Beyond the individual: a qualitative case study into the systemic determinants of speaking-up behaviour in multidisciplinary team meetings

BMJ Open Quality, vol. 14, pp. e003335

Abstract

BACKGROUND: Healthcare workers (HCWs) voicing their views (speaking up) is crucial for patient safety and care quality. Yet, this is underused, especially during multidisciplinary team meetings (MDTMs), where diverse professionals collaborate to optimise patient treatment plans. Despite the benefits of open communication, HCWs face barriers such as hierarchical dynamics, time constraints and psychological risks. AIM: This study examines factors influencing HCWs' speaking-up behaviours in MDTMs, focusing on motivators, barriers and dynamics across disciplines. METHOD: We conducted 21 semistructured interviews with MDTM participants of a gastrointestinal surgery ward, including surgeons, residents, nurses, nursing students, dieticians, ostomy nurses and physical therapists. Data were analysed collaboratively using thematic analysis. RESULTS: Participants are highly motivated to advocate for patients and provide optimal care. However, barriers impact speaking up during MDTMs. Three major themes were identified: (1) time pressure, (2) perception of goals and roles and (3) familiarity among team members. Structural, relational and contextual factors affect HCWs' ability to speak up, with nurses and paramedics experiencing more hesitancy than physicians. Lack of preparation time, ambiguous objectives, no formal agenda and unfamiliarity among team members hinder contributions, leading to unbalanced input. CONCLUSION: Findings support a systems-based approach to addressing barriers. Interventions should focus on clear goals, reduced time pressures and enhanced team cohesion, rather than placing the responsibility solely on individuals. For instance, adjusting meeting schedules to accommodate diverse availability improves participation across disciplines. Strengthening familiarity among team members fosters trust and lowers the perceived risks of speaking up, ensuring more balanced contributions during MDTMs.

Authors 6

1. Dimmy van Dongen

   Delft University of Technology

   Affiliation as printed

   Delft University of Technology, Delft, The Netherlands

   Delft University of Technology, Delft, The Netherlands d.m.g.vandongen@tudelft.nl

2. Jaco Tresfon Aachen Quality and Patient Safety

   Leiden University Medical Center · Delft University of Technology

   Affiliation as printed

   Delft University of Technology, Delft, The Netherlands

   Quality and Patient Safety, Leiden University Medical Center, Leiden, The Netherlands

3. Frank W. Guldenmund

   Delft University of Technology

   Affiliation as printed

   Delft University of Technology, Delft, The Netherlands

4. Daphne Roos

   Reinier de Graaf Hospital · Delft University of Technology

   Affiliation as printed

   Reinier de Graaf Gasthuis, Delft, The Netherlands

   Institute for Health Systems Science, Delft University of Technology, Delft, The Netherlands

5. Jop Groeneweg

   Reinier de Graaf Hospital · Delft University of Technology

   Affiliation as printed

   Delft University of Technology, Delft, The Netherlands

   Reinier de Graaf Gasthuis, Delft, The Netherlands

6. I Grossmann

   Delft University of Technology

   Affiliation as printed

   Institute for Health Systems Science, Delft University of Technology, Delft, The Netherlands

   Delft University of Technology, Delft, The Netherlands