A nurse in blue scrubs wearing a headset raises her hands mid-sentence in a hospital corridor with arched doorways, an older woman in a floral dress smiling beside her.

Learn / Speaking up for safety

Speaking up for safety training: rehearse the concern and the response

A concern only protects a patient if someone hears it and acts. Practise both sides of that conversation.

The moment

A concern needs somewhere to go

A junior nurse notices a risk. A registrar is busy. A consultant is senior. Speaking-up practice works when it tests what happens next: whether the receiver understands, responds and arranges action, and whether the speaker escalates if the concern stays unresolved.

A nurse leader wearing a headset stands in a ward corridor facing two simulated colleagues, one of whom has looked away. — A nurse leader faces two colleagues.

Nurses discuss a handover at a ward station, a headset on the nearer nurse, a corridor behind them. — A handover at the ward station.

A charge nurse in green scrubs briefs nurses at a ward station, a headset visible among them. — A charge nurse briefs nurses at the ward station.

The rules

Three health systems, one expectation

Australia, the United States and England each expect staff to raise a concern and the organisation to act on it.

A clinician wearing a headset stands at a hospital bedside facing a simulated patient propped up on pillows, practising the bedside conversation in a ward that looks like the ward. — A clinician at the bedside, in a ward that looks like the ward.

Australia: communication and governance together

For acute public and private hospitals, the national clinical governance model describes a workforce that feels safe to raise concerns, and organisations that act on risk. It names dismissed warning signs and weak escalation culture as problems. Buyers can assess how a proposed program supports their NSQHS Action 1.20 training requirements.

A team leader discusses escalation with a colleague. A VR training scenario for cross-sector. — A team leader discusses escalation with a colleague.

United States: the receiver has a role too

AHRQ’s TeamSTEPPS mutual support curriculum teaches assertion and escalation, and says the team member being challenged must acknowledge it. So a good scenario gives the receiver a part to rehearse, as well as the person speaking up.

A consultant speaks with a family member in a hospital corridor, one of them wearing a headset. — A consultant speaks with a family member in a corridor.

England: a concern and an emergency are different routes

NHS England’s national speak-up policy is the basis for local policies and explains how concerns are handled. An urgent clinical risk still follows immediate escalation. Scenarios use the local policy and the local escalation procedure.

The evidence

What happened when a hospital rehearsed it

Mater Education rebuilt its Speaking with Good Judgement program in VR. These figures come from Mater’s own program evaluation.

Inside the Mater build: an older patient sits up in a hospital bed, a meal tray across the blanket, curtains drawn beside him. — Inside the Mater build, at a hospital bedside.

Client evaluation: Mater Education

The pilot ran at Mater’s regional and Brisbane campuses with more than 60 staff. In Mater’s closure report, 90% of participants reported better concentration, 77% found the scenarios more engaging than face-to-face delivery, and over 96% wanted more training in VR.

Download the Mater case study PDF

An older woman wearing a VR headset stands face to face with a nurse in Mater scrubs, both with their hands raised, in a simulated hospital room. — A participant faces a nurse in Mater scrubs in a simulated room.

Read the full case

How the scenarios were written, who rehearsed them and what Mater plans next: the Mater case study.

Designing the scenario

Four parts of a speaking-up rehearsal

Each part is something a clinical reviewer can check before staff rehearse it.

A hospital tea room, two colleagues talking across a table. — Two colleagues talk across a tea-room table.

Make the risk specific

Define what the learner can observe, what is still uncertain, what delay would cost, and who has authority to act. Use a fictional or de-identified case, and have a clinical reviewer check the escalation fits the learner’s role.

Practise the receiving role

The receiver acknowledges the concern, clarifies the risk, states the action and confirms who owns it. Add a competing demand, and watch whether the team leaves with the same picture of what happens next.

Two clinical staff face each other in a corridor, one wearing a headset. — Two clinical staff face each other in a corridor.

Rehearse the unresolved concern

Let the first response leave a real concern open. The learner uses the local escalation pathway, and the receiver explains their decision. The debrief looks for the point where the pathway became unclear.

A nurse educator briefs a nursing student in a simulation laboratory, one of them wearing a headset. — A nurse educator briefs a student before the scenario.

Evaluate the system, not only the learner

Record whether staff know the route, whether receivers act, and whether the person who spoke up hears back. Keep simulated performance separate from later safety outcomes. The pilot evaluation guide sets the measures.

How it runs