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The Voice of the Clinician project commenced during an era when practitioner burnout, dissatisfaction, and turnover became an increasingly global health workforce concern. One key problem is clinical staff not being empowered to voice their concerns to decision-makers, as was found in this case study of an Australian public health organization. The following research question informed the present study: What is a better committee system for clinician engagement in decision-making processes? The paper aims to discuss this issue.

The Mid North Coast Local Health District in New South Wales aspired to improve engagement between frontline clinicians and decision-makers. Social network analysis methods and mathematical modeling were used in the discovery of how committees are connected to each other and subsequently to other committee members.

This effort uncovered a hidden organizational architecture of 323 committees of 926 members which overall cost 84,729 person hours and AUD$2.923 million per annum. Furthermore, frontline clinicians were located far from centers of influence, just 37 percent of committees had terms of reference, and clinicians reported that meeting agendas were not being met.

In response to the findings, a technological platform was created so that the board of directors could visually see all the committees and the connections between them, thus creating ways to further improve communication, transparency of process, and – ultimately – clinician engagement.

The breakthrough idea is that all organizational meetings can be seen as a system of engagement and should be analyzed to determine and describe the points and pathways where clinician voice is blocked.

For over three decades, researchers have sought to identify factors influencing employees’ responses to wrongdoing in work settings, including organizational, contextual, and individual factors. In focusing predominantly on understanding whistle-blowing responses, however, researchers have tended to neglect inquiry into employees’ decisions to withhold concerns. The major purpose of this study was to explore the factors that influenced how staff members responded to a series of adverse events in a healthcare setting in Australia, with a particular focus on the role of perceptions and emotions.

Based on publicly accessible transcripts taken from a government inquiry that followed the event, we employed a modified grounded theory approach to explore the nature of the adverse events and how employees responded emotionally and behaviorally; we focused in particular on how organizational and contextual factors shaped key employee perceptions and emotions encouraging silence.

Our results revealed that staff members became aware of a range of adverse events over time and responded in a variety of ways, including disclosure to trusted others, confrontation, informal reporting, formal reporting, and external whistle-blowing. Based on this analysis, we developed a model of how organizational and contextual factors shape employee perceptions and emotions leading to employee silence in the face of wrongdoing.

Although limited to publicly available transcripts only, our findings provide support for the idea that perceptions and emotions play important roles in shaping employees’ responses to adverse events at work, and that decisions about whether to voice concerns about wrongdoing is an ongoing process, influenced by emotions, sensemaking, and critical events.

The growth of research into whistle-blowing has produced some compelling insights into this important organizational phenomenon, but a number of areas remain under-explored, particularly the role of emotion and our understanding of the far more common response to wrongdoing, namely inaction. In this chapter we seek to problematize current conceptualizations of whistle-blowing and wrongdoing, as a basis for examining employee silence in the face of wrongdoing. We suggest that quiescent silence can be viewed as an emotion episode, and draw upon the feedback theory and the sensemaking paradigm to develop this proposition, illustrated through an analysis of accounts of quiescent silence in a clinical setting. We propose a new concept of “cues for inaction” which offers insights into the way quiescent silence arises and persists.

The chapters in this volume are drawn from the best contributions to the 2006 International Conference on Emotion and Organizational Life held in Atlanta, in conjunction with the Academy of Management's Annual Meetings. (This bi-annual conference has come to be known as the Emonet conference, after the listserv of members). The selected conference papers were then complemented by additional invited chapters. This volume contains six chapters selected from conference contributions for their quality, interest, and appropriateness to the theme of this volume, as well as eight invited chapters. We acknowledge in particular the assistance of the conference paper reviewers (see Appendix). In the year of publication of this volume the 2008 Emonet conference will be held in France, and will be followed by Volumes 5 and 6 of Research on Emotion in Organizations. Readers interested in learning more about the conferences or the Emonet list should check the Emonet website http://www.uq.edu.au/emonet/.

Gregory Ashley is a Ph.D. student at the University of Nebraska at Omaha in the area of Industrial/Organizational (I/O) Psychology. Greg holds undergraduate degrees in Psychology and telecommunications, and Masters degrees in Business and Economics. His research has been published in both economic and psychology-related publications. Prior to entering academia, Greg accrued over 20 years of hands-on business experience working in a variety of management positions in the telecommunications industry.