SAĞLIK ÇALIŞANLARININ ÖRGÜTSEL SESSİZLİK, SESSİZLİĞİN NEDENLERİ VE SONUÇLARINA İLİŞKİN GÖRÜŞLERİ

Abstract

Importance of the physical and mental capacity of manpower in the provision of health services and the idea that the concept of organizational silence will become more important with the effect of employee motivation and performance indicates the focus of this study. In Turkey, studies regarding organizational silence of health care employees mostly conducted with nurses, approximately 50%. 42% of this studies conducted with the participation of all staff in the organization and 8% of this studies conducted with both physicians and nurses (Bayin et al., 2015). Studies conducted with all staff in the organization investigate the reasons of organizational silence (Aliogullari, 2012; Cinar et al., 2013), types of organizational silence (Deniz et al., 2013; Aktas ve Şimsek, 2013), and the consequences of this concept with reasons (Afsar, 2013). There is no research in the literature that studies the subjects which employees remain silent, reasons of silence and perceived results of silence with all staff in the organization. In addition to these, current study examines whether the results differ according to individualistic and demographic variables and with this feature the study becomes more original. The study conducted in one of the state hospitals in Ankara. There are 884 staff in the hospital from various occupations (physicians, midwives/nurses, other healthcare personnel, administrative personnel). Instead of using sampling methods, researchers have tried to reach all staff in the hospital. Totally 291 questionnaire were collected due to reasons such as leave of absence (such as sickness, birth, annual leave), shifts, and unwillingness to participate in the study. 15 of the collected questionnaires excluded because of physicians, 98 midwives/nurses, 67 other healthcare personnel and 70 administrative personnel participate the study and this total number of 276 health care workers included in the study accounted for the 31.2% of the hospital population. The questionnaire developed by Cakici (2008) were used to collect data. The Questionnaire consist of two parts; first one is Personal Information Form for individual and demographic information and second part is Organizational Silence Scale. SPSS 21.0 (Statistical Package for the Social Sciences) were used to analyze collected data. In the data analyzing process, frequencies and percentages were used to reveal the descriptive findings related to the individual and demographic characteristics of the staff that participate in the research. After this step, validity and reliability analysis were applied to the scales used in the study. In the next step, mean and standard deviation descriptive statistical methods were used to related to the sub-dimensions of the scales used in the study. In order to determine whether the scales and sub-dimensions used in the study differ according to the individual and demographic characteristics of the participants, the significance test (Standard t test) and one-way analysis of variance (one-way ANOVA) were used. If there was a significant difference between the groups, Scheffe test, which is one of the Post-hoc tests, was used to compare all possible linear combinations between the groups in order to find out from which group the significance was caused. When the individual and social-demographic characteristics of the participants were examined, it was seen that big part of the participants (59.1%) were women. 85.1% of the participants were married, 50.7% of them are 38 of age and under, 49.3% of them are 39 age and above. In terms of working experience of participants in the specific hospital; 60.5% of the participants were working for 6 years and less, remaining 39.5% of them were working of 7 years and more. In terms of educational levels, 19.9% of participants had primary and high school degrees, 26.5% had associate degree, 36.6% had undergraduate degree and 17% had graduate education degrees. It was seen that 14.9% of the participants were physicians, 35.5% were midwives / nurses, 24.3% were other health care staff and 25.4% were administrative staff. In terms of managerial position, it was seen that 17.8% of the participants were in the managerial position and 82.2% of the participants were in the non-managerial positions. As a result of the construct validity analysis of the scales used to measure subjects that employees remain silent, reasons of silence and perceived results of silence: Subjects that employees remain silent dimension is consist of ‘Working Opportunities and Responsibilities’, ’Management Problems', ’Employee Performance’, ‘Ethical Issues' and' Improvement Efforts' sub-dimensions. Reasons of silence dimension is consist of ’Administrative and Organizational Causes‘, ’Fears about Work and Fear of Isolation’, ‘Lack of Experience’ and ‘Fear of Damaging Relationships’ sub-dimensions. Perceived results of silence dimension is consist of ‘Results Affecting Performance and Synergy‘, ‘Results causing Staff Unhappiness’ and ‘Restrictions to Improvement and Development’ sub-dimensions. In this research, it is determined that, healthcare staff stays mostly silent about management problems (2.65±0.96) and staff performance (2.64±0.88), however healthcare staff gave lowest average to ethical issues dimension (1,79±0,73). According to this, it can be said that hospital staff do not remain silent or rarely remain silent, especially in ethical issues (abuse, molestation, etc.) and they remain silent most likely in problems caused by management and other staff. Results of the reasons for remain silence, the highest average was given to administrative and organizational reasons (3.10 ± 0.92) and the lowest average was given to lack of experience (2.39 ± 0.89). According to this results it can be said that administrative and organizational reasons are basic reasons of organizational silence. In the perceived results of silence dimension highest score was given to ‘Results Affecting Performance and Synergy’ (3.60±0.77) sub-dimension and lowest score was given to ‘Result Causing Staff Unhappiness’ (3.31±0.87) sub-dimension. In other words, employees believe that remaining silent creates consequences that affects performance and synergy. When the relation between organizational silence scores and demographic variables examined for each dimension statistically significant results were found according to sub-dimensions. In the '‘Subjects that Employees Remain Silent’' dimension there are statistically significant results as following: “Working opportunities and responsibilities” sub-dimension differs by status of holding a managerial position (t=-3.327; p<0.05); “management issues” sub-dimension differs to age (t=-2.116; p<0.05), marital status (t= 1.987; p<0.05) and working experience in hospital (t=-3.631; p<0.05); “performance of workers” sub-dimension differs according to status of holding a managerial position  (t=-2.802; p<0.05)  and working experience in hospital (t=-2.651; p<0.05); “ethical issues” sub-dimension differs according to education level (F=4.464; p<0.05) and   “improvement efforts” sub-dimension differs according to status of holding a managerial position (t=-3.058; p<0.05). In the ''Reasons of Silence’' dimension there are statistically significant results as following: “fear of work and fear of isolation” sub-dimension differs to age (t=2.123; p<0.05), marital status (t=-3.189; p<0.05), working experience in the hospital (t=2.002; p<0.05) and position in the hospital (F=2.782; p<0.05); “lack of experience” sub-dimension differs to marital status (t=-3.011; p<0.05), education level (t=-3.011; p<0.05) and position in the hospital (F=5.361; p<0.05). Finally, in the ‘'Perceived Results of Silence’' dimension there are significant results as following: “results affecting performance and synergy” sub-dimension differs to their position in hospital (F=3.287; p<0.05); '‘results causing staff unhappiness’' sub-dimension differs to gender (t=-2.261; p<0.05), marital status (t=-2.143; p<0.05) and their position in the hospital (F=5.806; p<0.05); ‘'restrictions to improvement and development’' sub-dimension differs according to marital status (t=-3.085; p<0.05) and working experience (t=2.568; p<0.05). According to results of the current study organizational silence can be prevent by choosing managers according to qualification, education, and experience. In addition to these, increasing corporate belonging by providing active participation of the staff with high average age and professional experience can prevent organizational silence. Finally, it is considered that incentives to increase the educational level of the employees and employing non-physician personnel in the fields appropriate to their education and position, and the establishment of interior career goals on the subject may be effective in preventing organizational silence.