MEDICAL PROFESSIONAL SILENCE
Understanding the forces that prevent medical professionals from speaking up at work
Victoria is an early career researcher at Griffith Business School, Griffith University in Brisbane, Australia.
Her PhD research aims to understand the forces that prevent medical professionals from speaking up at work. It draws on employee voice and silence theory viewed through an employment relations / human resources lens, approaching workplace issues from the perspective of organisations and employees. This brings a focus to medical professionals' silence in relation to patient safety and care (an organisational outcome) as well as their working conditions (an employee concern), enabling silence on both matters to be equally considered and addressed.
As it has recently been proposed that the relationship between working conditions voice and patient safety voice is a reciprocal one – and both types of voice independently and jointly lead to positive patient outcomes – understanding what impedes each is important.
However in the quest to resolve the persistent and dangerous problem of medical professionals’ silence on patient safety and care, silence in relation to their working conditions is overlooked. Whilst understandable, this misses an important piece of the puzzle.
The research project is grounded in employee voice and silence theory from the business discipline, draws on research on speaking up from the health discipline, and on literature on the professions from the sociology domain. A journal article that examines the role of profession in medical professional silence is also underway.
The paper positions professions as 'fields' of forces (Bourdieu, 1985) in which agenda-setting and acts of subtle aggression – designed to suppress the views of competitor professions – are the norm. These, and other professional norms and values, are transmitted and perpetuated via the socialisation processes individuals undertake (i.e. education, training and development) to gain and retain their place in the profession.
The paper argues in the medical professional context, such aggressive acts create a culture in which the views and voices of frontline medical professionals are stifled. Even though they are aware of 'the game' (Bourdieu & Wacquant, 1992) in which they are immersed, individuals comply with it – despite awareness of its rules and its (paradoxical) ability to undermine another professional value: the obligation to 'first, do no harm' by speaking up for patient safety and care.
In this environment, in which dissent is discouraged and individuals are unwilling to speak up about practices that harm patients – issues core to the work they undertake – voicing about working conditions is unlikely.
Early findings from the research data
The PhD research explores the experiences of junior doctors, a medical professional cohort especially vulnerable to silence and silencing. 38 interviews were conducted with junior doctors, senior doctors and stakeholders.
Early findings indicate a complex array of powerful professional, organisational and individual forces related to being a medical professional can lead to silence on working conditions and patient safety and care. These include:
entrenched professional norms that position junior doctors at the bottom of a hierarchy where they are to be seen but not heard
hospital, departmental and specialisation cultures that ensure same
professional discourse that emphasises overwork and non-complaint
a culture of teaching by humiliation in which they are afraid to voice
dependence on senior doctor supervisors for career progression and jobs
training organisations that fail to address workplace issues
hospitals that rely on unpaid labour
opaque HR systems that elide formal voicing of complaints
junior doctors who enter hospitals with little understanding of how to navigate complex organisational systems, and
individuals whose commitment to or desire to succeed in their profession leads to either self-sacrificing or patient safety silence or, frequently, both.
Understanding barriers to voice is critical in the healthcare context. This research will benefit individual medical professionals by enabling the bodies that educate, train and employ medical professionals to better support them – and in doing so, meet organisational goals by enhancing the quality of patient outcomes. This is increasingly important as community awareness of compromises to patient safety and care grows, especially those resulting from junior doctors’ working conditions.
Post-PhD, Victoria will focus on disseminating her findings via additional journal articles and other media to ensure it reaches academic, industry and mainstream audiences. Future research will examine this problem in more detail and identify interventions.
Victoria is also passionate about the wellbeing of another kind of junior doctor: those in the process of obtaining a PhD or who are working post-PhD as early career academics (ECAs) in university settings.
To this end she undertakes several roles representing the interests of higher degree by research (Master by Research/Master of Philosophy and PhD) students at Griffith University and ANZAM (the Australian and New Zealand Academy of Management). In her spare time, she is co-authoring a book chapter on how the process of becoming an academic impacts ECA mental health, again with a focus on the role of profession.
On 1 February 2023 Victoria paused her PhD for 6 months to commence work on research that examines voice and silence in the ECA supervisory relationship, and in the mentoring relationships ECAs form with academics outside the supervisory relationship.
MBus (Philanthropy & Nonprofit Studies)
Peer support for healthcare professionals and doctoral researchers
Researcher interested in unravelling the hard-to-unravel organisational issues
Higher degree by research student representative and doctoral workshop chair
Nonprofit consultant and non-executive director
Small business owner-operator
Former manager and interim CEO (change manager)
Victoria is a leader who takes a strategic approach to business, people and research problems. She uses critical thinking skills to shine a light on complex organisational issues in a way that respects the interests of organisations and individuals.
Her previous research examined dysfunctional leadership in the nonprofit sector, and how to replicate services typically delivered in a fixed, traditional setting in an atypical, transient environment.