title: Deafening silence? Time to reconsider whether organisations are silent or deaf when things go wrong.
abstract: Several public inquiries into healthcare failings in the UK have noted that employees of failing organizations attempt to raise concerns about shortcomings in care, often over a prolonged period of time, only for those concerns to be ignored. However, healthcare literature has largely focused on how organizations and their employees are silent in the face of such failings, positioning employees as daring not to speak in response to serious workplace problems or issues. We argue that only focussing on organizational silence is a critical mistake which misrepresents actual events and overly-simplifies the complexities of workplace culture. The disregard shown by academics, practitioners and policy makers to employee voice strategies, which do not amount to whistle-blowing, but equally cannot either be defined as "silence", results in signals being ignored that can be effective in preventing and ending wrongdoing by others. In addition to understanding silence we suggest therefore that better understanding of why organizations are deaf to, or disregard, employee concerns are needed. We propose that a virtuous cycle is possible, whereby the introduction of systems that result in better listening and valuing of employee concerns reinforces a culture of speaking up and, in turn, organizational learning. Similarly, organizations that disregard employees concerns are destined not to learn, ultimately falling silent and failing.
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: Aled
authors.initials: A
authors.lastname: Jones
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kelly
mesh_terms: D006801:Humans; D019300:Medical Errors; D015279:Organizational Culture; D061214:Patient Safety / Q000592:standards; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D006113:United Kingdom; D035642:Whistleblowing
keywords: Communication; Patient safety; Quality improvement; Safety culture