ArticleJournal of health services research & policy2022
What counts as a voiceable concern in decisions about speaking out in hospitals: A qualitative study.
Article in Journal of health services research & policy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Pooled it
- Pain only she knows.Anaesthesia · 2026Article
- Integrating equity into hospital incident reporting and patient concerns systems: study protocol for a mixed methods study.BMJ open · 2025Article
- Coproducing data-driven organizational safety with patients: development and cognitive testing of a multisetting patient-reported safety concern tool.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2025Article
- Psychological safety in an ECMO retrieval team: a qualitative study to inform improvement.BMJ open quality · 2024Article
- Locum doctor working and quality and safety: a qualitative study in English primary and secondary care.BMJ quality & safety · 2024Article
- Why Talking Is Not Cheap: Adverse Events and Informal Communication.Healthcare (Basel, Switzerland) · 2024Article
- How do cultural elements shape speak-up behavior beyond the patient safety context? An interprofessional perspective in an obstetrics and gynecology department.Frontiers in medicine · 2024Article
- Middle manager responses to hospital co-workers' unprofessional behaviours within the context of a professional accountability culture change program: a qualitative analysis.BMC health services research · 2023Article
- Impact of the COVID-19 pandemic on antimicrobial stewardship support for general practices in England: a qualitative interview study.BJGP open · 2023Article
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 3 countries.
Funding
Abstract
objectivesThose 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.
methodsWe 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.
resultsOur 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.
conclusionsUnderstanding 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.
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Registered trials
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