--- title: "Speaking up for safety training: the concern and the reply" description: "For hospital educators and safety leads: what Australian, US and English guidance expects of speaking up, how to design the rehearsal, and what Mater reported." canonical: https://peopletechrevolution.com/learn/speaking-up-for-safety-training --- [Learn](https://peopletechrevolution.com/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 faces two colleagues. A handover at the ward station. 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 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](https://www.safetyandquality.gov.au/clinical-topics/clinical-governance/2026-national-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](https://peopletechrevolution.com/learn/standards/nsqhs-action-1-20) training requirements. A team leader discusses escalation with a colleague. ### United States: the receiver has a role too [AHRQ’s TeamSTEPPS mutual support curriculum](https://www.ahrq.gov/teamstepps-program/curriculum/mutual/teach/two-day.html) 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 corridor. ### England: a concern and an emergency are different routes [NHS England’s national speak-up policy](https://www.england.nhs.uk/publication/the-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, 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](https://peopletechrevolution.com/uploads/docs/people-tech-revolution-mater-immersive-learning-pilot-case-study.pdf), 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](https://peopletechrevolution.com/uploads/docs/people-tech-revolution-mater-immersive-learning-pilot-case-study.pdf) 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](https://peopletechrevolution.com/work/case-studies/mater-speaking-with-good-judgement). Designing the scenario ## Four parts of a speaking-up rehearsal Each part is something a clinical reviewer can check before staff rehearse it. 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. Practising feedback in a ward scenario. ### 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. ### 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 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](https://peopletechrevolution.com/insights/evaluate-de-escalation-training-pilot) sets the measures. How it runs ## Rehearse in the room it will happen in Staff practise in a [VR headset](https://peopletechrevolution.com/xr/virtual-reality) or with an [AI roleplay partner](https://peopletechrevolution.com/ai/ai-roleplay-practice) in a browser, then debrief with a facilitator. A ward scenario on Apple Vision Pro. Face to face with a reflection, mid-conversation. A clinical character answers inside the headset. Questions ## What hospital buyers ask first Short answers. A GP welcomes a patient across the desk. ### Is confidence enough? Confidence does not show that a concern reached someone able to act. Observe the message, the response, the escalation and the follow-through. ### Should everyone use the same words? Agree on recognisable safety language and practise it in context. The aim is a clear concern and an effective response. A palliative care nurse talks with a visitor. ### Is this whistleblowing training? It is clinical communication practice. Protected disclosures, complaints and employment concerns have their own processes. ### Can training fix speaking-up culture? Practice and feedback are one part. Leadership response, staffing and follow-through are the others, so put them in the pilot brief. - [NSQHS Action 1.20](https://peopletechrevolution.com/learn/standards/nsqhs-action-1-20) - [Mater case study](https://peopletechrevolution.com/work/case-studies/mater-speaking-with-good-judgement) - [Evidence for innovation teams](https://peopletechrevolution.com/work/innovation-teams) - [Healthcare](https://peopletechrevolution.com/work/industries/healthcare-medical) Rehearsing a safety concern? [Open the contact form](https://peopletechrevolution.com/learn/speaking-up-for-safety-training#contact) Ask our CEO Simon Lowe’s Digital Twin a question ## Sources Each rule in full, on the regulator’s own site. ### [National Model for Clinical Governance, 2026](https://www.safetyandquality.gov.au/clinical-topics/clinical-governance/2026-national-model) Australian Commission on Safety and Quality in Health Care A workforce that feels safe to raise concerns, and organisations that act on risk. ### [TeamSTEPPS: mutual support](https://www.ahrq.gov/teamstepps-program/curriculum/mutual/teach/two-day.html) Agency for Healthcare Research and Quality Assertion and escalation, and the challenged member’s duty to acknowledge. ### [The national speak up policy](https://www.england.nhs.uk/publication/the-national-speak-up-policy/) NHS England The basis for local speak-up policies and how concerns are handled. ### [Mater immersive learning pilot](https://peopletechrevolution.com/uploads/docs/people-tech-revolution-mater-immersive-learning-pilot-case-study.pdf) Mater Education program evaluation, hosted by PTR Concentration, engagement and demand for more VR training.