Reducing Treatment Errors in Hospitals: The Role of Employee Voice in Unsafe Clinical Practice

Incorrect treatment in hospitals can lead to serious harm and can even result in the death of patients. This work theorizes and empirically investigates whether and under what circumstances employee-voiced concerns reduce fatal patient safety incidents over time. Integrating insights from the attention-based view of the firm with voice literature, we stress the importance of feedback from hospital employees for reducing treatment errors and theorize that increases in collective voice can reduce fatal patient safety incidents. Our study is based on a large, longitudinal data set of acute hospitals in the UK covering the newest available data from 2015 - 2019. The final data set contained 628 hospital-level observations (132 NHS-Trusts over 5 years), including a total of 1,347,617 hospital staff survey responses. We use hybrid regression analyses to test our dynamic theory. The results demonstrate that, within organizations, an increase in voice of one standard deviation reduces the number of fatal patient safety incidents by 9 percent over time. Between hospitals, a one standard deviation increase in voice reduces the number of fatal patient safety incidents by 30 percent. Moreover, we identified hospital’s prior performance as a boundary condition of the within-hospital relationship of voice and patient safety incidents, in the way that the link is stronger for hospitals with a lower prior performance.