The role of the informal and formal organisation in voice about concerns in healthcare: A qualitative interview study

The importance of employee voice—speaking up and out about concerns—is widely recognised as fundamental to patient safety quality care. However, failures voice continue occur, often with disastrous consequences. In this article, we argue that the enduring sociological concepts informal organisation formal offer analytical purchase in understanding causes such problems how they can be addressed. We report a qualitative study involving 165 interviews across three healthcare organisations two high-income countries. Our analysis emphasises interdependence organisation. describes codified formalised elements structures, procedures processes for exercise voice, but participants found it frustrating, ambiguous, poorly designed. organisation—the practices, social connections, methods making decisions are key coordinating organisational activity—could facilitate through its capacity help people understand complex processes, make sense their concerns, frame them ways likely prompt an appropriate response. Sometimes compensated gaps, ambiguities inconsistencies policies systems. At same time, had dark side, potentially subduing by creating hierarchies, prioritising cohesion, providing opportunities retaliation. not exclusive or independent: interact mutually reinforce each other. findings have implications efforts improve culture relation organisations, pointing need address deficits organisation, potential building on strengths crucial supporting voice.