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Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents

John G. Richmond (School of Health and Related Research, The University of Sheffield, Sheffield, UK)
Nicola Burgess (Warwick Business School, University of Warwick, Coventry, UK)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 28 February 2023

Issue publication date: 17 May 2023




Supporting and nurturing effective communication between healthcare professionals is vital to protect patients from harm. However, not all forms of employee voice are effective. Fear can lead to defensive voice, while the role of other emotions to drive voice behaviour is less well understood. This paper aims to understand what role the broader range of emotions, including compassion and shame, experienced by healthcare professionals following patient safety incidents (PSI) play in the subsequent enactment of prosocial voice, a positive and other-oriented form of communication.


This study is based on data from a single English NHS hospital: interviews with healthcare professionals involved in PSIs (N = 40), observations at quality and risk committees and meetings (N = 26 h) and review of investigative documents (N = 33). Three recent PSIs were selected for cross-case analysis based upon organisational theory related to professional hierarchy, employee voice and literature on emotions.


Among three cases, the authors found variance in context, emotional experience and voice behaviour. Where professionals feared blame and repercussion, voice was defensive. Meanwhile where they experienced shame and compassion, prosocial voice was enacted to protect patients.

Practical implications

Healthcare organisations seeking to foster prosocial voice should: (1) be more considerate of professionals' emotional experiences post-PSI and ensure adequate support for recovery (2) establish norms for professionals to share their struggles with others (3) reward professionals who demonstrate caring behaviour (4) buffer professionals from workplace pressures.


The authors’ study highlights how emotional experiences, such as shame and compassion, can mediate blame and defensiveness and lead to the enactment of prosocial voice in the professional hierarchy.



Funding: This work was supported by the National Institute for Health and Care Research - Warwick Business School PhD Studentship (2014-2018).


Richmond, J.G. and Burgess, N. (2023), "Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents", Journal of Health Organization and Management, Vol. 37 No. 3, pp. 327-342.



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