Understanding authority gradient: tips for speaking up for patient safety (and how to enhance the listening response)

Abstract

Up to one‐third of healthcare personnel still have concerns about speaking up when they notice potential errors. Cultivation of a shallow authority gradient encourages trainees to clarify instructions, challenge decisions and voice concerns, thereby reducing ambiguity and potential errors. Senior doctors should support junior team members who raise concerns by encouraging a working environment that is effective and safe. Aviation, rail and maritime industries recognise that steep authority gradients can lead to reluctance to escalate, resulting in near misses and fatalities.