Employee silence in health care: Charting new avenues for leadership and management.

ISSUE: Health care management is faced with a basic conundrum about organizational behavior; why do professionals who are highly dedicated to their work choose to remain silent on critical issues that they recognize as being professionally and organizationally significant? Speaking-up interventions in health care achieve disappointing outcomes because of a professional and organizational culture that is not supportive. CRITICAL THEORETICAL ANALYSIS: Our understanding of the different types of employee silence is in its infancy, and more ethnographic and qualitative work is needed to reveal the complex nature of silence in health care. We use the sensemaking theory to elucidate how the difficulties to overcoming silence in health care are interwoven in health care culture. INSIGHT/ADVANCE: The relationship between withholding information and patient safety is complex, highlighting the need for differentiated conceptualizations of silence in health care. We present three Critical Challenge points to advance our understanding of silence and its roots by (1) challenging the predominance of psychological safety, (2) explaining how we operationalize sensemaking, and (3) transforming the role of clinical leaders as sensemakers who can recognize and reshape employee silence. These challenges also point to how employee silence can also result in a form of dysfunctional professionalism that supports maladaptive health care structures in practice. PRACTICE IMPLICATIONS: Delineating the contextual factors that prompt employee silence and encourage speaking up among health care workers is crucial to addressing this issue in health care organizations. For clinical leaders, the challenge is to valorize behaviors that enhance adaptive and deep psychological safety among teams and within professions while modeling the sharing of information that leads to improvements in patient safety and quality of care.

The Effect of Personality on Occupational Stress in Veterinary Surgeons.

Statistics show that veterinary surgeons are in one of the professions with the highest suicide rates. This indicates the sector has significant well-being issues, with high levels of occupational stress and burnout. Previous research has focused on environmental factors in isolation, overlooking the influence of personality. This study aimed to establish that personality is a better predictor of occupational stress than environment. UK veterinary surgeons (n=311) completed an online survey composed of three questionnaires; the NEO Five-Factor Inventory, the Maslach Burnout Inventory, and the Job Stress Survey. Multiple regression analysis revealed that personality is a better predictor of occupational stress than environment (p<.001). Neuroticism is the trait that significantly predicts occupational stress (p<.001), and the components of neuroticism that contribute the most to stress are depression (p=.002) and anger hostility (p=.005). Demographic factors such as the number of years the veterinarian has been qualified acted as a mediator between depression and occupational stress (p<.001), and as a moderator between personal accomplishments and occupational stress (p=.028). Overall findings suggest that newly qualified veterinarians are at greater risk of suffering from high levels of occupational stress than those well established in the profession, and that veterinarians with higher levels of depression and anger hostility are likely to experience greater levels of occupational stress. Implications highlight the need for greater awareness of potentially susceptible personality traits in the veterinary admissions process. This would allow for the identification of those at risk and the implementation of interventions.

Recurrent hip arthroplasty dislocation: good outcome after cup augmentation in 20 patients followed for 2 years.

Recurrent posterior dislocation occurs after primary total hip arthroplasty at rates of up to 7%. Component revision is regarded as standard management, but this major surgery may be unsuitable for elderly patients. We have developed a congruent polyethylene acetabular posterior lip augmentation device (PLAD) with a stainless steel backing plate. This can be used when there is no gross malalignment, wear or loosening of the primary components. We retrospectively compared 20 patients who had revision surgery with twenty patients who had been treated with the PLAD for recurrent posterior dislocation after primary Charnley total hip arthroplasty. In the PLAD group, the mean operative time, intraoperative blood loss, time spent in the high-dependency unit (HDU), transfusion requirements and the duration of hospital stay were all less than that in the revision group. There was no difference in the Oxford Hip Score between the groups at latest review 2 years after surgery. None of the patients in either group had suffered another dislocation.