An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

Abstract

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016–2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

Understanding Employee Voice Behavior Through the Use of Digital Voice Channel in Long-Term Care: Protocol for an Embedded Multiple-Case Study

“…The current literature shows that employee voice has a positive impact on reducing burnout, promoting job satisfaction [16], and managing change [11,17]. It is important to note that most of the available data on employee voice in health care focuses on 1 aspect of employee voice, namely speaking up regarding patient safety and managing errors [34][35][36]. This leads to an unclear understanding of the phenomenon of employee voice in health care [36].…”

“…It is important to note that most of the available data on employee voice in health care focuses on 1 aspect of employee voice, namely speaking up regarding patient safety and managing errors [34][35][36]. This leads to an unclear understanding of the phenomenon of employee voice in health care [36]. Lainidi et al [36] argue that individual approaches and evaluations are needed to gain a deeper understanding of employee voice, especially in different settings.…”

“…The existing literature on the use of voice in health care focuses on the use of voice in the context of patient safety and error reporting. In summary, the current review by Lainidi et al [36] points to the lack of a comprehensive theory of employee well-being and communication in the health care sector, which leads to heterogeneous mechanisms and an unclear understanding of the phenomenon of employee voice in health care. Lainidi et al [36] argue that understanding the concepts of voice and silence from both organizational and employee perspectives is crucial, as is the need for different solutions for different contexts.…”

“…In summary, the current review by Lainidi et al [36] points to the lack of a comprehensive theory of employee well-being and communication in the health care sector, which leads to heterogeneous mechanisms and an unclear understanding of the phenomenon of employee voice in health care. Lainidi et al [36] argue that understanding the concepts of voice and silence from both organizational and employee perspectives is crucial, as is the need for different solutions for different contexts. This means that individual approaches and evaluations are needed to gain a deeper understanding of employee voice, especially in the long-term care sector.…”

Why Talking Is Not Cheap: Adverse Events and Informal Communication

“…Congruently, the need to gossip exists because many aspects are not discussed formally. The ubiquity of silence in healthcare sectors [ 86 , 87 ] suggests that there is a significant amount of information that never reaches the formal channels of communication. In times of crisis, informal conversations among trusted staff members are often related to “what is going wrong”; these conversations are a form of group-level sensemaking.…”