Improving Employee Voice About Transgressive or Disruptive Behavior: A Case Study.
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Authors
Campbell, Anne
Martin, Graham
Willars, Janet
Tarrant, Carolyn
Aveling, Emma-Louise
Sutcliffe, Kathleen
Clements, Janice
Carlstrom, Michelle
Pronovost, Peter
Publication Date
2019-04Journal Title
Acad Med
ISSN
1040-2446
Publisher
Ovid Technologies (Wolters Kluwer Health)
Volume
94
Issue
4
Pages
579-585
Language
eng
Type
Article
Physical Medium
Print
Metadata
Show full item recordCitation
Dixon-Woods, M., Campbell, A., Martin, G., Willars, J., Tarrant, C., Aveling, E., Sutcliffe, K., et al. (2019). Improving Employee Voice About Transgressive or Disruptive Behavior: A Case Study.. Acad Med, 94 (4), 579-585. https://doi.org/10.1097/ACM.0000000000002447
Abstract
PURPOSE: Employee voice plays an important role in organizational intelligence about patient safety hazards and other influences on quality of patient care. The authors report a case study of an academic medical center that aimed to understand barriers to voice and make improvements in identifying and responding to transgressive or disruptive behaviors. METHOD: The case study focused on an improvement effort at Johns Hopkins Medicine that sought to improve employee voice using a two-phase approach of diagnosis and intervention. Confidential interviews with 67 individuals (20 senior leaders, 47 frontline personnel) were conducted during 2014 to diagnose causes of employee reluctance to give voice about behavioral concerns. A structured intervention program to encourage voice was implemented, 2014-2016, in response to the findings. RESULTS: The diagnostic interviews identified gaps between espoused policies of encouraging employee voice and what happened in practice. A culture of fear pervaded the organization that, together with widespread perceptions of futility, inhibited personnel from speaking up about concerns. The intervention phase involved four actions: sharing the interview findings; coordinating and formalizing mechanisms for identifying and dealing with disruptive behavior; training leaders in encouraging voice; and building capacity for difficult conversations. CONCLUSIONS: The problems of giving voice are widely known across the organizational literature but are difficult to address. This case study offers an approach that includes diagnostic and intervention phases that may be helpful in remaking norms, facilitating employee voice, and improving organizational response. It highlights specific actions that are available for other organizations to adapt and test.
Keywords
Humans, Case-Control Studies, Interprofessional Relations, Workplace, Problem Behavior, Work Engagement
Sponsorship
This study was funded by Mary Dixon-Woods’ Wellcome Trust Investigator award (WT097899) and by Johns Hopkins Medicine. Graham Martin acknowledges the support of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM).
Funder references
Wellcome Trust (097899/Z/11/Z)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10026)
Identifiers
External DOI: https://doi.org/10.1097/ACM.0000000000002447
This record's URL: https://www.repository.cam.ac.uk/handle/1810/284120
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