Employee silence in health care: Charting new avenues for leadership and management

Abstract

IssueHealth care management is faced with a basic conundrum about organizational behavior; why do professionals who are highly dedicated to their work choose to remain silent on critical issues that they recognize as being professionally and organizationally significant? Speaking-up interventions in health care achieve disappointing outcomes because of a professional and organizational culture that is not supportive.Critical Theoretical AnalysisOur understanding of the different types of employee silence is in its infancy, and more ethnographic and qualitative work is needed to reveal the complex nature of silence in health care. We use the sensemaking theory to elucidate how the difficulties to overcoming silence in health care are interwoven in health care culture.Insight/AdvanceThe relationship between withholding information and patient safety is complex, highlighting the need for differentiated conceptualizations of silence in health care. We present three Critical Challenge points to advance our understanding of silence and its roots by (1) challenging the predominance of psychological safety, (2) explaining how we operationalize sensemaking, and (3) transforming the role of clinical leaders as sensemakers who can recognize and reshape employee silence. These challenges also point to how employee silence can also result in a form of dysfunctional professionalism that supports maladaptive health care structures in practice.Practice ImplicationsDelineating the contextual factors that prompt employee silence and encourage speaking up among health care workers is crucial to addressing this issue in health care organizations. For clinical leaders, the challenge is to valorize behaviors that enhance adaptive and deep psychological safety among teams and within professions while modeling the sharing of information that leads to improvements in patient safety and quality of care.

Understanding peer support: a qualitative interview study of doctors one year after seeking support

“…In the interviews, explicit statements were made indicating that speaking up at work entails taking a personal risk and that some of the interviewees did not know where else to turn for help with their work-related problems. This finding is in line with the conclusions of recent research suggesting that health care leadership must discover ways of increasing voice and decreasing silence among health care professionals [ 60 ]. Such an approach is likely to improve health workers physical and mental well-being.…”

“…Some researchers argue that psychological safety of employees, such as valued feed-back and openly admitting to mistakes, is not part of the organizational tradition in the field of health care [ 44 , 60 ]. To create psychological safety, Schein suggests several activities that can be implemented including a focused dialogue with the goal of helping participants to relax sufficiently to examine their own assumptions and to be able to consider other assumptions as equally valid or true.…”

Evaluation of the reboot coaching workshops among urology trainees: A mixed method approach

“…Raising awareness of burnout can be essential for reducing the urge to suffer in silence, as it is typical for healthcare workers to remain silent regarding medical-related errors. 34 However, the present study had several limitations. First, it only measured the short-term effects of Reboot-C, and there is a need for more research that measures the long-term effects.…”

“…Yet, Reboot‐C is the first prophylactic intervention to be tested in urology trainees. Raising awareness of burnout can be essential for reducing the urge to suffer in silence, as it is typical for healthcare workers to remain silent regarding medical‐related errors 34 …”

Voice is not enough

“…However, there has not been comparable attention to ensuring employee voice is translated into organizational change. The absence of a holistic understanding of how voiced ideas result (or do not result) in implementation provides insight into why voice may not produce the intended benefits (Montgomery et al, 2023) and why health care innovation persistently lags (Nembhard et al, 2009). We address this considerable gap by integrating disparate strands of organizational research into a model that illuminates the recursive processes through which voiced ideas reach implementation, even when initially rejected.…”