A Realist Informed Study on Speaking up in Healthcare – Supervisors’ Perceptions of New Graduates Speaking Up

Introduction: For healthcare organizations to adapt and improve, staff need to speak up for patient safety and quality improvement. Speaking up has been explored in nursing and medicine with little known about speaking up in allied health. This study is part of a larger project investigating speaking up in allied health new graduates. This paper is taking a realist position to look at the perspectives of supervisors of allied health new graduates and further develop the Initial Program Theory (IPT) developed from the new graduate study. Method: Data was collected from two focus groups. Inductive thematic analysis was employed to develop themes and further realist informed analysis was completed using context-mechanism-outcome configurations leading to a refined IPT. FINDINGS: This study reports on the causal mechanisms and contextual features which supervisors believe activate speaking up in new graduates. A further developed IPT which combines findings from both studies will be introduced. CONCLUSION: Supervisors of allied health new graduates are aware of the complexity of speaking up in healthcare. Taking a realist position, this study has highlighted the importance of professional supervision and cultural supervision in speaking up for allied health new graduates.