M. Dixon-Woods is Health Foundation Professor of Healthcare Improvement Studies and director, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom. A. Campbell is research associate, Division of Infectious Diseases, Imperial College, London, United Kingdom. G. Martin is director of research, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom. J. Willars is visiting research fellow, Department of Health Sciences, University of Leicester, Leicester, United Kingdom. C. Tarrant is associate professor, Department of Health Sciences, University of Leicester, Leicester, United Kingdom. E.L. Aveling is research scientist, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. K. Sutcliffe is Bloomberg Distinguished Professor of Business and Medicine, Johns Hopkins University, Baltimore, Maryland. J. Clements is Mary Wallace Stanton Professor of Faculty Affairs and vice dean of faculty, Johns Hopkins University School of Medicine, Baltimore, Maryland. M. Carlstrom is founder, Safe at Hopkins, Johns Hopkins University, and principal consultant and executive coach, Build a Better Culture, Baltimore, Maryland. P. Pronovost is adjunct professor, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Acad Med. 2019 Apr;94(4):579-585. doi: 10.1097/ACM.0000000000002447.
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.
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.
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.
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.
员工的意见在组织对患者安全隐患和其他影响患者护理质量的因素的了解中起着重要作用。作者报告了一个关于学术医疗中心的案例研究，该中心旨在了解阻碍员工发声的因素，并改善识别和应对违规或破坏性行为的能力。
该案例研究集中在约翰霍普金斯医学中心的一项改进工作上，该工作旨在通过诊断和干预的两阶段方法来提高员工的意见。2014 年，对 67 名个人（20 名高级领导，47 名一线人员）进行了保密访谈，以诊断员工不愿就行为问题发表意见的原因。针对调查结果，2014 年至 2016 年期间实施了一项鼓励员工发表意见的结构化干预计划。
诊断访谈发现，鼓励员工发表意见的既定政策与实际情况之间存在差距。一种恐惧文化弥漫在整个组织中，再加上普遍存在的徒劳感，阻碍了员工对关注问题发表意见。干预阶段涉及四项行动：分享访谈结果；协调并正式确定识别和处理破坏性行为的机制；培训领导鼓励员工发表意见；以及建立进行困难对话的能力。
在组织文献中，发表意见的问题广为人知，但难以解决。本案例研究提供了一种方法，包括诊断和干预阶段，这可能有助于重塑规范、促进员工发表意见和改善组织反应。它强调了其他组织可以借鉴和测试的具体行动。
