,M. . "Impact of SPEAK UP™ on Patients' Participation and Safety among People Referring to Babolsar Hospitals", Health Education and Health Promotion, 8, 4, 2025, 181-188.
HARVARD
Mousavi S., Rezai-Rad M. (2025). 'Impact of SPEAK UP™ on Patients' Participation and Safety among People Referring to Babolsar Hospitals', Health Education and Health Promotion, 8(4), pp. 181-188.
CHICAGO
S. Mousavi and M. Rezai-Rad, "Impact of SPEAK UP™ on Patients' Participation and Safety among People Referring to Babolsar Hospitals," Health Education and Health Promotion, 8 4 (2025): 181-188,
VANCOUVER
Mousavi S., Rezai-Rad M. Impact of SPEAK UP™ on Patients' Participation and Safety among People Referring to Babolsar Hospitals. Health Education and Health Promotion, 2025; 8(4): 181-188.