A significant amount of emotional labor takes place during teaching. Teaching is a multitasking profession that consists of both cognitive and emotional components, with teachers engaging in emotional labor on a daily basis as an instrumental part of achieving teaching goals and positive learning outcomes. The purpose of the present review was to explore the relationship between emotional labor and burnout in school settings. The review focused specifically on teachers from elementary and high schools, between January 2006 and August 2021, and 21 studies fit the inclusion criteria. Overall, the review of the literature supports the significant associations between burnout and emotional labor with the majority of results pointing to the consistent relationship between surface acting and burnout. However, the results regarding the association of deep acting and naturally felt emotions with burnout were mixed. There is considerable scope for improvement in our study of emotional labor in terms of the study designs we employ, the variables we study and our appreciation of the historical and cultural factors that moderate and mediate the relationship between emotional labor and burnout.

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.

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.

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.

Objectives: Various psychological concepts have been proposed over time as potential solutions to improving patient safety and quality of care. Psychological safety has been identified as a crucial mechanism of learning and development, and one that can facilitate optimal patient safety in healthcare. We investigated the quantitative evidence on the relationship between psychological safety and objective patient safety outcomes. Methods: We searched 8 databases and conducted manual scoping to identify peer reviewed quantitative studies published up to February 2024. Objective patient safety outcomes of any type were eligible. The findings were analysed descriptively and discussed in a narrative synthesis. Results: Nine papers were selected for inclusion which reported on heterogeneous patient safety outcomes. Five studies showed a significant relationship between psychological safety and patient safety outcomes (e.g., ventilator associated events, reported medical errors). The majority of studies reported on the experiences of nurses working in healthcare from the USA. Patient safety is consistently characterised as the absence of harm rather than a culture that creates a safe environment. Conclusions: No clear conclusions can be extracted regarding the relationship between psychological safety and patient safety. For example, reporting patient safety problems in a team can be an indication of both high and low psychological safety. Patient safety may be contradictory to elements of psychological safety, as the absence of harm is not congruent with a safety environment approach. Systematic review registration: This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD4202347829).

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.