Allied health new graduates’ voice behavior – new perspectives using realist synthesized narratives
Authors: Friary Philippa M. , McAllister Lindy , Martin Rachelle , Purdy Suzanne C. , Barrow Mark 
Published: June 2024

PurposeEffective voice behavior in healthcare workers is critical for patient safety, quality improvement and workforce well-being. A review of the literature on voice behavior in healthcare highlights that little is known about the voice behaviors of new graduates in allied health and that current theory, from medical and nursing research, does not adequately apply to this sector. New knowledge about voice behavior for this sector of the workforce will support education and healthcare institutions in building and sustaining a healthy voice behavior culture.Design/methodology/approachThis paper reports on phase two of a two-phase study looking at the voice behavior experiences of new allied health graduates over one year. Using a realist perspective and narrative analysis, we uncover and illustrate what works, with whom and under what conditions.FindingsFour synthesized narratives outline the contexts and mechanisms that result in different voice behavior outcomes – speaking up effectively, speaking up with unmet expectations, not speaking up and a reduction in speaking up over time. Experiences of positive interprofessional collaboration and reflective supervision supported effective voice behavior.Research limitations/implicationsThis study used a case study approach, focusing on healthcare providers within a large New Zealand city and a cohort of 10 participants. Some researchers argue that small numbers limit the generalization of findings to different populations. Realists argue that, given the way in which knowledge is developed using realist methodologies, the resultant theory is portable. Interviews were conducted online during the COVID-19 pandemic. This may have impacted the connection between the interviewer and interviewee, causing the interviewees to not express their true thoughts. However, the interviewer did take time to connect with the interviewees and build trust over the three interviews over one year. Participants did not capture the diversity in the allied health workforce – most identified as female and none identified as Māori/Indigenous. And finally, participants could inhibit or exaggerate information due to the influence of social desirability. This does not appear to be a significant limitation in this study, given the many examples shared by the participants highlighted their challenges.Practical implicationsThis study provides an in-depth exploration of how new graduates in allied health experience speaking up. Our findings enrich the knowledge of speaking up by using synthesized narratives to provide insights into what factors can enable a healthy speaking up culture within the new graduate allied health workforce. This is new knowledge that will be of interest at the individual, team and organizational levels of healthcare. The findings will support curriculum design and new graduate support frameworks for the education and health sectors. Highlighted in this study are the importance of the following factors in supporting speaking up for allied health new graduates: the employment of reflective supervision, purposeful facilitation of team belonging and interprofessional collaboration and tailored speaking up training for allied health new graduates and leaders in healthcare.Originality/valueBy taking a realist perspective and using narrative analysis, we gain an understanding of the voice behavior experiences of new graduates in allied health and the contextual factors and mechanisms that activate effective voice behavior in sub-acute and rehabilitation settings. These findings differ from nursing and medicine and highlight the benefits of reflective supervision and interprofessional collaborative practice.