Nembhard Ingrid M, Labao Israel, Savage Shantal
Ingrid M. Nembhard, PhD, MS, is Associate Professor, Yale School of Public Health and Yale School of Management, Yale University, New Haven, Connecticut. E-mail:
Health Care Manage Rev. 2015 Jul-Sep;40(3):225-36. doi: 10.1097/HMR.0000000000000028.
Research suggests that staff voice-discretionary communication of ideas, suggestions, concerns, or opinions about work-related issues with the intent to improve organizational or unit functioning-is associated with quality improvement, which most agree is needed in health care. Nevertheless, health professionals often do not voice. Little research has explored their reluctance to speak up and, relatedly, the conditions under which they voice.
We examine the drivers of voice for health professionals in hospitals. Specifically, we investigate the factors that influence their voice, why these factors are influential, and the purposes for which staff use their voice.
We conducted a qualitative study using data from 99 in-depth interviews with diverse staff at 12 randomly sampled hospitals in the United States. Data were collected from December 2007 to December 2008, the first year of a 4-year study of improvement. By national standards, all of the hospitals had significant room for improvement in their care of patients experiencing heart attack, suggesting that there were potentially issues and suggestions for staff to voice.
Factors related to individuals (e.g., tenure), work (e.g., work configuration), organizational context (e.g., culture), data (e.g., benchmarking), and the external environment (e.g., attention) influenced health professionals' voice. These factors shaped their sense of safety, efficacy, opportunity, and/or legitimacy, all of which affected their belief about the risk and benefit of voice and willingness to voice. They voiced for three purposes: to learn for themselves, inform others, and protect patients.
These findings indicate that hospitals and their leaders must attend to multiple factors (e.g., work configuration, culture, etc.) if they wish to increase staff voice in service of quality improvement. The presence of many influential factors suggests that there are several levers that leaders can use to elicit voice, noting that voice can be used in multiple ways to facilitate improvement.
研究表明，员工建言——即出于改善组织或单位运作的目的，就与工作相关的问题自行交流想法、建议、关切或意见——与质量改进相关，而多数人认为医疗保健领域需要质量改进。然而，医疗专业人员常常不建言。很少有研究探讨他们不愿发声的原因，以及与之相关的他们发声的条件。
我们研究医院中医疗专业人员建言的驱动因素。具体而言，我们调查影响他们建言的因素、这些因素具有影响力的原因，以及员工建言的目的。
我们开展了一项定性研究，使用了对美国12家随机抽样医院的99名不同员工进行深度访谈的数据。数据收集时间为2007年12月至2008年12月，这是一项为期4年的改进研究的第一年。按照国家标准，所有这些医院在治疗心脏病患者方面都有很大的改进空间，这表明员工有可能有问题要提出、有建议要建言。
与个人（如任期）、工作（如工作配置）、组织环境（如文化）、数据（如标杆管理）和外部环境（如关注度）相关的因素影响了医疗专业人员的建言。这些因素塑造了他们的安全感、效能感、机会感和/或合法性，所有这些都影响了他们对建言的风险和益处的看法以及建言的意愿。他们建言有三个目的：为自己学习、告知他人和保护患者。
这些发现表明，如果医院及其领导希望增加员工建言以促进质量改进，就必须关注多个因素（如工作配置、文化等）。存在许多有影响力的因素表明，领导可以利用几个杠杆来引发建言，并指出建言可以通过多种方式用于促进改进。
