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Organizational Silence in the NHS: ‘Hear no, See no, Speak no’

ABSTRACT There have been major health care failings in the UK National Health Service (NHS) over many years. The persistent dysfunctional organizational culture, an inability to learn and the need for change has been identified within literature. The concept of organizational silence forms one aspect of the proposed model of organizational dysfunction in the NHS. Forty-three interviews and six focus groups have been conducted to test the model. From generalized evidence, it is suggested that the NHS is systemically and institutionally deaf, bullying, defensive and dishonest. There appears to be a culture of fear, lack of voice and silence. The cost of suppression of voice, reluctance to voice and the resulting ‘sea of silence’ is immense. There is a resistance to ‘knowing’ and the NHS appears to be hiding and retreating from reality. There is an urgent need for action to be taken to address this dysfunctional culture. The NHS needs to embrace the identity of being a listening, learning and honest organization, with a culture of respect. It needs to choose to hear, see and speak for the benefit of patients and staff. There are implications for the wider UK society due to the apparent inability to learn and improve.