Have a hunch that something is not quite right? Don’t dismiss it. Voicing your concerns promptly can make a big difference to your patients.


Trusting her guts

Senior Patient Care Assistant (SPCA) Sa’ad Siti Aishah’s job includes sending patients to and from the Major Operating Theatre at KK Women’s and Children’s Hospital (KKH).

On one occasion, SPCA Siti noticed a female patient was unusually drowsy during pre-operative checks. Although the patient was responsive, she could not keep her eyes open and had difficulty lifting her arm. From her experience caring for family members who have had a stroke, SPCA Siti knew something was wrong.

SPCA Siti shared her concerns with the ward nurse who checked the patient’s latest ECG record and confirmed that it was normal. Still worried, SPCA Siti approached the ward nurse to request for a doctor to check on the patient. Doctors assessed the patient and agreed she was not fit for the procedure. A CT scan was arranged which revealed a blood clot in the patient’s brain. This validated SPCA Siti’s observations and her prompt and persistent escalation of her concerns for the patient.

Standing your ground

Senior Staff Nurse (SSN), Roselle Joy Lacap from Ward 84, KKH recalled a patient who was prescribed Clexane, an anticoagulant used mainly to treat and prevent deep vein thrombosis (DVT).

Following the established protocol, SSN Joy checked the patient’s background and condition before administering the medication. The patient had no history or high risk of DVT. As the patient was due to deliver, SSN Joy was concerned that taking the blood thinner would cause excessive bleeding during the delivery.

SSN Joy checked with the Pharmacy Department, which agreed that the medication was not recommended for the patient. SSN Joy brought the case to the Medical Officer’s and the Registrar’s attention and the medication order was cancelled promptly. Her actions prevented putting the patient at risk of bleeding as the anticoagulant may inhibit the clotting time.

Speaking up

Speaking up when you sense something is amiss or pointing out to someone senior or who has more expertise than you, can be intimidating. However, your action or inaction can make a big difference to the well-being of your patients. SPCA Siti and SSN Joy shared their experience in voicing their concerns at work effectively:

Put your patients’ interest first
SSN Joy shared, “Bear in your mind and in your heart, that our priority is to keep our patients safe. Correcting something which is not right, however small it may seem, can make a big difference.”

“We are not looking for credit or pinpointing other’s mistakes; we are encouraging each other to save lives and prevent harm from reaching our patients,” SPCA Siti added.

Indeed, SSN Joy and SPCA Siti’s persistence in speaking up and the prompt actions of those who they raised their concerns to, have paid off for their patients.

Treat mistakes as learning points
Human errors are unavoidable. How one views and learns through the mistakes can shape the level of trust in the organisation’s work culture.

“Nobody who works in a hospital wants to make mistakes. If somebody checks your work, it’s to help you avoid mistakes. That’s out of concern for the patient, and for you too. I’ve made errors before and felt awful when I found out. What is more important is that everyone learns from them,” said SSN Joy, whose ward openly shares learning points for team improvement and risk mitigation.

Being vigilant makes the environment safer, not just for patients but for you and your colleagues too.

Be tactful
On speaking to others about their concerns, both SPCA Siti and SSN Joy agreed that being tactful and non-confrontational is key.

“For example, instead of saying, ‘this is wrong’, you could frame it as a question, such as, “Could we please reconfirm?” suggested SPCA Siti.

Learn from others
Seeing how others voice their concerns and are supported by their supervisors and colleagues can boost your confidence in speaking up.

SPCA Siti shared that she was less confident about voicing her doubts when she first joined KKH. “Being new and not from the nursing profession, I was hesitant. But I started speaking up after hearing my Nurse Manager encouraging us to do so for the sake of our patients.”

One way to start is to voice your concerns to your supervisor, who can further guide you on how to approach and resolve the issue.

Being heard

Speaking up has become a culture at SingHealth, thanks to consistent messaging by leaders at all levels.

“Our voices can make a difference, regardless of job title or seniority. It’s very fulfilling and encouraging when the management listens, and improvements happen when our feedback is heard,” shared SSN Joy. “If nobody listens and no actions are taken, then people won’t bother to speak up.”

Brought to you by Strategy Retreat Group 9 – A Safety Culture.

TeamSPEAK® at SingHealth

TeamSPEAK® Workshop is an introductory module designed to create awareness of Speaking Up for Safety and understanding psychological safety. By applying TeamSPEAK® strategies at critical situations/opportunities, learners are motivated to speak up in delivering better and safer care for patients.

Learning Outcomes
o Recognise the importance of speaking up for safety
o Be aware of TeamSPEAK® strategies to facilitate mutual support
o Describe ways to respond positively when spoken up to
o Practice speaking up