Errors in clinical procedures, hygiene violations, and Qingyangshengenin-B communication errors with ����a now-or-never timeframe���� do, however, occur frequently in the presence of patients or relatives. HCPs are then faced with the difficult maneuver to correct fallibilities and prevent harm without undermining the patient relationship. We suggest that leaders provide guidance, in particular for younger and less experienced staff when and how to speak up under such conditions. The use of gestures and ����stop-words���� may be useful to intervene safely but more Ginkgolide-B research is clearly needed to explore effective approaches. The repeat occurrence of a rule violation affected speaking up likelihood in the medication double check frame, but not in the lumbar puncture vignettes. With all else being equal, respondents were more likely to withhold voice when they had been instructed that the violation of the double check had been observed and discussed before. Obviously, respondents ����learned the lesson���� that speaking up would be ineffective and not worth the efforts fast. The adaption to rule violating behavior and the ����normalization of deviance���� have been identified as genuine risks to patient safety. Amalberti describes how deviances from safety rules occur, stabilize, and become routine if they are not actively managed by healthcare organizations. Our study suggests that HCPs forecast their speaking up behaviors�� adaption to resistant rule violations and that these processes may spread to a ����culture of silence���� in the long-term. Our study has some weaknesses. The main limitation is that we did not observe speaking up but asked subjects to report their anticipated behaviors. Thus, our speaking up estimates are likely to be subject to hypotheticality and social desirability bias. Previous research into clinical decision making shows, that judgments made in response to vignettes are often similar to those made with actual patients. To the contrary, actual speaking up decisions are likely to be affected by factors we could not simulate in our vignette approach.