Speaking Up for Safety: The Non-Technical Skill That Saves Lives

Non-technical skills have become an increasingly important focus of patient safety efforts worldwide.

Non-technical skills are the interpersonal, communication, cognitive, and leadership skills that enable healthcare professionals to work effectively as part of a team. While clinical competencies remain essential, the ability to communicate concerns, collaborate with colleagues, and make sound decisions under pressure can be equally critical to keeping patients safe.

More Than a Soft Skill

Among all non-technical skills, speaking up for safety is emerging as one of the most powerful. Speaking up means:

Raising concerns when something does not seem right

Questioning decisions that may place patients at risk

Challenging unsafe practices respectfully

Escalating issues when immediate action is needed

Sharing observations that could prevent harm

Although these actions may appear straightforward, they can be difficult in healthcare environments where hierarchy, workload pressures, or fear of negative consequences discourage open communication. Patient and workforce safety culture is shaped not only by policies, but by daily interactions between staff, teams and managers, including how concerns, near misses and safety events are reported and responded to (Murray et al., 2024).

Creating the Conditions for Staff to Speak Up

The ability to speak up is closely linked to psychological safety, a concept that has gained significant attention in healthcare over the past decade. Psychological safety exists when team members feel comfortable asking questions, admitting mistakes, offering ideas, and raising concerns without fear of blame, embarrassment, or punishment (Clinical Excellence Commission, 2026)

Research shows that psychologically safe teams are more likely to identify risks early, learn from incidents, and work together to solve problems. Simply encouraging staff to speak up is not enough. Organisations must also create cultures where concerns are genuinely welcomed, listened to, and acted upon (Bahadurzada, et al., 2024).

This places an important responsibility on leaders. Whether formal or informal, leaders influence how safe people feel when raising concerns. Teams are more likely to speak up when leaders demonstrate curiosity, actively seek feedback, respond respectfully, and view mistakes as opportunities for learning rather than occasions for blame (Clinical Excellence Commission, 2026).

A Global Focus on Safety Culture

Around the world, patient safety organisations are increasingly recognising that safer care depends on more than technical expertise. The World Health Organization's Global Patient Safety Action Plan 2021-2030 highlights safety culture, workforce capability, and human factors as essential elements in reducing avoidable harm.

Encouragingly, progress is being made. The WHO reported in 2025 that more than 100 countries have advanced patient safety policies, strengthened reporting and learning systems, improved workforce capability, and increased patient engagement in safety initiatives

However, important gaps remain:

Only around one-third of countries have dedicated national patient safety programmes or action plans.

Just 25% are actively fostering a safety culture.

Only 23% have adopted human factors approaches to safety improvement.

Patient safety education is integrated into healthcare curricula in only 20% of countries.

As healthcare becomes more complex, non-technical skills are no longer viewed as secondary to clinical expertise. Communication, teamwork, leadership, situational awareness, and speaking up are now recognised as core patient safety competencies. By building cultures where every voice is heard and every concern is taken seriously, healthcare organisations can move closer to a future where avoidable harm is significantly reduced and safer care becomes the norm.

Reference List

Bahadurzada S, Doyle K, Tarrant C, et al. Psychological Safety in Healthcare: A Systematic Review. Healthcare. (2022). https://www.mdpi.com/2227-9032/12/8/812

Clinical Excellence Commission. Psychological Safety. NSW Clinical Excellence Commission. (2026). https://cec.health.nsw.gov.au/improving-practice-and-culture/for-teams/psychological-safety .

Murray J, Sorra J, Gale B, Mossburg S. Ensuring Patient and Workforce Safety Culture in Healthcare. AHRQ PSNet. (2024). https://psnet.ahrq.gov/perspective/ensuring-patient-and-workforce-safety-culture-healthcare .

World Health Organization. Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. World Health Organization. (2021). https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan .

World Health Organization. Progress on Patient Safety Across Health Systems Around the World. World Health Organization. (2025). https://www.who.int/news/item/23-05-2025-progress-on-patient-safety-across-health-systems-around-the-world .