Peering through the Glassdoor: using employee voice to inform organisational learning in the National Health Service (NHS)

Abstract

High-reliability organisations such as hospitals and other healthcare organisations operate under a paradox of learning: there persists a culture of organisational silence that discourages staff from speaking up about potential threats to (patient) safety, but staff feedback has long been identified as a valuable source of information for organisational learning and harm prevention. How do we overcome this irony and help the organisation learn? The purpose of this paper is to leverage a source of data where employees voice complaints about their organisation without the threat of exposure: the employee review website Glassdoor. In this chapter, we analyse reviews from 531 employees of the National Health Service (NHS) in the period from June 2008 to May 2017. From these reviews, we identify 1743 issues that employees voiced about. We thematically analysed these issues using an abductive analytic framework and found that employees voiced largely about management problems, relationship problems, occupational well-being problems, and patient care problems. Using human factors theory, we theorise that staff complaints fill a blind spot that patient complaints do not, by virtue of being privy to “back-end” organisational structures and functions. From a sociological standpoint, we also theorise that challenges arise in healthcare due to a clash between strategic action and communicative action and consider how better dialogical communication can bridge the two. We conclude by discussing the implications of using non-reactive data sources to aid in organisational learning and propose humanities-driven recommendations that can be adopted by healthcare organisations to improve staff and patient outcomes.