Workplace bullying, speak-up climate and perceived patient safety compromise among radiographers practising in the United Kingdom

IntroductionWorkplace bullying and harassment (WBH) may undermine speak-up climate, suppress organisational voice, and negatively affect patient safety. However, quantitative evidence examining these relationships within radiography practice remains limited. This study aimed to examine associations among WBH exposure, speak-up climate, and perceived compromise of patient safety among UK radiographers.MethodsA UK-wide cross-sectional survey of 385 HCPC-registered radiographers, recruited via non-probability sampling, was conducted using an online questionnaire that incorporated the Negative Acts Questionnaire–Revised (NAQ-R), patient safety impact items, and speak-up climate indicators. Composite Safety Impact and Speak-Up Climate scores were constructed. Internal consistency was assessed using Cronbach's alpha. Associations were evaluated using Spearman correlations with Benjamini-Hochberg false discovery rate correction. Multivariable linear regression models with HC3-robust standard errors were used to assess adjusted associations. Exploratory mediation analyses using 5,000 bootstrap samples examined the indirect association involving Speak-Up Climate. Optional free-text responses were analysed using inductive qualitative content analysis.ResultsGreater WBH exposure was associated with poorer Speak-Up Climate (rho = 0.51, q < 0.001) and greater perceived compromise in patient safety (rho = 0.17, q = 0.003). In covariate-adjusted models, the NAQ-R mean score was associated with poorer Speak-Up Climate (N = 369; B = 0.688, 95% CI 0.550–0.825, p < 0.001; R2 = 0.250, adjusted R2 = 0.231) and greater perceived Safety Impact (N = 358; B = 0.316, 95% CI 0.179–0.453, p < 0.001; R2 = 0.118, adjusted R2 = 0.096). When Speak-Up Climate was added to the Safety Impact model, the adjusted NAQ-R association was attenuated and no longer statistically significant (N = 357; B = 0.052, 95% CI −0.095–0.199, p = 0.488). By contrast, poorer Speak-Up Climate remained associated with greater perceived Safety Impact (B = 0.378, 95% CI 0.255–0.501, p < 0.001; model R2 = 0.230, adjusted R2 = 0.208). An exploratory 5,000-resample bootstrap analysis identified an indirect association via Speak-Up Climate (B = 0.264, 95% bootstrap CI 0.169–0.373). Complete-case sensitivity analyses produced materially unchanged estimates. Qualitative findings included the following categories: organisational silence and psychological unsafety, leadership and organisational accountability and building psychologically safe workplace culturesConclusionSpeak-Up Climate statistically accounted for part of the observed cross-sectional association between WBH exposure and perceived compromise of patient safety. Longitudinal research is required to evaluate temporal or causal relationships.Implications for practicePsychologically safe reporting environments and anti-retaliation cultures are plausible organisational priorities that warrant prospective evaluation.