Olga Lainidi

Healthcare management faces significant challenges related to upward communication. Sharing information in healthcare is crucial to the improvement of person-centered, safe, and effective patient care. An adverse event (AE) is an unintended or unexpected incident that causes harm to a patient and may lead to temporary or permanent disability. Learning from adverse events in healthcare is crucial to the improvement of patient safety and quality of care. Informal communication channels represent an untapped resource with regard to gathering data about the development of AEs. In this viewpoint paper, we start by identifying how informal communication played a key factor in some high-profile adverse events. Then, we present three Critical Challenge points that examine the role of informal communication in adverse events by (1) understanding how the prevailing trends in healthcare will make informal communication more important, (2) explaining how informal communication is part of the group-level sensemaking process, and (3) highlighting the potential role of informal communication in “breaking the silence” around critical and adverse events. Gossip, as one of the most important sources of informal communication, was examined in depth. Delineating the role of informal communication and adverse events within the healthcare context is pivotal to understanding and improving team and upward communication in healthcare organizations. For clinical leaders, the challenge is to cultivate a climate of communication safety, whereby informal communication channels can be used to collect soft intelligence that are paths to improving the quality of care and patient safety.

An increased interest in the impact of the so called "Dark Traits" of personality (e.g., narcissism, Machiavellianism, psychopathy, sadism) on the organizational well-being and job performance has been observed during the last ten years, aiming to lead to a better understanding of phenomena like toxic leadership, abusive supervisor behaviors and corporate psychopathy. These Dark Traits are usually expressed through behaviors characterized by manipulativeness, deceitfulness, callousness, hostility, and antagonism, as well as irresponsibility and risk propensity. We review the existing evidence on how these Dark Traits affect positive and negative aspects of workplace well-being (e.g., burnout, work-engagement etc.) and organizational performance (e.g., absenteeism, turnover intention etc.) and propose directions for future research.

Background: Teaching is a highly demanding profession, with teachers reporting increasing levels of burnout. Accumulated evidence indicates that inhibiting the expression of one's thoughts, emotions, and behaviors continuously can take a psychological toll actively resulting in physiological and psychological symptoms (e.g. stress, emotional exhaustion, strain). The purpose of this study was to assess the different types of employee silence among teachers and examine their relationship with job burnout, job engagement and psychological safety. Methods: A convenience sampling method approach was used whereby 150 primary school education teachers from Greece participated in a survey. Self-reported measures for burnout, work-engagement, psychological safety and employee silence motives were used in this cross-sectional study. Results: Psychological safety mediated the relationship between burnout and employee silence, and more specifically between the three core components of burnout and both acquiescent and quiescent silence, but not prosocial silence. In terms of engagement, the indirect effect was significant between vigor/ dedication and both quiescent and acquiescent silence. Conclusions: The present research highlighted the importance of acquiescent and quiescent silence, two forms of silence that are rooted in fear and hopelessness respectively. This research adds to the growing picture of teaching as a profession that is characterized by increasing levels of burnout, employee silence and low levels of psychological safety.

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016–2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

Evidence on the association of burnout with objective indicators of performance is scarce in healthcare. In parallel, healthcare professionals ameliorate the short-term impact of burnout by prioritizing some tasks over others. The phenomenon of employee silence can help us understand the evolution of how culture is molded toward the prioritization of some tasks over others, and how this contributes to burnout. Silence in healthcare has been associated with concealing errors, reduced patient safety, and covering up errors made by others. Conversely, there is evidence that in organizations where employees are encouraged to speak up about concerns, and where concerns are responded to appropriately, better patient outcomes such as improved patient safety and patient experience occur. Interventions to promote "speaking-up" in healthcare have not been successful and are rooted in a professional culture that does not promote speaking out. In this paper, we review the evidence that exists within healthcare to argue why healthcare education should be interested in employee silence, and how silence is a key factor in understanding how burnout develops and impacts quality of care. The following key questions have been addressed; how employee silence evolves during medical education, how is silence maintained after graduation, and how can leadership style contribute to silence in healthcare. The impact of withholding information on healthcare professional burnout, patient safety and quality of care is significant. The paper concludes with a suggested future research agenda and additional recommendations.

Both panic disorders and burnout are significant challenges in the workplace. However, to date knowledge in these areas has progressed in parallel and there have been few attempts to systematically connect these overlapping syndromes. The objectives of this chapter are to address this gap in the literature by addressing the following: how panic disorder symptoms can be masked under the “burnout-umbrella” meaning they can go under-the-radar, how the overlap between sub-clinical anxiety physical symptoms and panic disorder symptoms might lead to the latter remaining undiagnosed, and the extent to which burnout can contribute to experiencing panic disorder symptoms. Particularly, we will focus on professions that require high levels of emotional labor (e.g., healthcare employees, teaching professions) and which are characterized by pathological altruism, where individuals feel that they are not allowed to experience a panic attack in their work environment—and if they do, they will have to hide it. Moreover, such hiding leads to increased feelings of guilt and apathy, which in turn increases the likelihood of a depressive symptomatology to be developed. Finally, we argue that the field is hampered by the fact that employees are less likely to report the real intensity of their anxiety and stress-related symptoms.