Improving patient safety and quality of care: What can residents do?

When, why and how should residents speak up? Learn how medical residents can contribute to improving patient safety and quality of care.

Can residents help make systemic improvements to healthcare organizations? Yes, but the process can be complicated.

Ten years ago, nursing was at the center of the patient safety conversation when a study revealed that more often than not, nurses were staying quiet when faced with a colleague’s error, as FierceHealthcare reported at the time. The silence stemmed from a mix of factors, but ultimately the study highlighted the opportunity that an entire profession had for improving patient safety and quality of care.

Today, medical residents are in a similar position, yet they’re also facing new challenges.

The growing potential of the resident voice

As a result of the evolving Covid-19 pandemic, the experiences and opinions of residents have been appearing in the headlines. Multiple states have called on medical trainees to support their response teams, leading to discussions about what these residents are experiencing and how they feel about their work.

However, the pandemic is just the tip of the iceberg. Healthcare institutions are becoming increasingly complex, and these new challenges can be solved by those whose voices may not have been heard in the past, including medical residents. These new voices can weigh in on topics like improving patient safety and quality of care, modification of standard procedures and even the use of healthcare software and technology.

Residents have a unique perspective on organizational barriers, policies and inefficiencies because they’ve had experience in multiple departments during their training. They also have a more objective perspective than others because they’re new members of the organization. Residents might witness excessively long waits in an obstetric clinic, glaring inefficiencies in a workflow or unnecessary redundancies in administrative tasks.

A paper published in Academic Medicine, “Why Medical Residents Do (and Don’t) Speak Up About Organizational Barriers and Opportunities to Improve the Quality of Care,” examines the dynamics around the resident “voice,” finding that residents most often want to speak up about:

1. Frustrating, inefficient work processes.
2. Procedures that negatively affect the patient experience.
3. New ways to enhance existing workflows.

Read the full paper in Academic Medicine.

Why residents don’t speak up

Even though they have the potential to improve an organization, residents may still stay quiet. As the New York Times reports, doctors and nurses are being fired for voicing concerns about safety and patient care, so today’s residents might be reluctant to make waves.

The Academic Medicine study found that residents ask themselves several questions when deciding whether or not to stay quiet. First, they ask themselves whether speaking up would be effective: Realistically, will things ever change? Should they be more carefully choosing their battles? Is now the time to keep their heads down and pay their professional dues?

Second, they ask whether it’s safe to say anything. In the study, residents were concerned about causing harm to their image as hardworking medical professionals. They perceived a risk of being seen as weak compared to residents who had come before them — or even of being considered a “troublemaker.”

They also worried that if they did speak up, their colleagues would have to shoulder the burden of fixing the issue.

How to be an advocate as a medical resident

As an individual, it can be difficult to change an entire organization, especially one that’s entrenched in its behaviors or so hierarchical that attendings and senior staff won’t listen to someone lower on the professional ladder. However, residents can still find opportunities to speak up.

Stay suggestion-oriented vs. problem-focused

However glaring the problem seems to you, you’re more likely to gain traction with colleagues and superiors if you frame your observations as suggestions for improvement rather than criticisms. This can even help you position yourself as a more valuable asset to the organization.

Know your organizational policies

In an age of provider branding, most hospitals and health systems have explicit codes of conduct and policies that govern how staff can and should address issues. When seeking change, be mindful of those policies and understand how they might be viewed by administrators and other staff. For example, healthcare workers have been suspended recently when bringing attention to Covid-related issues via social media posts. This was because administrators decided that the posts violated organizational privacy standards for patients, according to the New York Times.

Get to know your organization

Residents report that it’s easier to present ideas when they understand the organization and know the majority of colleagues and management. Take advantage of opportunities to get to know your co-workers, supervisors and administrators so you feel as comfortable as possible when you do need to speak up.

Be prepared

When you attempt to initiate change, prepare beforehand. Gather your facts, avoid being defensive and assume the best possible outcome.

As you develop your career, it’s important to prioritize working with organizations that welcome input from all levels, are open to resident suggestions and involve residents in staff meetings and decision-making. These organizations will be more likely to support your professional growth and allow you to be a part of the change you want to see.