Table 3.
Results of multilevel logistic regression analysis with frequent speak up (SUS) and frequent withholding voice (WVS) as outcomes
| Variable | Frequent speaking up* | Frequent withholding voice* | ||
| OR (95% CI) | P values | OR (95% CI) | P values | |
| Individual level variables | ||||
| Frequency of perceived concerns (quantiles) | 2.733 (2.367 to 3.155) | <0.001 | 1.586 (1.399 to 1.798) | <0.001 |
| Psychological Safety (PSS) | 0.784 (0.634 to 0.969) | 0.024 | 0.839 (0.685 to 1.029) | 0.091 |
| Encouraging environment (EES) | 1.253 (1.071 to 1.466) | 0.005 | 0.816 (0.705 to 0.945) | 0.006 |
| Resignation (RES) | 1.024 (0.896 to 1.170) | 0.732 | 1.494 (1.309 to 1.705) | <0.001 |
| Female gender | 1.424 (0.871 to 2.327) | 0.159 | 0.811 (0.510 to 1.288) | 0.374 |
| Age, years | 1.003 (0.984 to 1.023) | 0.751 | 0.996 (0.978 to 1.015) | 0.699 |
| Clinical function (to base: Nurse in training) | ||||
| Nurses | 1.360 (0.852 to 2.171) | 0.198 | 0.891 (0.569 to 1.394) | 0.613 |
| Nursing experts | 3.507 (1.457 to 8.443) | 0.005 | 0.426 (0.193 to 0.943) | 0.035 |
| Head nurses | 1.941 (0.843 to 4.470) | 0.119 | 0.607 (0.280 to 1.314) | 0.205 |
| Resident doctors | 0.835 (0.409 to 1.705) | 0.621 | 0.547 (0.278 to 1.076) | 0.081 |
| Attending doctors | 0.833 (0.347 to 2.003) | 0.683 | 0.742 (0.339 to 1.624) | 0.456 |
| Senior/chief doctors | 2.214 (0.974 to 5.032) | 0.058 | 0.284 (0.131 to 0.618) | 0.002 |
| Employment in this hospital >10 years | 0.829 (0.545 to 1.261) | 0.382 | 0.683 (0.457 to 1.020) | 0.062 |
| Hospital-site level variables | ||||
| Psychological safety (PSS), hospital-site mean | 1.396 (0.500 to 3.897) | 0.524 | 1.018 (0.458 to 2.266) | 0.965 |
| Encouraging environment (EES), hospital-site mean | 0.886 (0.285 to 2.757) | 0.834 | 0.971 (0.381 to 2.474) | 0.950 |
| Resignation (RES), hospital-site mean | 1.380 (0.258 to 7.389) | 0.707 | 1.072 (0.322 to 3.575) | 0.910 |
| McKelvey and Zavoina’s R2 | 0.425 | 0.359 | ||
| Overall model p | <0.001 | <0.001 | ||
| Intraclass correlation coefficient | 0.010 | 0.001 | ||
*Positive outcome defined as frequency equal to or higher than the sample median, to base frequency below sample median.
EES, encouraging environment for speaking up scale; PSS, psychological safety for speaking up scale; RES, resignation scale; SUS, speak up scale; WVS, withholding voice scale.