What counts as a voiceable concern in decisions about speaking out in hospitals: A qualitative study.
Authors
Aveling, Emma L
Campbell, Anne
Ansari, Akbar
Willars, Janet
Pronovost, Peter
Mitchell, Imogen
Bates, David W
Dankers, Christian
McGowan, James
Martin, Graham
Publication Date
2022-04Journal Title
J Health Serv Res Policy
ISSN
1355-8196
Publisher
SAGE Publications
Volume
27
Issue
2
Pages
88-95
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Dixon-Woods, M., Aveling, E. L., Campbell, A., Ansari, A., Tarrant, C., Willars, J., Pronovost, P., et al. (2022). What counts as a voiceable concern in decisions about speaking out in hospitals: A qualitative study.. J Health Serv Res Policy, 27 (2), 88-95. https://doi.org/10.1177/13558196211043800
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.
Keywords
Original Research, Voice behaviour, qualitative research, hospitals
Sponsorship
Data collection for this study was funded by the Wellcome Trust (grant number: WT097899) and by one of the participating hospitals. Analysis and write-up was funded by the Health Foundation’s grant to THIS Institute (grant number: RG88620). The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. MDW is a National Institute for Health Research (NIHR) Senior Investigator (NF-SI-0617-10026).
Funder references
Wellcome Trust (097899/Z/11/Z)
Health Foundation (unknown)
Identifiers
10.1177_13558196211043800
External DOI: https://doi.org/10.1177/13558196211043800
This record's URL: https://www.repository.cam.ac.uk/handle/1810/335409
Rights
Licence:
https://creativecommons.org/licenses/by/4.0/
Statistics
Total file downloads (since January 2020). For more information on metrics see the
IRUS guide.
Recommended or similar items
The current recommendation prototype on the Apollo Repository will be turned off on 03 February 2023. Although the pilot has been fruitful for both parties, the service provider IKVA is focusing on horizon scanning products and so the recommender service can no longer be supported. We recognise the importance of recommender services in supporting research discovery and are evaluating offerings from other service providers. If you would like to offer feedback on this decision please contact us on: support@repository.cam.ac.uk