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Differences in interpretation will lead to different ways of formulating and addressing the problem. This will become an even bigger problem when the justification of measuring voice or silence in a certain way is not clearly related to a specific definition. The fragmentation related to the silence and voice research does however not only emerge from differences in concept definitions, but also results from an unstructured framework related to the two concepts. The various antecedents (e.g., condition and situations, issues that trigger voice/silence response, motives) are all mixed in various ways. Motives for silence are for example sometimes understood as feelings or conditions and other times as situations, while also being classified as forms of silence and/or voice. As indicated by the studies that use the Van Dyne et al. (53) scale, the types of prosocial silence, acquiescent silence and defensive silence emerge from associated motives, while Yalcin and Baykal (40) measured silence motives as silence climate, silence based on fear, acquiescent silence and silence based on protecting the organization. Thus, motives can be both feelings (e.g., fear) and can indicate perceptions of organizational conditions as well as the type of context which triggers the silence behavior (e.g., a relational context in which one wants to protect the organization or to cooperate smoothly with colleagues). Overall, the concepts of voice and silence are understood in very heterogenous ways, and the ways in which voice and silence are framed are fragmented and bleary. This creates a vague starting point when trying to identify suitable interventions in order to create conditions that promote voice in healthcare organizations and might be a reason for why existing interventions seem to fail.

In terms of employee voice/silence as theoretical constructs, acknowledging the theoretical and operational definitions in which the different measures of employee voice/silence are rooted is of critical importance. The current review suggests that the measures used in the reviewed studies reflect a variety of operationalizations (e.g., intentions or self-reported past behaviors or motives, self VS organizational climate) and approaches (e.g., Organizational Behavior VS Industrial Relations approach) and variations in the content (e.g., safety voice). Thus, there is a need for better justification of the chosen measure for employee voice/silence which should also be reflected in the rationale of each study.

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Sound of Silence is a campaign that addresses the importance of mental health and its relationship to substance use and addiction with a focus on breaking through the stigma that is associated with discussing these topics. By informing students and their families of the many available resources; by supporting them as they learn to manage the unavoidable stresses of life; and by helping them use their voices- and listening to them- to ensure that they do not suffer in silence, we promote resiliency in the youth of our community. ff782bc1db