Healthcare professionals' voice as a road to burnout and work engagement? The role of relational outcomes: An exploratory study of European countries

PURPOSE

Healthcare professionals are key in healthcare organisations but are subject to long working hours and may have to make complex life-and-death decisions. As frontline agents dealing with human lives, giving them a voice is paramount. This study explores the impact of employee voice (assessed based on employee perceptions on how much they are consulted and how much influence they have on task-related decisions) on health professionals' work engagement and burnout when mediated by relational outcomes (perceived organisational support, workplace trust, workplace recognition and meaningful work).

DESIGN/METHODOLOGY/APPROACH

A sample of 3,266 health professionals retrieved from the European Working Condition Survey was used. The quantitative analysis was performed using the partial least square structural equation modelling and multiple regression analyses.

FINDINGS

The results indicate that employee voice has a direct positive impact on work engagement, but employee voice's direct effects on burnout still need to be confirmed. Relational outcomes are found to mediate the relationship between employee voice and burnout (decreasing it) and between employee voice and work engagement (increasing it).

PRACTICAL IMPLICATIONS

Practices of employee voice in the workplace are fundamental to promoting health professionals' well-being. Trust, recognition, support and the feeling of doing meaningful work increase the influence of employee voice, especially in reducing the levels of burnout.

ORIGINALITY/VALUE

This is the first study that assesses, at a European level, the importance that 'giving health professionals a voice' has on crucial employee outcomes: work engagement, burnout and relational outcomes.

Relational leadership and organizational citizenship behavior: do employee well-being and employee voice matter?

PURPOSE

This study aims to investigate the mediation effects of employee voice and employee well-being on the relationship between relational leadership and organizational citizenship behavior.

DESIGN/METHODOLOGY/APPROACH

This study used a Web-based survey method to collect data from 301 respondents in the four public hospitals of the Sekondi-Takoradi Metropolis. This study used PLS-SEM (WarpPLS) to test the study's hypotheses.

FINDINGS

The findings show that relational leadership has a positive impact on organizational citizenship behavior, and that this link is mediated in part by both employee voice and employee well-being.

PRACTICAL IMPLICATIONS

This study demonstrates the importance of leaders, paying close attention to employees' well-being and opinions when attempting to drive organizational citizenship behavior in the health sector.

ORIGINALITY/VALUE

Based on the review of the extant literature on the impact of leadership on employee behavior and to the best of the authors' knowledge, it is likely that this study will be the first to show how relational leadership, employee voice, employee well-being and organizational citizenship behavior are related in the health sector, thereby advancing the thrusts of the social exchange and relational leadership theories.

When and why are employees willing to engage in voice behavior: a power cognition perspective

Previous studies have found that sense of power is an important predictor of employee voice; however, the mechanism underlying the relationship between these factors remains unclear. To explore this mechanism, 642 valid questionnaires from 45 enterprises were used to conduct an empirical test based on the approach-inhibition theory of power. The results showed that sense of power can affect error risk taking positively, error risk taking mediates the relationship between sense of power and employee voice; and power congruence moderates both the direct relationship between sense of power and employee voice and their indirect relationship via error risk taking. This study thus provides a useful reference for improving employees' enthusiasm for voice behavior and can help enhance the competitiveness of enterprises.

Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff? A qualitative study

Healthcare organisations' responses to concerns and complaints often fall short of the expectations of patients and staff who raise them, and substandard responses to concerns and complaints have been implicated in organisational failures. Informed by Habermas's systems theory, we offer new insights into the features of organisations' responses to concerns and complaints that give rise to these problems. We draw on a large qualitative dataset, comprising 88 predominantly narrative interviews with people raising and responding to concerns and complaints in six English NHS organisations. In common with past studies, many participants described frustrations with systems and processes that seemed ill-equipped to deal with concerns of the kinds they raised. Departing from existing analyses, we identify the influence of functional rationality, as conceptualised by Habermas, and embodied in procedures, pathways and scripts for response, in producing this dissatisfaction. Functionally rational processes were well equipped to deal with simple, readily categorised concerns and complaints. They were less well placed to respond adequately to concerns and complaints that were complex, cross-cutting, or irreducible to predetermined criteria for redress and resolution. Drawing on empirical examples and on Habermas's theory of communicative action, we offer suggestions for alternative and supplementary approaches to responding to concerns and complaints that might better address both the expectations of complainants and the improvement of services.

Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study

OBJECTIVES

To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice.

DESIGN

Semi-structured qualitative interviews.

SETTING

National Health Service, regulatory and third-sector organisations in England.

PARTICIPANTS

Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13).

MAIN OUTCOME MEASURES

Not applicable.

RESULTS

Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional 'cultural engineering' to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of 'blacklisting' of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour.

CONCLUSIONS

Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.

Effects of ethical leadership on bullying and voice behavior among nurses

PURPOSE

This study aims to investigate the effects of ethical leadership on employee's bullying and voice behavior, considering poor working conditions, organizational identification and workload as mediating variables.

DESIGN/METHODOLOGY/APPROACH

Questionnaire survey design was used to elicit responses of 564 nurses from hospitals located in various cities of Pakistan.

FINDINGS

Analysis through structural equation modeling proved that ethical leadership has a positive and significant impact on both organizational identification and voice behavior, but a negative and significant impact on workload, poor working conditions and bullying at the workplace. Furthermore, organizational identification, poor working conditions and workload proved to be partial mediators.

ORIGINALITY/VALUE

The study adds value to the limited literature on ethical leadership, bullying and voice behavior in nursing. Additionally, organizational identification, workload and poor working conditions have not previously been examined as mediators.

Culture, silence and voice: The implications for patient safety in the operating theatre

Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or 'voice'. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.