Medical residents are experts on work “how it’s done,” as they work at the frontline of health care delivery day in day out. This means that they are valuable sources of information to improve the quality of health care. However, my colleagues’ and my research, presented in a recent Academic Medicine article, suggests that residents tend to remain silent when they have ideas for change. In short, they feel that it is not safe to speak up or that it would not make a difference. In this blog post, I offer suggestions for how to empower medical residents in your training program or organization to share their valuable experiences.
The key is to take a proactive approach to enable medical residents to speak up. Speaking up is not an easy task, even for optimistic and/or safe issues such as sharing suggestions for improvement or innovation. To speak up, it is important for employees to feel that their environment appreciates their suggestions for change and that they experience a sense of control over their environment. Do they know where to start or who to contact, for example? Health care organizations and medical educators could use these principles to lower barriers to speaking up. Creating direct lines of communication—for instance, by appointing someone who helps residents identify the first steps to implement their suggestions for change—is helpful, especially in large organizations. Additionally, sharing suggestions for change should not automatically mean that the person who speaks up is responsible for fixing the problem. In environments where this is the case (or perceived to be the case), it could mean that residents who are already struggling with their workload remain silent.
Medical residents are masters of adaptation: Driven by their professional nature, they usually conform to current standards and routines. They usually do not learn to speak up about the differences they experience between the departments or organizations in which they’ve worked. To enable residents to speak up about such differences, you can ask them about their experiences on your ward or organization as part of routine evaluations or—even better—during informal conversations over morning coffees. You might not get a full quality improvement project idea the first time you ask them, but it triggers them to think about the organizational side of health care delivery and to look at their daily work differently. Another powerful mechanism is to invite residents to (managerial) staff meetings. This way they get an overview of important organizational issues, and they are actively invited to think through issues with management. Residents are young, smart, and talented workers who have fresh ideas. Formally inviting them to such meetings could lower the barriers to speaking up, make them feel more like a part of the team, and increase their sense of responsibility.
Keeping an open attitude and mindset toward suggestions for change is key to an open, safe, and sharing learning environment. For this reason, it is important that medical educators and medical staff are aware of their attitudes toward change. It could be beneficial to set up faculty development training sessions in which educators learn basic change management skills and become reflective over their own assumptions and attitudes toward their residents and their ideas for change.
The bottom line is that speaking up and sharing suggestions for improvement is not easy and is not embedded in current medical culture. To enable residents to speak up, it is important to proactively invite them to share their suggestions and make them feel that it is safe and beneficial to do so.
By: Judith Voogt, MD, PhD
J.J. Voogt recently finished her PhD on medical leadership and speaking up by medical residents at Utrecht University, Utrecht, the Netherlands. She now works as an internal medicine resident at Diakonessenhuis Utrecht, Utrecht, the Netherlands, and as an advisor for The Council for Health and Society, The Hague, the Netherlands.
Voogt JJ, Kars MC, van Rensen ELJ, Schneider MME, Noordegraaf M, van der Schaaf MF. Why medical residents do (and don’t) speak up about organizational barriers and opportunities to improve the quality of care [published online ahead of print October 1, 2019]. Acad Med. doi: 10.1097/ACM.0000000000003014