Employee voice and silence in the health sector



Healthcare systems in most developed countries, including Australia, are facing dramatic challenges in providing high quality and error free patient care. While there are many culprits to this state of affairs, inadequate frontline worker voice is often seen as a potential contributor to poor quality of patient care and unacceptably high medical and medication error rates (for examples of voice related to patient care see Avgar et al., 2016; and Schwappach & Gehring, 2014). In short, voice (or lack thereof) is a critical safety issue that has real-world life and death implications in the health context. 

Nevertheless, despite its centrality, healthcare researchers have documented the widespread prevalence of frontline providers’ reluctance to use voice to address behaviours and practices that are inconsistent with the delivery of high-quality patient care (Okuyama et al., 2014). Frontline employee reluctance to speak up in healthcare has been linked to team-level psychological safety (Nembhard & Edmondson, 2006), which highlights the importance of the organisational climate and context in promoting effective forms of voice. The healthcare literature also points to the importance of voice barriers, posed by status (such as between doctors and nurses) and occupational differences (Nembhard & Edmondson, 2006; Okuyama et al., 2014). In Australia we saw the Queensland Public Hospitals Commission of Inquiry (QPHCI), which arose out of complaints relating to the actions of Dr Jayant Patel at Bundaberg base hospital in 2004 and early 2005, and the inability of other staff to voice their concerns (Wilkinson et al., 2015).  

Our issue explores the role that different forms of worker voice play in promoting the conditions for the delivery of high-quality patient care. To improve patient care outcomes, research on voice in the healthcare context must, therefore, conceptualise and empirically document the type of voice practices made available by employers and the range of voice strategies employed by frontline healthcare workers.  

In addition, healthcare research on the role of worker voice is not well connected with how voice can be used to address concerns that healthcare staff have about their own welfare (for an exception, see Clark et al., 2001). The findings of the Standing Committee on Community Affairs: Inquiry into the Medical Complaints Process in Australia found that bullying and harassment was a widespread and significant problem (2016 p. 41). Equally, the Australasian College for Emergency Medicine (ACEM) reported that more than a third of those surveyed said they had experienced bullying (see Australian Medical Association, 2017). As discussed below, the use of voice to address employee concerns about working conditions is also likely to influence and promote voice that targets patient care-related shortcomings.  

Thus, staff who do not speak up about bullying and other dimensions of poor working conditions may also be less likely to make suggestions for organisational improvements related to patient care.  


Topic areas 

Indicative list of themes and key features of the Special Issue  

  • What are the voice practices used by employees in the healthcare setting?  
  • What are the barriers to using voice practices or speaking up and why do they exist?  
  • What is the relationship between patient care voice and voice focused on working conditions and how do these influence patient and employee outcomes? 
  • What steps can be taken to improve the overall voice system in the healthcare context? 
  • How can voice practices improve psychological safety in the healthcare context? 
  • What are the voice experiences of different health care professional types and hierarchies?  


Guest Editors

Adrian Wilkinson,

Griffith University and University of Sheffield,

[email protected] 

Michael Barry,

Griffith University,

[email protected]


Paula Mowbray,

Griffith University,

[email protected] 

Ariel Avgar,

Cornell University,

[email protected]


Submissions Information

Submissions are made using ScholarOne Manuscripts. Registration and access are available at: https://mc.manuscriptcentral.com/jhom

Author guidelines must be strictly followed. Please see: https://www.emeraldgrouppublishing.com/journal/jhom#author-guidelines

Authors should select (from the drop-down menu) the special issue title at the appropriate step in the submission process, i.e. in response to ““Please select the issue you are submitting to”.

Submitted articles must not have been previously published, nor should they be under consideration for publication anywhere else, while under review for this journal. 


Key deadlines 

Opening date for manuscripts submissions: 31 May 2023

Closing date for manuscripts submission: 30 June 2023

Closing date for abstract submission: 28 February 2023

Email for abstract submissions: [email protected]