Academic journal article Journal of Healthcare Management

Promoting Employee Voice and Upward Communication in Healthcare: The CEO's Influence/PRACTITIONER APPLICATION

Academic journal article Journal of Healthcare Management

Promoting Employee Voice and Upward Communication in Healthcare: The CEO's Influence/PRACTITIONER APPLICATION

Article excerpt

EXECUTIVE SUMMARY

As noted by the Institute of Medicine (2004), a lack of critical upward feedback in the hospital setting has adverse effects on direct patient care and health outcomes. Employees are oftentimes reluctant to share information, as those above them might interpret the information to be negative or threatening. Leaders then may make important decisions based on assumptions or inaccurate feedback. The situation is especially significant in the healthcare setting, where hierarchical structures (Nembhard and Edmondson 2006), divisions between administrators and clinicians, and lack of collaboration across teams reinforce employee silence and undermine organizational learning (Ramanujam and Rousseau 2006).

Chief executive officers play a key role in developing a culture that fosters employee voice and upward communication (Ashford, Sutcliffe, and Christianson 2009). Hospitals winning performance excellence awards, such as those utilizing the Malcolm Baldrige National Quality Award Criteria for Performance Excellence, present a model of high performance with demonstrated results. The purpose of this study was to understand specific CEO behaviors and actions promoting employee voice and upward communication in performance excellence award-winning healthcare organizations.

Results suggested the award-winning CEOs facilitated employee voice by being approachable, mainly achieved through their regular presence throughout the organization. By being consistently visible and available to employees these CEOs fostered relationships, built trust, and promoted open communication. Leaders in the study created a cultural focus on continuous improvement largely built around transparency of information, particularly looking for the bad news from their employees. Voice invitation and positive voice response from leaders reinforced that critical upward feedback is not only welcome, but expected.

INTRODUCTION

In the healthcare setting, feedback from all levels of the organization is necessary to make improvements and prevent life-threatening errors (IOM 2004; Tucker and Edmondson 2003). While most leaders agree on the value of upward communication and its role in organizational effectiveness, many organizations still struggle with upward communication of both negative and positive information (Milliken, Morrison, and Hewlin 2003). Employee voice, defined in this study as the discretionary provision of information intended to improve organizational functioning to someone with the authority to act (Detert and Burris 2007), is necessary if leaders are to receive honest upward feedback from individuals throughout all levels of the institution.

Chief executive officers (CEOs) play a key role in developing a culture that fosters employee voice and upward communication (Ashford, Sutcliffe, and Christianson 2009). Having a culture of safety increases the chances employees will take positive risks and speak candidly. For organizational success, healthcare leaders must develop a culture in which employees realize that a sense of safety exists (Valadares 2004).

Findings from studies about psychological safety and communication in the healthcare environment have not articulated the actual leadership behaviors and practices necessary to create a culture of safety other than encouraging and training employees to speak up (Valadares 2004; Nembhard and Edmondson 2006). McAlearney (2006) notes that healthcare organizations pay little attention to improving management practices, which increases the likelihood of repeating previous mistakes. The purpose of this study was to understand CEO behaviors and actions that promote employee voice and upward communication in performance excellence award-winning healthcare organizations, addressing a gap in current literature.

The research questions guiding this study were: ( 1 ) How do CEOs of performance excellence awardwinning healthcare organizations foster employee voice and upward communication of both positive and negative information in their organization? …

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