Why is it so hard for doctors to speak up when they see an error occurring?

The ability of doctors to `speak up? when a medical error occurs is a cornerstone of patient safety. Hand hygiene (HH) is one of the simplest methods of reducing patient harm and represents a behavioural model in which to observe medical staff interaction. Our hypothesis is that the hierarchical structure amongst doctors prevents them from speaking up, which in turn contributes to poor HH compliance.