Understanding power in relation to voice and silence on patient safety among surgical professionals in Ghanaian teaching hospitals

Employee voice is essential in positive work outcomes and harm prevention. However, there is a dearth of research on how power influences voice and silence in organisations (e.g Morrison et al., 2015). This study aims at understanding the implication of upward and interdisciplinary power relationships on voice and silence among Healthcare Professionals (HCPs) on patient safety in surgery. Sixty-seven (67) interviews and policy documents were analysed from two teaching hospitals in Ghana. The study found that formal power inequality is often reinforced by sociocultural authority. This enables superiors to take unilateral decisions and disregard inputs of team members resulting in preventable harm as well as apathy and silence on patient safety. Likewise, authority gradient creates a psychological barrier in hierarchy and undermine voice at interpersonal and broad surgical levels. The unequal power relationships coupled with lack of organisational support exposes those who speak up to risk. Beyond these, military authority often reinforces power or overrides healthcare authority and undermine voice in the military hospital. In terms of interdisciplinary power relationships, doctors’ authority often undermines nurses’ voice and compel them to undertake perceived harmful practices. However, a sense of equal interdisciplinary power relationship between surgeons and anaesthesiologists give rise to power struggles that promote voice in their respective speciality but undermine voice across speciality. Finally, HCPs adopt ingenious voice strategies to avoid appearing offensive and enhance receptivity to voice. Although sociocultural values generally reinforce formal power and silence, these equally provide unique interpersonal access that occasionally permeates power barriers for effective voice. Findings imply the need to empower HCPs, especially nurses, and shift surgical responsibility from individuals such as surgeons to teams as a way of mitigating unequal power and promoting a sense of involvement to encourage voice. Surgery may also consider ‘transdisciplinary approach’ as a creative solution to interdisciplinary power challenges to voice. Further implications for management and practice are presented in the conclusion of the study

How power, expertise, and hierarchy influence Voice on Patient Safety: A study of surgeons and anaesthesiologists

This paper adds a novel perspective to employee voice literature by thematically analysing 36 in-depth interviews of surgeons and anaesthesiologists, who work together but in the context of a blurred hierarchy. We found that these two professions effectively leveraged expertise in speaking up on safety concerns relating to their own speciality, when speaking to each other, irrespective of hierarchy. Further, as interdependent roles make cross speciality voice vital for patient safety, they also spoke up on occasions to negotiate risk and safety concerns across speciality. However, power struggles and protection of speciality authority predisposed each professional group to undervaluing the contribution of the other and often attributing self-interest and opportunistic motives to those speaking up. This led to each group resisting influence making silence a commonplace on cross speciality safety concerns. These contexts present an intriguing environment for voice behaviour which requires research and management attention

Professional Disrespect between Doctors and Nurses:Implications for Voicing Concerns about Threats to Patient Safety

Purpose (limit 100 words) Previous research has demonstrated that social-relational factors are instrumental to employee voice. An essential aspect of this relates to notions of respect or disrespect. Although nurses commonly report experiencing professional disrespect in their interaction with doctors, earlier studies have focused on how the professional status hierarchy and power imbalance between doctors and nurses hinder speaking up without considering the role of professional disrespect. Addressing this gap, we explore how professional disrespect in the doctor-nurse relationship in surgical teams influences the willingness of nurses to voice legitimate concerns about threats to patient safety. Design/methodology/approach (limit 100 words) Fifty-seven (57) semi-structured interviews with nurses drawn from a range of specialities, ranks and surgical teams in three hospitals in a West African Country. In addition, two (2) interviews with senior representatives from the National Registered Nurses and Midwifery Association (NRNMA) of the country were undertaken and analysed thematically with the aid of NVivo 12. Findings (limit 100 words) Disrespect is expressed in doctors’ condescending attitude towards nurses and undervaluing their contribution to care. This leads to the safety concerns raised by nurses being ignored, downplayed, or dismissed, with deleterious consequences for patient safety. Feeling disrespected further motivates nurses to consciously disguise silence amidst speech and engage in punitive silence aimed at making clinical practice difficult for doctors. Originality/value (limit 100 words) We draw attention to the detrimental effect of professional disrespect on patient safety in surgical environments. We contribute to employee voice and silence by showing how professional disrespect affects voice independently of hierarchy and conceptualise the notion of punitive silence

Professional Disrespect between Doctors and Nurses: Implications for Voicing Concerns about Threats to Patient Safety

Previous research has demonstrated that social-relational factors are instrumental to employee voice. An essential aspect of this relates to notions of respect or disrespect. Although nurses commonly report experiencing professional disrespect in their interaction with doctors, earlier studies have focused on how the professional status hierarchy and power imbalance between doctors and nurses hinder speaking up without considering the role of professional disrespect. Addressing this gap, we explore how professional disrespect in the doctor-nurse relationship in surgical teams influences the willingness of nurses to voice legitimate concerns about threats to patient safety

Assessing knowledge and awareness of COVID-19 among traders and sanitary workers in the Cape Coast Metropolis of Ghana

# Background Since its emergence, Coronavirus Disease 2019 (COVID-19) has infected over half a billion people, killed over 6 million others, and ravaged the global economy on a scale that is unprecedented in recent history. In response, a global health emergency was launched that led to further disruptions in the ordinary way of life of people. The knowledge, attitudes, and practices (KAP) of people towards COVID-19 are central to infection control policies and the future course of the pandemic. # Methods We employed an interviewer-administered, cross-sectional survey to examine the KAP of salespersons in a local market and sanitation workers of a public institution within the Cape Coast Metropolis of Ghana. Results were analysed by frequencies of responses for each KAP item on the questionnaire. Sociodemographic variables that predicted good knowledge of COVID-19 or preventive practices were determined using adjusted odds ratios (aORs). # Results Out of the 206 participants, 123 (59.7%) obtained a knowledge score ≥16.75 out of a total of 21, which was the threshold for good knowledge, while 41.3% were classified as possessing poor knowledge. On good attitudes towards COVID-19 prevention, 141 participants (68.4%) scored ≥10.69 out of 12 to pass the threshold, while 31.6% had poor attitudes. Being female (aOR=6.19, *P*<0.001) or possessing a high school education (aOR=0.25, *P*=0.009) significantly predicted high knowledge scores. Being in the 15-30 age group (aOR=6.91, *P*=0.003) significantly predicted poor attitudes, while possessing a high school education (aOR=0.11, *P*<0.001) significantly predicted good attitudes. # Conclusions The findings of this study underscore the need for intensified, targeted educational campaign on COVID-19 as the world prepares to live with the disease for the long while