Mary Dixon-Woods1, Emma L Aveling2, Anne Campbell3, Akbar Ansari4, Carolyn Tarrant5, Janet Willars6, Peter Pronovost7,8, Imogen Mitchell9, David W Bates10, Christian Dankers11, James McGowan12, Graham Martin13. 1. Health Foundation Professor of Healthcare Improvement Studies, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK. 2. Research Scientist, Department of Health Policy and Management, 1857Harvard TH Chan School of Public Health, Boston, MA, USA. 3. Research Associate, 572200The NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK. 4. Research Associate, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK. 5. Professor of Health Services Research, Department of Health Sciences, 4488University of Leicester, UK. 6. Honorary Visiting Fellow, Department of Health Sciences, 4488University of Leicester, UK. 7. Chief Clinical Transformation and Chief Quality Officer, 24575University Hospitals Cleveland, OH, USA. 8. Professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Western Reserve University, Cleveland, OH, USA. 9. Executive Director, 104822Research and Academic Partnerships, Canberra Health Services and Australian National University. 10. Chief, Division of General Internal Medicine, 1861Brigham and Women's Hospital, Boston, MA, USA. 11. Associate Chief Quality Officer, Quality and Patient Experience, 1813Mass General Brigham, Boston, MA, USA. 12. Clinical Research Associate, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK. 13. Director of Research, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK.
Abstract
OBJECTIVES: Those who work in health care organisations are a potentially valuable source of information about safety concerns, yet failures of voice are persistent. We propose the concept of 'voiceable concern' and offer an empirical exploration. METHODS: We conducted a qualitative study involving 165 semi-structured interviews with a range of staff (clinical, non-clinical and at different hierarchical levels) in three hospitals in two countries. Analysis was based on the constant comparative method. RESULTS: Our analysis shows that identifying what counts as a concern, and what counts as a occasion for voice by a given individual, is not a straightforward matter of applying objective criteria. It instead often involves discretionary judgement, exercised in highly specific organisational and cultural contexts. We identified four influences that shape whether incidents, events and patterns were classified as voiceable concerns: certainty that something is wrong and is an occasion for voice; system versus conduct concerns, forgivability and normalisation. Determining what counted as a voiceable concern is not a simple function of the features of the concern; also important is whether the person who noticed the concern felt it was voiceable by them. CONCLUSIONS: Understanding how those who work in health care organisations come to recognise what counts as a voiceable concern is critical to understanding decisions and actions about speaking out. The concept of a voiceable concern may help to explain aspects of voice behaviour in organisations as well as informing interventions to improve voice.
OBJECTIVES: Those who work in health care organisations are a potentially valuable source of information about safety concerns, yet failures of voice are persistent. We propose the concept of 'voiceable concern' and offer an empirical exploration. METHODS: We conducted a qualitative study involving 165 semi-structured interviews with a range of staff (clinical, non-clinical and at different hierarchical levels) in three hospitals in two countries. Analysis was based on the constant comparative method. RESULTS: Our analysis shows that identifying what counts as a concern, and what counts as a occasion for voice by a given individual, is not a straightforward matter of applying objective criteria. It instead often involves discretionary judgement, exercised in highly specific organisational and cultural contexts. We identified four influences that shape whether incidents, events and patterns were classified as voiceable concerns: certainty that something is wrong and is an occasion for voice; system versus conduct concerns, forgivability and normalisation. Determining what counted as a voiceable concern is not a simple function of the features of the concern; also important is whether the person who noticed the concern felt it was voiceable by them. CONCLUSIONS: Understanding how those who work in health care organisations come to recognise what counts as a voiceable concern is critical to understanding decisions and actions about speaking out. The concept of a voiceable concern may help to explain aspects of voice behaviour in organisations as well as informing interventions to improve voice.
Entities:
Keywords:
Voice behaviour; hospitals; qualitative research
Authors: Frances Wu; Mary Dixon-Woods; Emma-Louise Aveling; Anne Campbell; Janet Willars; Carolyn Tarrant; David W Bates; Christian Dankers; Imogen Mitchell; Peter Pronovost; Graham P Martin Journal: Soc Sci Med Date: 2021-05-20 Impact factor: 4.634
Authors: Graham P Martin; Emma-Louise Aveling; Anne Campbell; Carolyn Tarrant; Peter J Pronovost; Imogen Mitchell; Christian Dankers; David Bates; Mary Dixon-Woods Journal: BMJ Qual Saf Date: 2018-02-19 Impact factor: 7.035