An employee wearing a headset stands facing a simulated senior stakeholder seated at a boardroom table, leaning back.

Speaking up when authority is in the room: what the data shows

In the 2024 AHRQ hospital survey database, speaking up about risks to care averaged 84% positive, and 74% when the risk comes from someone with more authority, a gap held since 2021.

By Kim Loza, Head of Product at People Tech Revolution

Published 27 September 2026 Last updated 28 September 2026 Version 1.0

Connect with Kim on LinkedIn Cite this research

National Safe Work Month, week 2

Week 2 asks what work health and safety protects

For Week 2 of National Safe Work Month, For health, 12 to 18 October: where speaking up about risk falls away.

A simulated hospital corridor seen through the headset, nurses ahead and a floating panel of replies at the right. — Nurses talk in a hospital corridor.

A student wearing a headset reaches carefully toward the arm of a simulated elderly patient in a ward bay. — A student reaches toward a patient’s arm.

A pharmacist stands at the medication room bench. A first person VR training scenario for healthcare, seen through the headset. — A pharmacist at the medication bench.

United States

Speaking up scores 84% for risks to care, 74% when the risk is senior

In the 2024 AHRQ hospital database, speaking up about risks to patient care (C4) averaged 84% positive across hospitals; speaking up when someone with more authority does something unsafe (C5), 74%.

US hospitals: speaking up items, 2021 to 2024

Speak up about risks to care (C4)Speak up when someone with more authority is unsafe (C5)Those with more authority are open to concerns (C6)Not afraid to ask questions (C7)

See the data (average percent positive)

	2021	2022	2024
Speak up about risks to care (C4)	83	83	84
Speak up when someone with more authority is unsafe (C5)	72	73	74
Those with more authority are open to concerns (C6)	75	75	77
Not afraid to ask questions (C7)	71	72	72

Average across hospitals; different hospitals each year; C7 is reverse worded. Source: AHRQ 2021; AHRQ 2022; AHRQ 2024.

Inside the simulation: executives sit at the far end of a boardroom table facing the viewer, a panel of replies floating nearby. — Executives across a boardroom table.

The gap held at 10 or 11 points

C4 minus C5 was 11 points for 2021 and 10 for 2022 and 2024. The 2024 database held 445 hospitals and 284,036 respondents, voluntarily submitted and not representative of all US hospitals.

Reporting

Reporting without fear averages 78% positive

In the 2024 AHRQ workplace safety items, being able to report workplace safety concerns without fear of negative consequences averaged 78% positive across hospitals.

An officer wearing a headset sits opposite a simulated adult speaking quietly with eyes down, in a plain interview room, practising a sensitive disclosure conversation. — An officer across from a quiet man.

Encouragement to report averages 86%

A supervisor, manager or clinical leader encouraging staff to report workplace safety concerns averaged 86% positive.

A manager wearing a headset sits opposite a simulated employee who is speaking carefully, hands together, rehearsing a sensitive workplace concern in a private meeting room. — A manager listens to an employee.

The other 22% includes neutral answers

Percent positive counts agreement; the rest mixes disagreement and neutral answers. Track the item yearly in your own units.

Australia

Bullying and harassment lead psychological claims

Mental stress caused 16,800 serious claims in the year to June 2024 (preliminary), 11.5% of the total (Key WHS Statistics 2025).

Mental stress claims by type, 2024

Harassment and workplace bullying33.2%

Work pressure24.2%

Exposure to violence and harassment15.7%

See the data (share of mental stress claims)

Measure	Share of mental stress claims
Harassment and workplace bullying	33.2%
Work pressure	24.2%
Exposure to violence and harassment	15.7%

Share of mental stress serious claims, year to June 2024 (preliminary). Types record what caused a claim, not whether anyone spoke up. Source: Safe Work Australia.

Australian mental stress claims, 2015 to 2024

Mental stress, all types

See the data (serious claims)

	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024p
Mental stress, all types	6,261	6,391	7,144	8,078	10,143	10,781	11,816	11,785	14,617	16,839

Years to June; p is preliminary; serious claims have a working week or more off. Source: Safe Work Australia NDS, claims by mechanism.

A crew member wearing a headset stands behind seated simulated colleagues, a woman smiling and a man looking away. — A colleague smiles, another looks away.

Bullying sits ahead of work pressure

Harassment and workplace bullying is the recorded cause of more mental stress claims than work pressure. See psychosocial hazards at work.

Return to work

Fewer workers with a psychological injury had returned to work

In the National Return to Work Survey 2025, 76.5% of workers with a psychological injury had returned to work, against 90.2% with a physical injury.

