• Stephen Harden

Research Reveals a Shockingly Simple Tool to get Staff to Speak Up




Recent research has revealed a simple, but totally effective tool for getting your staff to speak up every single time they perceive a problem with patient care.


The research, conducted by staff at Crucial Skills, sought to find out how easy it was to teach people a socially acceptable script for speaking up, and if they would actually use the script once they learned it.


To answer these questions, a group of graduate students was asked to cut into movie theater lines. The goal was to count how many people would say something to the line cutter. When the experiment was conducted, no matter the gender, size, or demeanor of the line cutter, nobody spoke up.


The desire to avoid potential conflicts was stronger than the desire to protect one’s place in line.


Next, students were directed to cut in front of fellow students who had been secretly placed in line. The student in line was instructed to become upset and heatedly say, "Hey, quit cutting in line!" to the cutter, who would then go to the end of the line. After waiting a minute, another student would cut in front of the person standing immediately behind the student “plant” who had just chewed out the line cutter. The researchers wanted to know if the experimental subjects would be emboldened from the demonstration of speaking up they had just witnessed and now speak their minds. The answer was no. Not one person spoke up to a line cutter after watching someone else do the same.


For the third trial, line jumpers cut in front of a student who had been instructed on how to use a diplomatic script for speaking up. The student was to say, "Excuse me. Perhaps you're unaware. We've been waiting in line for over 15 minutes." The student cutter was instructed to then apologize and go to the end of the line.


During the fourth trial the question was: Would onlookers learn and use their new and diplomatic “speaking up” script? One minute after trial three, which included the positive script, students cut in front of the subject standing immediately behind the positive role model.



More than 80 percent of the people who observed the effective interaction driven by a good script, spoke up. In fact, they said the exact words they heard modeled.


Here are some simple lessons you can learn from this research about reliably getting staff to speak up:


1. Develop a diplomatic script for the speaking up language you want staff to use.

In the heat of the moment when a problem with patient care is perceived, staff do not have time to figure out what to say. Their language should be automatic; key words at key times.


2. Model the behavior and desired script in your training.

Show your staff what “effective” looks like. By using a positive role model, you can teach a social script that can be immediately put into action. This is so effective that many people can use it without even realizing they have been taught. Humans can very easily observe, learn, and put into play, the skill of using social scripts.


3. Provide multiple opportunities to practice.

Muscle memory is important and practice makes permanent.


4. Reward speaking up behavior in staff meetings, huddles, and shift changes.




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