Executive Summary:

How can front-line workers be encouraged to speak up when they know how to improve an organization's operation processes? This question is particularly urgent in the US health- care industry, where problems occur often and consequences range from minor inconveniences to serious patient harm. In this paper, HBS doctoral student Julia Adler-Milstein, Harvard School of Public Health professor Sara Singer, and HBS professor Michael W. Toffel examine the effectiveness of organizational information campaigns and managerial role modeling in encouraging hospital staff to speak up when they encounter operational problems and, when speaking up, to propose solutions to hospital management. The researchers find that both mechanisms can lead employees to report problems and propose solutions, and that information campaigns are particularly effective in departments whose managers are less engaged in problem solving. Key concepts include:

• Front-line workers offer more solutions to operational problems in departments whose managers are more engaged in problem solving.
• Information campaigns that promote process improvement generate more solutions from front-line workers, especially from workers whose managers are less routinely engaged in problem solving.
• Efforts at the organizational level can compensate for managers who cannot or do not create an environment that inspires front-line workers to speak up.