--- title: "Speaking up when authority is in the room: what the data shows" description: "Speaking up scores lower when the risk comes from someone senior. US hospital, Safe Work Australia and WorkSafe New Zealand data, and how to measure it." canonical: https://peopletechrevolution.com/insights/speaking-up-authority-gap --- [Insights](https://peopletechrevolution.com/insights) # 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](https://linkedin.com/in/kimberlyloza), Head of Product at People Tech Revolution Published 27 September 2026 · Last updated 28 September 2026 · Version 1.0 [Connect with Kim on LinkedIn ↗](https://linkedin.com/in/kimberlyloza) 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](https://www.safeworkaustralia.gov.au/national-safe-work-month), For health, 12 to 18 October: where speaking up about risk falls away. Nurses talk in a hospital corridor. A student reaches toward a patient’s arm. 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](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/databases/hospital/2024-hospital-database-report-ptI.pdf), 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](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2021-HSOPS2-Database-Report-Part-I-508.pdf); [AHRQ 2022](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2022-hsops2-database-report.pdf); [AHRQ 2024](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/databases/hospital/2024-hospital-database-report-ptI.pdf). 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](https://www.ahrq.gov/sops/databases/hospital/index.html). Reporting ## Reporting without fear averages 78% positive In the [2024 AHRQ workplace safety items](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/databases/hospital/2024-hospital-workplace-safety-report-ptI.pdf), being able to report workplace safety concerns without fear of negative consequences averaged 78% positive across hospitals. 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 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](https://data.safeworkaustralia.gov.au/insights/key-whs-statistics-australia/latest-release)). Mental stress claims by type, 2024 Harassment and workplace bullying 33.2% Work pressure 24.2% Exposure to violence and harassment 15.7% 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](https://data.safeworkaustralia.gov.au/insights/key-whs-statistics-australia/latest-release). 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](https://data.safeworkaustralia.gov.au/sites/default/files/2025-10/National%20Dataset%20for%20Compensation%20Based%20Statistics%20detailed%20data%20file.xlsx). 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](https://peopletechrevolution.com/learn/standards/psychosocial-hazards). Return to work ## Fewer workers with a psychological injury had returned to work In the [National Return to Work Survey 2025](https://data.safeworkaustralia.gov.au/insights/return-work/national-return-work-survey), 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, 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% 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](https://data.safeworkaustralia.gov.au/insights/return-work/national-return-work-survey); [analysis report, pages 9 and 24](https://data.safeworkaustralia.gov.au/sites/default/files/2025-11/NRTW_Survey_Analysis_Report_Nov2025.pdf). 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](https://www.worksafe.govt.nz/research/a-psychosocial-survey-of-healthcare-workers/) of 1,067 healthcare workers found 33% reported bullying; its [2021 survey](https://www.worksafe.govt.nz/research/new-zealand-psychosocial-survey/) of 3,612 workers found 23%. New Zealand: bullying reported, by survey Healthcare workers, 2022 survey 33% All workers, 2021 survey 23% 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](https://www.worksafe.govt.nz/research/a-psychosocial-survey-of-healthcare-workers/); [all-worker survey](https://www.worksafe.govt.nz/research/new-zealand-psychosocial-survey/). 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 woman beside a floating reply panel. ### Training can improve speaking up: a 26-study review [Okuyama and colleagues](https://doi.org/10.1186/1472-6963-14-61) (26 studies) found hesitancy to speak up can contribute to communication errors, and training can improve speaking up behaviour. [Cook and colleagues](https://doi.org/10.1001/jama.2011.1234) (609 studies) found health professions simulation training consistently associated with large effects on knowledge, skills and behaviours. A colleague across a meeting table. ### Changing the climate is harder [O’Donovan and McAuliffe](https://doi.org/10.1186/s12913-020-4931-2) reviewed 14 interventions and found mixed results. [Jones and colleagues](https://doi.org/10.1016/j.healthpol.2020.12.016) 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. 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](https://peopletechrevolution.com/uploads/docs/people-tech-revolution-mater-immersive-learning-pilot-case-study.pdf)). These measure the experience. See the [Mater case study](https://peopletechrevolution.com/work/case-studies/mater-speaking-with-good-judgement). [Download the Mater case study PDF](https://peopletechrevolution.com/uploads/docs/people-tech-revolution-mater-immersive-learning-pilot-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. ### 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. 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](https://peopletechrevolution.com/insights/evaluate-de-escalation-training-pilot) and [workplace violence claims data](https://peopletechrevolution.com/insights/workplace-violence-claims-data). - [Speaking up for safety training](https://peopletechrevolution.com/training/speaking-up-for-safety) - [How speaking up training works](https://peopletechrevolution.com/learn/speaking-up-for-safety-training) - [Difficult conversations training](https://peopletechrevolution.com/training/difficult-conversations) - [Training for safety and wellbeing leads](https://peopletechrevolution.com/training/for-safety-and-wellbeing-leads) ## 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 Copy citation 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. ### Version history Version Date What changed Version 1.0 27 September 2026 First published. Planning what to bring to the October safety meeting? [Open the contact form](https://peopletechrevolution.com/insights/speaking-up-authority-gap#contact) Ask our CEO Simon Lowe’s Digital Twin a question ## Sources Each survey, dataset and review at its publisher. ### [SOPS Hospital Survey version 2.0: 2024 User Database Report](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/databases/hospital/2024-hospital-database-report-ptI.pdf) Agency for Healthcare Research and Quality 2024 items. ### [SOPS Hospital Survey version 2.0: 2022 User Database Report](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2022-hsops2-database-report.pdf) Agency for Healthcare Research and Quality 2022 items. ### [SOPS Hospital Survey version 2.0: 2021 User Database Report](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2021-HSOPS2-Database-Report-Part-I-508.pdf) Agency for Healthcare Research and Quality 2021 items. ### [Hospital Workplace Safety Supplemental Items, 2024](https://www.ahrq.gov/sites/default/files/wysiwyg/sops/databases/hospital/2024-hospital-workplace-safety-report-ptI.pdf) Agency for Healthcare Research and Quality Reporting without fear. ### [Key Work Health and Safety Statistics Australia 2025](https://data.safeworkaustralia.gov.au/insights/key-whs-statistics-australia/latest-release) Safe Work Australia Claim types. ### [National Return to Work Survey 2025](https://data.safeworkaustralia.gov.au/insights/return-work/national-return-work-survey) Safe Work Australia Return to work. ### [A psychosocial survey of healthcare workers](https://www.worksafe.govt.nz/research/a-psychosocial-survey-of-healthcare-workers/) WorkSafe New Zealand Healthcare workers, 2022. ### [Speaking up for patient safety by hospital-based health care professionals](https://doi.org/10.1186/1472-6963-14-61) BMC Health Services Research, 2014 A literature review. ### [Interventions promoting employee “speaking-up” within healthcare workplaces](https://doi.org/10.1016/j.healthpol.2020.12.016) Health Policy, 2021 A systematic narrative review. ### [Mater immersive learning pilot closure report](https://peopletechrevolution.com/uploads/docs/people-tech-revolution-mater-immersive-learning-pilot-case-study.pdf) Mater Education, the client’s own evaluation Experience measures.