Introduction: All healthcare workers are responsible for patient safety and quality improvement and need to “speak up” to communicate issues. As healthcare systems strain under the impact of reduced staffing and workloads increase, allied health new graduates are feeling under pressure and unsupported. Understanding their experiences of speaking up as they transition into the workforce will identify what support they require to fulfil their patient safety and quality improvement responsibilities. Method: An exploratory study was conducted to investigate how new graduates in allied health speak up. Informed by a realist theoretical position, this study was interested in what contexts and resources support new graduates to speak up or not. Two different focus groups with allied health new graduates were used to collect data. Reflexive thematic analysis was employed to draw out key themes and sub-themes. Results: Three main themes were generated –advocacy drives speaking up, scaffolding, and transition impact. Further analysis identified context-mechanism-outcome configurations which were then developed into an initial programme theory. Conclusion: Further in-depth exploration of speaking up behaviour with allied health new graduates will inform leaders within education and workplace settings about ways to develop confident and competent professionals who can speak up for patient safety and quality improvement.

Author Bio(s)

Philippa Friary, BSLTHons and speech-language therapist, is the Director of Clinical Education for the Speech Science programme at The University of Auckland, New Zealand and currently completing her PhD.

Suzanne Purdy (Te Rarawa, NgāiTakoto), Prof and Audiologist, is currently Head of School of Psychology. Previously (2003-2018) she was Head of Speech Science in the School of Psychology, Auckland, New Zealand.

Lindy McAllister is Emeritus Professor of Work Integrated Learning in the Work Integrated Learning (WIL) Unit of the Faculty of Health Sciences, University of Sydney, Australia.

Mark Barrow, Assoc Prof, was appointed as Dean of the Faculty of Education and Social Work in 2018, University of Auckland, New Zealand.

Rachelle Martin, Dr, Physiotherapist, works as a Lecturer with the Rehabilitation Teaching and Research Unit (RTRU) in the Department of Medicine at the University of Otago, Wellington, New Zealand.


We wish to thank all participants who have offered their time and thoughts to this study.

Friary et al title page.docx (18 kB)
Title page



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