Abstract
Employee voice research focusing on psychological safety within formal hierarchies as the primary condition for speaking up offers a limited understanding of how the power and legitimacy of knowledge shape voice in knowledge-intensive contexts. Drawing on an in-depth qualitative study of 67 multidisciplinary surgical teams, we reconceptualise employee voice as conditioned on knowledge and the legitimacy of knowledge rather than solely structured by hierarchy. Our findings demonstrate that although knowledge often constitutes authority and a psychological enabler for voice independent of formal positions, invisible legitimisation of knowledge in a steep hierarchy certifies or de-certifies whose knowledge counts towards voice or silencing. Where formal hierarchy is less pronounced, knowledge can override positional authority for voice and knowledge status allows extremely knowledgeable individuals to monopolise authority, suppressing collective sensemaking and voice. Finally, knowledgeability creates psychological conditions that have a multilevel effect on voice within hierarchy. Extending existing voice theories beyond hierarchy, we suggest the need for greater scholarly and managerial attention to knowledge to promote voice in knowledge-intensive settings.
Key Words: Knowledge, Hierarchy, Voice and Silence, Patient Safety, Surgery