"I feel I have no voice": hospital doctors' workplace silence in Ireland.

Jennifer Creese,Aoife M Mcdermott,Edel Conway,John-Paul Byrne,Anne Matthews,Niamh Humphries

doi:10.1108/jhom-08-2020-0353

Abstract

Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland. A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October-November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question "If you had concerns about your working conditions, would you raise them?". In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions. Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships. This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.

Highlights

This research builds on existing work on organisational voice in a healthcare context, examining the reasons why hospital doctors in Ireland are reluctant to voice their concerns about their working conditions
Silence and apathy While studies from the corporate world suggest that employees are more likely to keep silent out of fear rather than apathy (Milliken et al, 2003; Ryan and Oestreich, 1991), respondent doctors in in this study reported being more likely to remain silent about working conditions due to apathy than fear, and this was identified across all demographics of those who said they would not voice
This study has highlighted why hospital doctors may opt to remain silent about their workrelated concerns

Summary

Introduction

Organisational voice and silence are of vital importance in healthcare settings, impacting workplace staff experiences, organisational capabilities and patient safety (Dixon-Woods et al, 2019; Martin et al, 2018; Wilkinson et al, 2015). The right for health workers to express concerns about working conditions is enshrined in the Conventions of the International Labour silence in Ireland. Learning from the voices of frontline staff is key for responsive health services and competitive healthcare organisations and is important in the context of the COVID-19 pandemic where healthcare systems and organisations need to act and learn as fast as possible (Bohmer et al, 2020; Daphna-Tekoah et al, 2020). This research builds on existing work on organisational voice in a healthcare context, examining the reasons why hospital doctors in Ireland are reluctant to voice their concerns about their working conditions. Voice and silence are distinct behaviours, such that enablers of voice may not be sufficient to overcome silence (Knoll and Redman, 2016)

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