Abstract
While research highlights how the desire for harmony and deference to authority endanger silence in collectivist cultures, there is mixed evidence that the duty of mutual care and affection enshrined in collectivist cultures creates a safe environment for voice. Similarly, while research highlights the instrumental effect of positive relationships on voice, there is little empirical evidence on the role of poor relationships to this effect. This study explores how the quality of interpersonal relationships in collectivist cultures shapes voice and silence on patient safety. An ongoing analysis of in-depth interviews with 60 multidisciplinary healthcare professionals shows that positive interpersonal relationships create a safe and effective voice environment that breaks barriers, including hierarchy, for voice. Similarly, team members leverage positive interpersonal relationships to voice through intermediaries (Third Parties) to address patient safety concerns. Meanwhile, poor, and negative interpersonal relationships erode professional relationships, cooperation and trust leading to silence. This paper sheds insight on mixed findings and complexities of voice and silence in collectivist cultural contexts.