Psychological against physical injury, 2025

Returned to work, psychological76.5%

Returned to work, physical90.2%

Felt supervisor thought they were exaggerating or faking, psychological64.5%

Felt supervisor thought they were exaggerating or faking, physical23.1%

Employer offered return to work education or training, psychological7.7%

Employer offered return to work education or training, physical17.4%

See the data (percent of injured workers)

Measure	Percent of injured workers
Returned to work, psychological	76.5%
Returned to work, physical	90.2%
Felt supervisor thought they were exaggerating or faking, psychological	64.5%
Felt supervisor thought they were exaggerating or faking, physical	23.1%
Employer offered return to work education or training, psychological	7.7%
Employer offered return to work education or training, physical	17.4%

Source: Safe Work Australia; analysis report, pages 9 and 24.

An adult wearing a headset stands in the middle of an open-plan office, looking around, rehearsing a return-to-work moment while simulated colleagues work nearby. — A worker walks back into the office.

64.5% felt their supervisor thought they were exaggerating or faking

Workers with a psychological injury, recalling when they considered a claim, against 23.1% with a physical injury.

New Zealand

33% of healthcare workers report bullying

WorkSafe New Zealand’s 2022 survey of 1,067 healthcare workers found 33% reported bullying; its 2021 survey of 3,612 workers found 23%.

New Zealand: bullying reported, by survey

Healthcare workers, 2022 survey33%

All workers, 2021 survey23%

See the data (percent reporting)

Measure	Percent reporting
Healthcare workers, 2022 survey	33%
All workers, 2021 survey	23%

Separate surveys of different groups. Source: WorkSafe New Zealand; all-worker survey.

A palliative care nurse talks with a visitor. A VR training scenario for healthcare. — A nurse talks with a visitor.

Separate surveys, a year apart

The comparison shows where bullying is reported more, not a trend.

Research

Training can improve speaking up, a 26-study review finds; changing the climate is harder

Reviews report mixed or inconclusive results for speaking up interventions.

A mentor teacher meets a junior colleague. A first person VR training scenario for education, seen through the headset. — A woman beside a floating reply panel.

Training can improve speaking up: a 26-study review

Okuyama and colleagues (26 studies) found hesitancy to speak up can contribute to communication errors, and training can improve speaking up behaviour. Cook and colleagues (609 studies) found health professions simulation training consistently associated with large effects on knowledge, skills and behaviours.

Colleagues talk across a meeting room table, a panel of replies between them, seen through the headset. — A colleague across a meeting table.

Changing the climate is harder

O’Donovan and McAuliffe reviewed 14 interventions and found mixed results. Jones and colleagues reviewed 34 studies, most inconclusive, and called a climate that supports speaking up immensely challenging to create.

Mater

What Mater measured

In the client’s own evaluation of Speaking with Good Judgement in VR, more than 60 participants took part at Mater’s regional and Brisbane campuses.

An older woman wearing a VR headset stands face to face with a nurse in Mater scrubs, hands raised, in a simulated hospital room. — A nurse and an older woman raise hands.

Experience measures

Over 96% wanted more training delivered in VR, 90% reported higher concentration and 77% found the scenarios more engaging than face to face delivery (closure report). These measure the experience. See the Mater case study.

Download the Mater case study PDF

Measure

How do you measure the gap before and after?

Run the same survey items before and after training, C4, C5, C6, C7 and reporting without fear, in the same units.

A team leader gives a colleague feedback. A VR training scenario for cross-sector. — A team leader gives a colleague feedback.

Count improvement in the scores, not the gap

Improvement means the C4 and C5 scores themselves rise. A smaller gap alone shows no improvement or training effect: it can come from C4 falling.

Colleagues talk in a staff meeting room, seen through the headset, a floating panel of replies between them. — A woman answers across a meeting table.

Agree the evaluation before the pilot

Set the items, units and dates before a pilot starts. See evaluating a practice pilot and workplace violence claims data.

Cite this research

Free to quote and cite with a link to this page. Name the version you read, so readers can see what has changed since.

APA 7

Loza, K. (2026, September 27). Speaking up when authority is in the room: what the data shows (Version 1.0). People Tech Revolution. https://peopletechrevolution.com/insights/speaking-up-authority-gap

Data: AHRQ SOPS Hospital Survey version 2.0 database reports 2021, 2022 and 2024, and 2024 workplace safety items; Safe Work Australia Key WHS Statistics 2025, National Dataset detailed data file (1 October 2025) and National Return to Work Survey 2025; WorkSafe New Zealand. Read 26 September 2026. Limits: AHRQ figures average hospital scores from voluntary, nonrepresentative data; serious claims have a working week or more off; mental stress types record what caused a claim, not whether anyone spoke up.