How power, expertise, and hierarchy influence voice on patient safety: a study of surgeons and anaesthesiologists

Abstract

This paper adds a novel perspective to employee voice literature by thematically analysing 36 in-depth interviews of surgeons and anaesthesiologists, who work together but in the context of a blurred hierarchy. We found that these two professions effectively leveraged expertise in speaking up on safety concerns relating to their own speciality, when speaking to each other, irrespective of hierarchy. Further, as interdependent roles make cross speciality voice vital for patient safety, they also spoke up on occasions to negotiate risk and safety concerns across speciality. However, power struggles and protection of speciality authority predisposed each professional group to undervaluing the contribution of the other and often attributing self-interest and opportunistic motives to those speaking up. This led to each group resisting influence making silence a commonplace on cross speciality safety concerns. These contexts present an intriguing environment for voice behaviour which requires research and management attention.