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Related Experiment Video

Updated: Feb 5, 2026

Foreign Accent and Forensic Speaker Identification in Voice Lineups: The Influence of Acoustic Features Based on Prosody
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Improving Employee Voice About Transgressive or Disruptive Behavior: A Case Study.

Mary Dixon-Woods1, Anne Campbell, Graham Martin

  • 1M. Dixon-Woods is Health Foundation Professor of Healthcare Improvement Studies and director, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom. A. Campbell is research associate, Division of Infectious Diseases, Imperial College, London, United Kingdom. G. Martin is director of research, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom. J. Willars is visiting research fellow, Department of Health Sciences, University of Leicester, Leicester, United Kingdom. C. Tarrant is associate professor, Department of Health Sciences, University of Leicester, Leicester, United Kingdom. E.L. Aveling is research scientist, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. K. Sutcliffe is Bloomberg Distinguished Professor of Business and Medicine, Johns Hopkins University, Baltimore, Maryland. J. Clements is Mary Wallace Stanton Professor of Faculty Affairs and vice dean of faculty, Johns Hopkins University School of Medicine, Baltimore, Maryland. M. Carlstrom is founder, Safe at Hopkins, Johns Hopkins University, and principal consultant and executive coach, Build a Better Culture, Baltimore, Maryland. P. Pronovost is adjunct professor, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Academic Medicine : Journal of the Association of American Medical Colleges
|September 14, 2018
PubMed
Summary

Barriers like fear and futility prevent employees from speaking up about patient safety issues. This case study shows how diagnosis and targeted interventions can improve employee voice and organizational response.

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Area of Science:

  • Healthcare Management
  • Organizational Psychology
  • Patient Safety

Background:

  • Employee voice is crucial for organizational intelligence, particularly concerning patient safety.
  • Understanding barriers to employee voice is essential for improving the quality of patient care.

Purpose of the Study:

  • To investigate barriers to employee voice in an academic medical center.
  • To implement and evaluate interventions aimed at improving the identification and response to disruptive behaviors.

Main Methods:

  • A two-phase case study approach was employed at Johns Hopkins Medicine.
  • Phase 1 involved confidential interviews with 67 individuals to diagnose reluctance in voicing concerns.
  • Phase 2 (2014-2016) implemented interventions based on diagnostic findings.

Main Results:

  • Interviews revealed a gap between stated policies and actual practice regarding employee voice.
  • A pervasive culture of fear and perceptions of futility significantly inhibited employees from speaking up.
  • Interventions included sharing findings, formalizing response mechanisms, leadership training, and communication skills development.

Conclusions:

  • Addressing employee voice challenges requires a structured approach combining diagnosis and intervention.
  • This case study provides actionable strategies for organizations to foster employee voice and enhance responses to behavioral concerns.
  • Remaking organizational norms is key to facilitating employee voice and improving overall organizational response.