The upward voicing of ideas is vital to organizational performance. Yet power differences between voicers and those with authority may result in valuable ideas being overlooked. In this ethnographic, 31-month longitudinal study of a multi-disciplinary team in the healthcare sector, we examine how upwardly voiced ideas can endure to reach implementation. Of 208 upwardly voiced ideas, most were rejected in the moment, but 49 reached implementation despite appearing to be initially rejected. These ideas were kept alive by other team members who later drew upon and revived the initial ideas through what we call the voice cultivation process. We detail this process and describe five pathways through which voiced ideas stayed alive to reach implementation by overcoming different forms of resistance. We illustrate how the allyship of others can help voice live on beyond its initial utterance to reach implementation and generate change, even when the person who initially spoke up is no longer on the team or advocating for the idea. By reconceptualizing voice as a collective, interactional process rather than a one-time dyadic event, this paper develops new theory on how employees can help one another’s voice be heard to positively impact their teams and organizations.

Background: Psychological safety—the belief that it is safe to speak up—is vital amid uncertainty, but its relationship to feeling heard is not well understood. Purpose: The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty. Methodology: We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling. Results: Psychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety’s relationship to burnout and process adaptation. Conclusion: Psychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty. Practice Implications: For health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.

Novel forms of teamwork—created by rapid change and growing diversity among collaborators—are increasingly common, and they present substantial methodological challenges for research. We highlight two aspects of new team forms that challenge conventional methods. Factors pertaining to change (e.g., in membership) create entitativity challenges such as whom to count as team members, while factors pertaining to difference (e.g., in expertise) create concordance challenges such as how to interpret disagreement in groups. We review research methods that are well-suited to each of these specific challenges. We identify the particular challenges of studying teams that exhibit high difference and change simultaneously and call for adaptive methods that enable insight into how they work. Clarity about the dimensions of deviation from ideal team forms, along with shared terminology, will help researchers make and discuss tough methodological choices and assist reviewers in evaluating them.

Healthcare organizations face stubborn challenges in ensuring patient safety and mitigating clinician turnover. This paper aims to advance theory and research on patient safety by elucidating how the role of psychological safety in patient safety can be enhanced with joint problem-solving orientation (JPS). We hypothesized and tested for an interaction between JPS and psychological safety in relation to safety improvement, leveraging longitudinal survey data from a sample of 14,943 patient-facing healthcare workers. We found a moderation effect, in which psychological safety was positively associated with safety improvement, and the relationship was stronger in the presence of JPS. Psychological safety and JPS also interacted positively in predicting clinicians’ intent to stay with the organization. For theory and research, our findings point to JPS as a measurable factor that may enhance the value of psychological safety for patient safety improvement—perhaps because voiced concerns about patient safety often require joint problem-solving to produce meaningful change. For practice, our conceptual framework, viewing psychological safety and JPS as complementary factors, can help organizations adopt a more granular approach towards assessing the interpersonal aspect of their safety climate. This will enable organizations to obtain a more nuanced understanding of their safety climate and identify areas for improvement accordingly.

Issue: When frontline employees’ voice is not heard and their ideas are not implemented, patient care is negatively impacted, and frontline employees are more likely to experience burnout and less likely to engage in subsequent change efforts. Critical Theoretical Analysis: Theory about what happens to voiced ideas during the critical stage after employees voice and before performance outcomes are measured is nascent. We draw on research from organizational behavior, human resource management, and health care management to develop a multilevel model encompassing practices and processes at the individual, team, managerial, and organizational levels that, together, provide a nuanced picture of how voiced ideas reach implementation. Insight/Advance: We offer a multilevel understanding of the practices and processes through which voice leads to implementation; illuminate the importance of thinking temporally about voice to better understand the complex dynamics required for voiced ideas to reach implementation; and highlight factors that help ideas reach implementation, including voicers’ personal and interpersonal tactics with colleagues and managers, as well as senior leaders modeling and explaining norms and making voice-related processes and practices transparent. Practice Implications: Our model provides evidence-based strategies for bolstering rejected or ignored ideas, including how voicers (re)articulate ideas, whom they enlist to advance ideas, how they engage peers and managers to improve conditions for intentional experimentation, and how they take advantage of listening structures and other formal mechanisms for voice. Our model also highlights how senior leaders can make change processes and priorities explicit and transparent.

Background: Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines. Objective: We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting. Methods: We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes. Results: We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients. Conclusion: Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.