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

Mawuena, Emmanuel Kwasi


Emmanuel Kwasi Mawuena


Nicholas Snowden


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.


Mawuena, E. K. (2020). Understanding power in relation to voice and silence on patient safety among surgical professionals in Ghanaian teaching hospitals. (Thesis). University of Hull. Retrieved from

Thesis Type Thesis
Deposit Date Mar 11, 2021
Publicly Available Date Feb 23, 2023
Keywords Business
Public URL
Additional Information Business School, The University of Hull
Award Date Aug 1, 2020


Thesis (2.4 Mb)

Copyright Statement
© 2020 Mawuena, Emmanuel Kwasi. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

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